Beyond 2015:

A Novel Nursing and

Pharmacy Collaboration

Keeping Patients Safe

from Medicines in the

Busy Hospital

Safe and Secure Hospitals 2015

Noleen Nath: Pharmacist

Redcliffe Hospital QLD

Overview

• Explore Current Demands for Hospital Care

• Review how medicines effect patient outcomes

– Positive and Negative

• Review safety concerns with medicines

– Stories from Redcliffe Hospital

• Unravel the intricacies of a novel Nursing and Pharmacy

collaboration

• Looking Beyond 2015 to minimise misadventure with

medicines in hospitals

Australian Hospitals Today

• The number of hospital admissions is

rising ~ 3% each year

o 9.7 million hospital admissions in Australia (2013-2014)

o Largely driven by the aging population

o Complex admissions and more frequent admissions with

high care demands

o Elderly patients are at higher risk of declining health

High Workload Demands and Pressure on all Hospital

Staff

Redcliffe Hospital

• 250 Bed general hospital in Queensland serving a

catchment of 200,000 people

• Rapid growth in unplanned medical admissions

– Predicted growth ~ 6% per year

– Some of the shortest average length of stay in Qld

• Above average population of elderly people

• 5th Busiest Paediatric Emergency presentations/service

in Qld

Use of Medicines

within Hospitals

•Medicines: The commonest treatment used in healthcare

•Due to there common use and narrow therapeutic index,

medicines are associated with more errors and adverse

events than any other aspect of healthcare.

•Patients in hospitals are unwell and thus have reduced

capacity to overcome medication misadventure

–A large portion of medication errors are preventable

“We need to improve the safety and quality use of

medicines within hospitals at the level of both individual

practice and within organisational systems.”Professor Lloyd Sansom

Medication Errors within Hospitals

The Difference Between a Drug and a Poison?

• The Dose

• How it is given:

• Route

• Rate

• Time

• Reconstitution fluid

• Patient Factors (age, renal/ hepatic function,

allergies, weight)

The Medication Use Pathway

PATIENT

Prescribing

error rate

2.5 – 5.4%

0.08 – 0.8%

error rate

5 - 20%

error rate

Australian Council for Safety & Quality in Health Care

2nd Report on Patient Safety, June 2002

DOCTORS

NURSES

PHARMACY

Error rate

on discharge

5-17%Decision to

prescribe

Order entry

Review order

Supply

medicineSupply

information

Distribute

Administer

Monitor response

Transfer

information

Why Medication Errors Happen?

• Nurse

checking

• Pharmacists

• Senior Staff

• Organisation

/Workplace

• Lack of

Safety

Culture

• High risk

task

• Lack of

knowledge

• Lack of

information

• Distractions

• Team work?

• Slips

• Lapses

• Rule

violation

Vincent et al, (1998), BMJ 316: p 1154-1157

Underlying

(latent)

conditions

Error

making

conditions

Active

failuresBarrier

defencesACCIDENT

REPORT!

Improve

systems

and

practices

“Swiss Cheese Model” – sometimes the errors get through gaps in processes

Tales of Medication

Misadventure

• Adverse reaction to medicines

• Paracetamol overdose

• Medications doses missed

• Too much medication

Redcliffe Hospital:

Initiatives to Prevent Medication

Misadventure During Admission

Medication Safety

Initiatives

• Monthly Nursing Orientation Workshop

• Nursing Medication Safety Group

– Education Session

• Provides nurses with troubleshooting advice/

resources/ plan to maintain medication safety

• Improvements in formal Nursing/ Pharmacy collaboration

within the wards

– beyond our daily duties

Nursing Orientation

Workshop

• Medication Risk Awareness Outline the complexity of the medication use

process

Identify some of the factors involved with adverse

medication events

Identify the role of the nurse in preventing adverse

medication events

Describe a simple action plan of what to do when

faced with a potentially hazardous medication order

Medication Safety

Nursing Group (MSNG)

• Medication management requires a multidisciplinary

approach and interdisciplinary communication is

essential to reduce medication errors

• The nursing profession has been identified as essential

to the promotion of patient safety and reducing

medication errors

• The MSNG is a monthly meeting to raise awareness of

medication safety concerns detected in daily practice

MSNG

• One hour monthly meeting attended by nursing

representatives from wards and specialist areas,

pharmacist and patient safety officer

• Nursing staff raise medication safety issues

encountered in daily practice.

