Medication Safety Patient Safety Setting Direction Julie Simmons, Medication Safety Pharmacist January 2016 1
The patient journey Admission Ward Transfer Ward stay Discharge Medication storage and supply Drug charts Medication administration Patient monitoring TTOs Errors Resources 2
Where is medication stored on the ward? 3
Anaphylaxis treatment box Storage of drugs needed for anaphylaxis adrenaline 1in1000 (1ml) ampoules for injection, chlorphenamine 10mg in 1ml injection & hydrocortisone sodium succinate 100mg injection 4
Admission Patient details What do we need to know? Allergy status Why is this important? Drug History What is this? Prescription Many types at PHT Name, age, weight, DoB, NHS number / case number Summary Care Record / Hampshire Health Record / PODs / GP letter / patient / carer 5
Ordering medication 6
7
Controlled Drugs 8
Medication charts available at QAH Page 9
Labels In patient One stop / TTA 10
Validity of prescription is it complete and legal? 11
Pharmacy Annotation Adm Admitted on medication New Started whilst in hospital POW POD on ward POD= Patients Own Drugs PAH POD at home Qty Number of tablets / capsules brought into hospital 12
Disposal Waste Handling Policy http://www.porthosp.nhs.uk/downloads/policies And Guidelines/Management Policies/Waste%20Handling%20Policy.doc 13
What does administering medicines involve? Having the ability to administer medication safely to patients THE FIVE RIGHTS ARE? 14
The Right Patient 4 Identifiers Confirm identification by checking: patient s first name patient s surname, case note number date of birth with the patient, against the prescription chart and wrist band 15
What do we need to check? 16
The Right Route PO NG PEG PR IV bolus IV infusion SC IM Topical SL Buccal Ear/eye/nose PEJ PV 17
Oral dosage forms does it matter? Tablets Capsules Liquids Chewable Orodispersible Effervescent tablets Soluble tablets Sachets Modified Release MR, LA, XL, retard, slo-, SR 18
Right dose 19
The Right Time Timeliness drug round time vs patient need / prescription time With or after food On an empty stomach A missed dose occurs after 25% of the prescribed frequency has elapsed Sign once the patient has taken the medicine Before breakfast 20 minutes before meals 20
21
Medication Administration What can go wrong.? 22
Prescribing abbreviations OD OM BD TDS QDS ON PRN Once a day In the morning Twice a day Three times a day Four times a day At night As required 23
Patient observations Temperature Blood pressure Blood gases Blood glucose levels Oxygen saturation Adverse effects to medication Pressure areas Patient Monitoring Observations MUST be taken on patient transfer Observations MUST be documented VitalPac training 24
Escalation Recognition of the deteriorating patient Early Warning Scores (EWS) Challenge Incorrect doses Communication Make another nurse / Ward Sister / Nurse in Charge aware Hospital at Night (H@N) Nerve Centre 25
https://www.rcn.org.uk/professional development/accountability and delegation Accountability Health service providers are accountable to the criminal and civil courts to make sure their activities meet legal requirements. Employees are accountable to their employer to follow their contract of duty. Registered practitioners are also accountable to regulatory bodies in terms of standards of practice and patient care. Nursing and Midwifery Council (NMC). All practitioners must ensure that they perform competently and that they don't work beyond their level of competence. They must inform a senior member of staff when they are unable to perform competently. To be accountable, practitioners must: have the ability to perform the activity or intervention accept responsibility for doing the activity have the authority to perform the activity, through delegation and the policies and protocols of the organisation. 26
Flow chart for efficient TTO dispensing assuming TTO is already written (Step 1) Independent audit confirmed dispensing time to be 28 minutes when undertaken at speciality based remote dispensing points. TTO s written before 09:00 will be dispensed before 10:00 to facilitate discharge. TTOs with controlled drugs or NOMAD MDS systems take longer as these are prepared through dispensary. Page 27
28
Information to support you in practice Management of Medicines Policy Paediatric Drug Policies Procedure for the Administration of Medicines Pharmacy Intranet Site Controlled Drugs & Management Policy Injectable Medicines Policy for Adults and Children Competency for Administration and also Assisting in the giving of Medicines Neonatal Drug Policies VitalPAC Trust Intranet Policies and Guidelines NMC & HPC Code of Conduct & Standards for Medicines Administration The dosage interactions, formulation, route, side effects of the medicine prescribed. BNF! 29
Medication Incident Reports Actually caused harm or had the potential to cause harm: in the process of prescribing, dispensing, preparing, administering, monitoring or providing medicines advice. The most frequently reported types of medication incidents involve: wrong dose omitted or delayed medicines wrong medicine 30
National Campaigns Reducing Harm from High Risk Medicines Anticoagulants Warfarin overdose and inappropriate monitoring NPSA Alert 18 Insulin Wrong dose, omitted medicine and wrong product Opioids Overdose = respiratory depression or under dose = poor pain control Injectable sedatives Midazolam dosages inappropriate for the patient 31
Safety Learning Event Reporting Form PHT intranet access Desktop icon 32
Page 33
Learning from Adverse Incidents Our Key issues Prescribing errors Errors Wrong Doses, wrong medication, wrong patient Learning points medicine reconciliation and documentation TTO s discharge process Errors wrong medication to wrong patient, leaving without TTOS, wrong paperwork to wrong patient Learning points Discharge bundle, check medication and paperwork, never assume POD Lockers and storage Errors transferring medication with patient, not being locked away, broken lockers, policies not being followed Learning points keys and lockers, Carillion work log, movement of lockers, policies 34
Involve the Patient Have you informed the patient about their medicines? Has the patient consented to taking their medicines? Do you know about the Guideline for Self Administration of Medicines for Adults and Children PLEASE Make sure the patient is transferred between wards with their medicines! Page 35
Quality Care Review August 2015 Key Learning Themes Patients are able to use and access medications such as inhalers Labelling of open drug packs/ bottles date opened Disposing of expired medication Blister packs being removed from original packaging Unlocked and unsupervised drug trollies Lack of awareness of policies and procedures 36
Insulin A High risk medicine Do you know?... All opened insulin should be dated with the day of opening (and ideally an expiry date) Pen cartridges should NOT be used as a multidose vial Insulin should NOT be omitted for a patient requiring daily insulin All insulin must be prescribed in units not using u The patient usually knows more about their diabetes management than us! Which PHT insulin charts have you come across? 37
Insulin Continuous intravenous insulin infusion Missed doses Self administration Substitution of insulin/ brand confusion Long / short acting Storage Syringes U and Units Charts Humulin S Humulin I Humulin M3 Humalog Humalog Mix25 Humalog Mix50 38
Red Flags Giving more than 3 tablets/ capsules Using more than 2 vials/ampoules Check calculations Drugs with similar packaging Storage issues (e.g. POD lockers) 39
Finally Remember your accountability Red flags Look a like Sound a like Missed doses Stop, check and be safe 40
Medication Safety Team Karen Dutton Medication Safety Officer Julie Simmons Medication Safety Pharmacist Paul Rugman Medication Safety Pharmacy Technician Ext 5284 Pharmacy Offices, D Level QAH Email: Medication Safety Group Mailbox 41