Medication Errors What is being done to reduce

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Medication Errors: What is being done to reduce them & how? Rebecca Lissiman, Nurse

Medication Errors: What is being done to reduce them & how? Rebecca Lissiman, Nurse Educator Neurosciences, 7 South

Trend. Care & CCDM working together CCDHB have introduced The Care Capacity Demand Management

Trend. Care & CCDM working together CCDHB have introduced The Care Capacity Demand Management (CCDM) programme which is about better matching staff resources to patient demand so we can improve patient care, make the best use of resources and provide a better work environment for our staff at the front line. This is used in conjunction with Trend. Care which is a program designed to collect data around the wards acuity and capacity at a glance. This is used hospital wide. Each RN on shift predicts the acuity of their patient load and how much clinical time each patient requires and at the end of each shift the RN actualises how much time was required for each patient.

How did we decide to investigate medication errors? Trend. Care data feeds into all

How did we decide to investigate medication errors? Trend. Care data feeds into all aspects of the CCDM Programme including: Work Analysis and FTE Calculation, Variance Response Management (VRM), and Core Data Set (CDS) By addressing the monthly Reportable Events via Square, accurate data is critical for matching patient demand with the capacity to care.

CCDM Local Data Council Each month 7 South hold a local data meeting. Here

CCDM Local Data Council Each month 7 South hold a local data meeting. Here we brainstorm and identify issues and risks that are impacting our ward. It was identified through vigorous data analysis that medication errors were one of our major reportable events that happen every month. The idea of the local council is that we as a team identify, collect data and plan solutions for improvement.

Next step at ward level The idea of individual wards working together within the

Next step at ward level The idea of individual wards working together within the CCDM Data Council means we are in control of extracting information from our nursing colleagues and implementing measures to get the most out of the data collected.

Survey Monkey It was decided that we would send out a survey to all

Survey Monkey It was decided that we would send out a survey to all of 7 South RN’s to find out what people classed as a medication error and to see if people are comfortable and /or confident with medication administration. This would then potentially highlight any gaps in knowledge and for the Educators to work on regarding further education. It also gathers information around what RN’s feel the main cause of errors are.

The Survey. . How often do medication errors occur each month? 15% 41% 0

The Survey. . How often do medication errors occur each month? 15% 41% 0 to 3 3 to 6 6 to 10 44%

WHAT DO YOU CLASS AS A MEDICATION ERROR? 90. 00% 84. 60% 76. 90%

WHAT DO YOU CLASS AS A MEDICATION ERROR? 90. 00% 84. 60% 76. 90% 80. 00% 70. 00% 61. 50% 60. 00% 50. 00% 40. 00% 30. 00% 20. 00% 15. 30% 7. 60% 10. 00% 7. 60% 0. 00% Ommited Wrong Time. Wrong Drug Dose Wrong Patient NOK Patient NBM Witheld Wrong Dose Refused Drugs For R/V Series 1 Column 3 Column 2 Wrong Route All of the Above

WHAT DO YOU FEEL IS THE MAIN CAUSE OF MEDICATION ERRORS? 100. 00% 92.

WHAT DO YOU FEEL IS THE MAIN CAUSE OF MEDICATION ERRORS? 100. 00% 92. 50% 90. 00% 81. 40% 77. 70% 80. 00% 81. 40% 70. 00% 60. 00% 48. 10% 50. 00% 40. 00% 33. 30% 30. 00% 22. 20% 20. 00% 22. 20% 18. 50% 25. 90% 22. 20% 11. 10% 7. 40% 10. 00% 37. 00% Ti m es Ci rc le d No Pa W tie ris nt tb Un an d ab le to No Sp Na ea m k e Ab ov e Be Py d xi s. M ac hi ne Py xi s. R oo m Po or St af fin g Po or Sk ill M ix Hi Po gh or Ac Su ui pp ty Tr or ai t. N ni ng et /E w or du k ca tio n Iss ue s Re so ur ce s Eq ui pm en t rc l Ci es Ze ro Ti m g ro n W Ill eg ib l e Pr e sc rip tio ed n 0. 00% Series 1 Column 2 Column 1

Do you feel there is enough education regarding medications? 0% Unsure 15% Yes 31%

Do you feel there is enough education regarding medications? 0% Unsure 15% Yes 31% No 54%

Do you feel there are enough resources around medication? 0% Unsure 7% No 30%

Do you feel there are enough resources around medication? 0% Unsure 7% No 30% Yes 63%

How do medication errors make you feel as a nurse? 0% Bad for the

How do medication errors make you feel as a nurse? 0% Bad for the Patient, 37% Self critical, 56% OK, 0% These things happen, 7% Never Unsure, happened 0% to me, 0%

What actions could/should there be in place to minimise the risk of medication errors?

What actions could/should there be in place to minimise the risk of medication errors? Responses; Ø Consistent enough staffing and teaching session on basic meds administration like the timing of common meds given to 7 south pts. Ø Always follow protocol. If unsure, stop & clarify or investigate. Ø Computer prescriptions, more time, most of the time errors are due to work load and only having access to 2 Pyxis machines. Ø More support to take your time with medications. Ø Clear prescribing and vigilantly charting & updating of a medications duration of use or if it needs to be reviewed. Ø Clear writing, charts reviewed by ward pharmacist, additional training around specific medication. Ø Identify the medication or complex treatment plan that may require the experienced nurse input-allocate the equitable skill mix hence the errors can be reduced.

Action responses continued. . Better staff resourcing, more time with Educators for new staff.

Action responses continued. . Better staff resourcing, more time with Educators for new staff. Ø Minimal interruption in Pyxis room. Letting patient know what medications they are having before administering meds. Asking patients name & checking wristband. Right mention of timing whilst charting medications. Ø Adequate staffing & time to go through charts properly, fatigue an issue on nightshifts, more education for Doctors about circling when they want drug given. Ø Ø Injectable drugs info could be clearer as open to interpretation. Medication errors make me feel terrible (bad for patient/bad for nurse). Errors happen when there are too many distractions/competing demands for your time; when charts are illegible or incorrectly prescribed; when everything is too rushed. Ø Prescriptions more easily legible, times circled at correct times. Wrong time definitely unavoidable with only two Pyxis machines. Ø

Actions continued. . Ø No distractions at Pyxis, having less demands on time such

Actions continued. . Ø No distractions at Pyxis, having less demands on time such as lighter workloads to be able to focus. Some drugs take a long time to prepare and give such as nasogastric & IV drugs. The IV drug administration book is terrible to read and now online it takes too long to get the answers that you need. Ø Focus, take your time, triple check medications, use 5 R’s. Ø Double checking. Ø Limit each patient to six medications. Ø We do more on ‘What can be crushed’ especially if Pharmacy have not been around to ask. Ø Reduce pressure, more time to ‘get it right’. Ø Good staffing ratios help with higher acuity so less errors occur – I think errors are more likely to happen when people feel rushed to get things done.

To conclude: The results and responses are both interesting and positive, there is a

To conclude: The results and responses are both interesting and positive, there is a long way to go in order to get to the bottom of the errors but at least there is now visibility and transparency and something to work with. This will be an ongoing process and we aim to get as many people and professionals on board to ascertain some solutions. If you have any questions, queries, ideas or solutions we (7 South Local Data Council) would love to hear from you @ Rebecca. [email protected] org. nz

Thank you for your time

Thank you for your time