Patient Safety: Lecture 3

Team approach to preventing drug related errors

SelectionMost efficacious, least adverse drug reactions

(ADRs) Know your patient allergies, cautions and

contraindications

PrescribingClear instructions to other Health Care

Professionals and patientClear monitoring plans for effect and ADRs

(see front of BNF for good prescribing advice)

Team approach to preventing drug related errors

DispensingGood procedures (separate checker and

dispenser)Stock location of similar packagingOpen channels to challenge prescriptions

Team approach to preventing drug related errors

AdministrationClear prescribing instructionsClear guidance on how to administer

MonitoringClear roles (e.g. warfarin)

Team approach to preventing drug related errors

What situation did you vote on?

Situation overview here

Options hereOptions hereOptions hereOptions here

Voting

0

10

20

30

40

50

60

70

80

90

Option A Option B Option C Option D

Medics

Pharmacists

How confident were you that you vote represented the best

course of action? Voting options here

Voting options here

Voting options here

Voting options here

Not at all confidentNot overly confidentQuite confidentVery confident

Confidence with vote

0

10

20

30

40

50

60

70

80

90

Noconfidence

Littleconfidence

Quiteconfident

Veryconfident

Medics

Pharmacists

What did we think?We can outline our preference, if there is one

We can also outline any clear or relative optionsCan outline if students went for theseCan outline rated confidence levels if they did

How would I deal with this?

How would I deal with this?

A - Turn off the sink tap?

B - Turn off the water supply to the house?

C - Contact a local plumbing company and ask a plumber to attend immediately?

What would be the safest and quickest way to confirm the correct

dose?

What would be the safest and quickest way to confirm the correct

dose?

What would be the safest and quickest way to confirm the correct

dose?

What would be the safest and quickest way to confirm the correct

dose?

What would be the safest and quickest way to confirm the correct

dose?

Confidence  1 2 3 4

What would be the safest and quickest way to confirm the correct

dose?

Phone the GP surgery to confirm dose?

Ask patient to confirm dose?

Check patient own medication to confirm dose?

Look in case notes for recent letter from RA clinic to confirm dose?

Pharmacy Stamp AgeD o B

21/1/54

Name (including forename and address)

Alice Major1 High StreetAnytown

Dispenser’s Endorsement Number of days’ treatment N.B. Ensure dose is stated NP

PricingOffice

Pack & Quantity

Methotrexate 10mg Daily (4)

Signature of Prescriber A Doctor Date 6/4/00

ForDispenserNo. ofPrescns.On form

A DoctorA SurgeryAnytown

NHS PATIENTS – please read the notes overleaf

FP10C 0899

Pharmacy Stamp AgeD o B

21/1/54

Name (including forename and address)

Alice Major1 High StreetAnytown

Dispenser’s Endorsement Number of days’ treatment N.B. Ensure dose is stated NP

PricingOffice

Pack & Quantity

Nystatin oral suspension 1mL QDS (OP)Chlorhexadine 0.2% mouthwash 10mL BD (300mL)Clotrimazole 1% cream BD (OP)

Signature of Prescriber A Doctor Date 6/4/00

ForDispenserNo. ofPrescns.On form

A DoctorA SurgeryAnytown

NHS PATIENTS – please read the notes overleaf

FP10C 0899

Background

ENT

Methotrexate

How did you decide it was best to obtain the correct dose?

Phone the GP surgery to confirm dose?

Ask patient to confirm dose?

Check patient own medication to confirm dose?

Look in case notes for recent letter from RA clinic to confirm dose?

Small group workhttp://www.studentnet.manchester.ac.uk/

Click on Blackboard & sign in

Case Study (assignment 1)

Initial group assignment ID drug related problems & ID root causeAction plan to deal with the problemsExplain rationale behind proposed actions ID potential drug safety issues and how to monitorConsider generic lessons learned and actions to

improve patient drug safety

Deadline Midday Monday 9th November

Components Resources will be delivered to

blackboard Documents (e.g. case notes,

FP10, TPR chart) Audio (e.g. patient

interviews) Visual (e.g. photographs of

medication)

In groups discuss the case Allocated timetabled slot Discussion board Google docs Email ?twitter

http://www.studentnet.manchester.ac.uk/

'Tweeting' medics expose patients

“Patient confidentiality is paramount and medical students and doctors obviously need to be very careful about any information they post

online”

A British Medical Association spokesman

“Patient confidentiality is paramount and medical students and doctors obviously need to be very careful about any information they post

online”

A British Medical Association spokesman

BBC NEWS / NEWS FRONT PAGE

"You must make sure that your conduct at all times justifies your patients' trust in you and the

public's trust in the profession."

General Medical Council

"You must make sure that your conduct at all times justifies your patients' trust in you and the

public's trust in the profession."

General Medical Council“content may risk violation of patient privacy, even without using names or other identifiers”

http://news.bbc.co.uk/1/hi/health/8266546.stm (24.09.09)

Peer FeedbackAssignments will be peer reviewed by medicine /

pharmacy

Each group will complete a feedback form What they are happy with and why?What they would change / improve / modify and

how / why?

Deadline: Midday Monday 16th November

Guidance and forms on BB on providing feedback in a constructive manner

Final Assignment (2)In week 9 a critical incident will be released in BB

Check what incident is assigned to each groupResources will be available detailing the incident

Review the details and perform a root cause analysis of the incident

Adapt report 1 to take into consideration the critical incident

Review the peer feedback and take into consideration in the final report

Assignment deadline 5pm Friday 18th December

How to upload assignments

Peer contributionWe will be evaluating your peer views on your

contribution to the group work at the end of the module

If your assignment gets 60%

Your peers think you are entitled to only 70% of the group mark, your final mark would be 42%

SupportDrop in clinic (Thursdays in Stopford) 3-5pm

Online support

Wednesday 16th December (PM)Optional feedback and summary of the moduleMedical and pharmacy studentsDiscussion of the issues presented

How to improve confidence to minimise prescribing risk?

Back up plans with monitoring (what, when, how?)

Have key information at hand to aid decision making (e.g. U&Es)

Have knowledge of high risk drugs – consider risk benefit when prescribing

Be aware of NPSA alerts (http://www.npsa.nhs.uk/)

Build in safety when prescribing / reviewing medication