5 Standard iv infusion concentration in paediatric and neonatal units: a national survey

2018 ◽  
Vol 103 (2) ◽  
pp. e2.45-e2
Author(s):  
Nanna Christiansen
Keyword(s):  
Patient Safety ◽  
National Survey ◽  
Response Rate ◽  
Improve Patient Safety ◽  
National Standards ◽  
List Type ◽  
National Patient Safety Agency ◽  
National Patient ◽  
National Consensus ◽  
The Uk

AimThe National Patient Safety Agency in the UK has advocated the use of standard concentration (SC) infusions to improve patient safety and care.1 National standards have been adopted for infusions in the adult critical care setting however practice in paediatric and neonatal settings still varies and presents a challenge.2,3 This study is part of a multi-professional collaborative working towards a national consensus on SC infusions in paediatric and neonatal care. The study aims to explore the practice of standardised concentration usage for Intravenous (IV) infusions in paediatric and neonatal units in the UK, specifically:How many units use standardised concentration for IV infusions.Evaluate the variation and overlap of continuous IV infusion concentrations in practice.Assess what devices are used to administer these infusions.How standardised infusions are provided.MethodThe study used a quantitative descriptive survey design via an online self-administered questionnaire. Paediatric and neonatal intensive care units in the UK were surveyed through pharmacy, nursing, and medical networks to describe current practice. Data was collected for 25 days and analysed using SPSS.ResultA total of 194 NICUs and 39 PICUs were surveyed. Responses were received from 71 units: NICU 46 (65%); PICU 17 (24%) and 8 other (11%), giving an overall response rate of 30.5%.Twenty-eight units (40%) have established SC for IV infusions, 18 units provided information on presentation of SC infusions. Forty-six different medication infusions were standardised. Considering the differences in concentration, weight-bands, diluents, volume and presentation, there were 273 variations for these drugs. Taking only the concentration into account, there were 137 variations presented. The average number of variations per medication was 3 (range 1 to 14).15 units (53.6%) use ‘smart’ pumps for administration of SC infusions and 3 (10.7%) use other computer software for infusion rate calculations. Infusions are most commonly prepared on wards (81.3%) or in pharmacy (12.3%).ConclusionThe study is limited by the response rate; however the results suggest that 59% of paediatric and neonatal units in the UK use conventional weight-based methods for IV infusions. A third of units have established some SC with a wide variation of concentrations in this sample. Just over half of the units use ‘smart’ pump technology and over three quarters of SC infusions are prepared on the ward.Further data collection is required to acquire a fuller picture of SC infusions used in UK PICUs and NICUs. This data can then be used as the basis of a national consensus statement on SC infusion, facilitating adoption across the NHS.ReferencesNPSA Patient Safety Alert 20: Promoting safer use of injectable medicines2007. London: The National Patient Safety Agency.MacKay MW, Cash J, Farr F, et al. Improving paediatric outcomes through intravenous and oral medication standardisation. J Pediatr Pharmacol Ther2009;14:226–35.Phillips MS, Standardising IV. Infusion concentrations: National survey results. Am J Health Syst Pharm2011;68:2176–82.

scholarly journals P044 Can an electronic prescribing system ensure clear anticoagulation discharge communication?

2019 ◽  
Vol 104 (7) ◽  
pp. e2.49-e2
Author(s):  
Susie Gage
Keyword(s):  
Patient Safety ◽  
Discharge Summary ◽  
Electronic Prescribing ◽  
List Type ◽  
Heparin Infusion ◽  
National Patient Safety Agency ◽  
High Dependency ◽  
National Patient ◽  
Discharge Summaries