• Opportunity to discuss concerns colleagues in a

safe, secure and supportive environment

• Opportunity for insight into medication safety issues

and solutions within the hospital

** Promoting a culture which strives for excellence

with Medication Safety **

MSNG

• Objectives

• Identify medication safety issues and escalate

concerns or proposed solutions to hospital executive

committees

• Dissemination information and education pertaining to

medication safety

• Participate in procedure development and review

• Review medication safety incidents reported and

share lessons learnt

• Make recommendations to hospital executive committee on

possible avoidance measures for noting and further

discussion

MSNG

• Accomplishments

– Noted an medication incident occurred regarding cessation of a

epidural pump prematurely

• The epidural pump cessation procedure recirculated to all

wards

– Acute Pain CNC supported further education to wards

and staff

– Noted a new procedure for Ketoacidosis management is in

operation

• Staff alerted to the procedure and implications for nursing

staff noted

– Identified different protocols for iron infusion are in operation at

various hospitals within the district.

• Issue identified and escalated. Decision for only use of the

Redcliffe Protocol within Redcliffe Hospital

MSNG:

Education Sessions• Case based learning

• Review fundamentals of medicine safety in

each presentation, each time with a different

clinical scenario

• Review management options/ troubleshooting

ideas to maintain medication safety

– Review implications for medication error in

each scenario

• Promotes a culture which strives for safety with

medicines

Formal Nursing/Pharmacy

Collaboration within Wards• Encourages regular collaboration specific to medication

safety to ward clinical nursing staff

• Each presentation focuses a specific clinical topic

• Acknowledge the demands of their role as nurses are

very high – however medication safety cannot be

compromised

• Discuss the medications involved in each clinical topic

and the implication of medication error

• Discuss options for prevention and management

which are practicable within a busy working

environment

Medication Safety

Beyond 2015

• Promote regular formal Nursing and Pharmacy

collaboration

– Opportunity to provide information regarding current

medication safety concerns

• Gest speakers attending MSNG

– Nursing staff

– Representative from the medical profession

– Representative from pharmacy management

• Develop an electronic medication safety toolkit for the

hospital

Concluding Comments

• Appropriate use of medications is central to maintaining

hospital safety for patients and staff.

• Inappropriate medicine use fosters unnecessary patient

harm, complicates and extend hospital admissions and

increases risk of premature morbidity and mortality

• Employing the principles of quality use of medicines, can

assist in avoiding/ minimising medication misadventure

• Hospitals are becoming busier – organisations need to

develop and maintain avenues which support staff

achieving medication safety

Concluding Comments

• Committees which support staff to strive for medication

safety is essential in creating a healthy culture of risk

awareness

“It can be argued that medication safety committees are

more essential in ensuring the safe journey of patients

through hospital, rather than availability of the most modern

therapeutic and diagnostic modalities”

“The greatest opportunity to improve outcomes for patients

over the next quarter century will probably come not from

discovering new treatments, but from learning how to

deliver existing effective therapies safely”

References

• Australian Bureau of Statistics 2002, Social Trends in

Australia:2002, 2002, cat. no. 4102.0, ABS, Canberra.

• Semple SJ ,Roughead EE : Medication safety in acute care in

Australia: where are we now? Part

• 2: a review of strategies and activities for improving medication

safety 2002-2008. Aust New Zealand Health Policy 2009, 6:24

• Liu GG, Christensen DB. The continuing challenge of inappropriate

prescribing in the elderly: an update of the evidence. J Am Pharm

Assoc (Wash) 2002;42:847–57.

• Roughead EE, Anderson B, Gilbert AL. Potentially inappropriate

prescribing among Australian veterans and war widows/widowers.

Intern Med J 2007;37:402–5.

References

• Hilmer SN, Gnjidic D. The effects of polypharmacy in older adults.

Clin Pharmacol Ther 2009;85:86–8.

• National Prescribing Service. Anticipating the risks of polypharmacy.

NPS. 2013; August

• Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S,

Clemson LM, et al. Interventions for preventing falls in older people

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2012;(9):CD007146.

• Australian Council on Safety and Quality in Health Care. Achieving

safety and quality improvements in health care. Sixth report to the

Australian Health Ministers’ Conference. Commonwealth of

Australia, 2005.

• Australian Nursing Federation. Anf position statement: Quality Use

of Medicines. 2012

• Nath N, Jones E, Stride P, Premaratne M, Thaker D, Lim I. The nuts

and bolts of pills and potions: the functions of a drug safety working

group. Australian Health Review 35(4) 395-398

• Strid P, Seleem M, Nath N, Horne A, Kapitsalas C. Integration of

patient safety systems in a suburban hospital. Australian Health

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References