George Eliot Hospital NHS Trust Medication Safety Thermometer Elizabeth Holland Clinical Audit & Effectiveness Nurse George Eliot Hospital NHS Trust is a District General Hospital in Nuneaton 320 Beds including Maternity 1,580 staff Took part in the testing of Safety Thermometer Started M.S.T in September on one medical ward – Elizabeth 27 beds December 2 medical wards – Melly & Elizabeth 2 surgical wards – Victoria & Alexandra January 1 medical ward – Bob Jakin September we used the 3 page tool from Haelo October I adapted the input sheet from Haelo to test STEP 1 STEP 2 Omissions in last 24 hrs 1.6a Patient ID Gender Age 1.1 1.2 Allergy Meds Reconciliation Status Prescribed 1.4 1.3 1.5 Valid Clinical Reason e.g Number low BP Route Not Available (e.g NBM, Outstanding Med Not IV line Reconciliation Avail tissued) Patients Absent Patient at Meds Refused Round Dose Omitted dose critical meds 1.6b Other (put Not Doc code) AntiAnticoag Opiate Insulin effective High risk meds 1.7 AntiAnticoag Opiate Insulin effective Anticoags 2.1 Opiates 2.2 Injectable Sedatives 2.3 Insulin 2.4 Admin 10Resps 50% IV Admin of below Common Admin of Common Dextrose, Flumazenil comp glucagon VTE bleed Admin Vit K INR >6 Naloxone 12bpm comp Version 1 – same method as GEH Safety Thermometer Found it over complicated even using the 3 page guide as reference Ward: Hospital Number: M Version 2! Gender Patient's gender F <18 Age 19-40 Patient's age 41-69 >70 Y Is the allergy status documented? Inc NKDA on kardex N I decided to go back to one form per patient Printed double sided to cut down on paper Tested in November on 3 wards – 5 patients Used 3 page tool as reference guide Was medicine reconciliation for all medicines started within 24 hrs of admission No - patient within 24hrs Pharmacist has been involved N 0 How many regular medicine are prescribed? Omitted dose of regular medication in the last 24hrs? Omitted doses a critical medicine General comments from ward manager, sister & pharmacist were positive Y Has the patient received any of the following medicines in the last 24hrs 1-4 Not inc PRN, Stat doses, IV fluids, O2, food supplements or devices. Different doses of the same medicine count as one medicine 5-15 >15 Insert number Reason for omission Anticoag Opiate Insulin Anti-effectives Anticoag Warfarin Exclude Food supplements & O2 insert number of omissions using available info e.g. 3 omissions as pt refused & 2 route not available Number of omissions of a critical medicine Anticoags (Heparin, LMWH [excluding VTE proph], Warfarin & NOAC's) Opiates (exclude oral codeine & dihydrocodeine IV or SC sedatives, Insulin) Opiates IV/SC Sedatives Insulin If YES proceed to Section 2 Amendments have been made to Version 2 after discussions at the Webex & with Haelo Anticoag Heparin, LMWH, Warfarin & NOACs Y Potential for bleed, interactions with other medicines N Any bleed or any kind of VTE Administration of Vit K, Protamine or clotting factors e.g. Octaplex INR greater than 6 or APTT ration greater than 4 Opiates Y Admin of Naloxone Common complications of Opiates include sedation, respiratory depression & confusion Reps rate below 12bpm N Injectable Sedatives Common complications Admin of Flumazenil Midazolam, Lorazepam,, diazepam, clonazepam Y Common complications of over sedation include hypotension, delirium, respiratory depression, reduced GCS N Insulin Y Common complications (capillary blood sugar <4mmol/L) or symptoms of hypoglycaemia Admin of reversal agent for hypoglycaemia (10-50% IV Dextrose, Glucagon) Symptoms of hypocaemia including anxiety confusion, extreme hunger, fatigue, irritability, sweating or clammy skin, trembling hands N Diabetic Ketoacidosis (DKA) or Hyperosmolar Hyperglycaemisc State (HHS) Auditor (print name): Date: Version 4! Collection form Libby Style! Alterations to make it suitable for other organisations The collection form has now been developed into a tool for the Acute and community to test in January 14 Next steps? Sharing results The Band 7 on Elizabeth observed the first collection and asked to see their results. Pharmacist assisting the collection also interested in findings. Ward Dashboards To make the data look the same as classic Safety Thermometer I have put ward level data in a dashboard to share Elizabeth.Holland@geh.nhs.uk