AimThe National Patient Safety Agency (NPSA)1 identified heparin as a major cause of adverse events associated with adverse incidents, including some fatalities. By ensuring good communication, this should be associated with risk reduction.1 The aim of this study was to ensure there is clear anticoagulation communication on discharge, from the paediatric intensive care unit (PICU) electronic prescribing system (Philips), to the paediatric cardiac high dependency unit and paediatric cardiac ward. To investigate whether the heparin regimen complies with the hospital’s anticoagulant guidelines and if there is any deviation; that this is clearly documented. To find out if there is an indication documented for the heparin regimen chosen and if there is a clear long term plan documented for the patient, after heparin cessation.MethodsA report was generated for all patients who were prescribed a heparin infusion on PICU, between 1st January 2018 and 30th June 2018, from the Philips system. All discharge summaries from the PICU Philips system were reviewed. Only paediatric cardiac patients were included that had a heparin infusion prescribed on discharge, all other discharge summaries were excluded from the study. Each discharge summary was reviewed in the anticoagulant section; for the heparin regimen chosen, whether it complies with the hospital’s anticoagulant guidelines and if there was any deviation whether this was documented. The indication documented of which heparin regimen was chosen and whether a clear long term plan was documented after heparin cessation; for example if the patient is to be transferred onto aspirin, clopidogrel, warfarin or enoxaparin.Results82 discharge summaries were reviewed over the 6 month period between 1st January 2018 and 30th June 2018; 16 were excluded as were not paediatric cardiac, leaving 66 paediatric cardiac discharge summaries that were reviewed. 45 out of 66 (68%) complied with the hospital’s heparin anticoagulation guidelines. Of the 32% that deviated from the protocol; only 33% (7 out of 21) had a reason documented. Only 50% (33) of the summaries reviewed had an indication for anticoagulation noted on the discharge summary and 91% of discharge summaries had a long term anticoagulant plan documented.ConclusionThe electronic prescribing system can help to ensure a clear anticoagulation communication as shown by 91% of the anticoagulation long term plan being clearly documented; making it a more seamless patient transfer. On the Philips PICU electronic prescribing system there is an anticoagulant section on the discharge summary that has 3 boxes that need to be completed; heparin regimen, indication and anticoagulation long term plan. However, despite these boxes; deviations from the anticoagulant protocol were poorly documented as highlighted by only 33% having the reason highlighted in the discharge summary, only 50% of the indications were documented. Despite having prompts for this information on the discharge summary, the medical staffs needs to be aware to complete this information, in order to reduce potential medication errors and risk.ReferenceThe National Patient Safety Agency (NPSA). Actions that make anticoagulant therapy safer. NPSA; March 2007.

Open to scrutiny: incident reporting and transparency in the NHS

2010 ◽  
Vol 92 (3) ◽  
pp. 82-83
Author(s):  
Suzette Woodward
Keyword(s):  
Patient Safety ◽  
Management System ◽  
Improve Patient Safety ◽  
Incident Reporting ◽  
National Patient Safety Agency ◽  
National Patient ◽  
Reduce Risk ◽  
A Priority ◽  
Set Up ◽  
Improve Patient

The National Patient Safety Agency (NPSA) has been set up to improve patient safety for all NHS patients, wherever they are treated. An important part of the work of the NPSA is to learn from incidents that are reported nationally to provide sound, representative guidance and recommendations to reduce risk and harm in healthcare. Incident reporting should not be seen as a management system but as a culture in which patient safety is a priority.

The Packaging and Labelling of Solid Oral Medicine Using Oral Methotrexate as an Example

Volume 3 ◽  
2004 ◽  
Author(s):  
James Ward ◽  
P. John Clarkson ◽  
Peter Buckle ◽  
Wendy Harris
Keyword(s):  
Patient Safety ◽  
Improve Patient Safety ◽  
Patient Treatment ◽  
Effective Measure ◽  
Oral Methotrexate ◽  
It Systems ◽  
National Patient ◽  
The Uk ◽  
The Right ◽  
Packaging And Labelling

Solid oral Methotrexate (Methotrexate in tablet form) has been used for many years as an effective measure to treat severe rheumatoid arthritis and severe psoriasis. When taken at the right frequency and dose Methotrexate is a safe medication. However, in the community in the UK between 1993 and 2000, Methotrexate has been implicated in the deaths of some 25 patients and a further 26 cases of serious harm which have required hospitalisation [1,2]. In 2003 the National Patient Safety Agency (NPSA) began a programme of work to investigate the causes of errors with Methotrexate and to develop and implement solutions in response. Since then, three projects have been undertaken: • The development of a new patient treatment diary; • An investigation of IT systems in GP’s surgeries and community pharmacies; and • An assessment of the packaging and labelling of Methotrexate with patients and healthcare practitioners and the identification of changes which should improve patient safety. This paper describes the research and results from the third project.

P10 To give, or not to give…

2018 ◽  
Vol 103 (2) ◽  
pp. e2.11-e2
Author(s):  
Zoe Lansdowne
Keyword(s):  
Patient Safety ◽  
Opioid Analgesics ◽  
Time Of Day ◽  
Electronic Prescribing ◽  
Time Range ◽  
List Type ◽  
University Hospitals ◽  
Policy Document ◽  
National Patient Safety Agency ◽  
National Patient

Aim‘Between September 2006 and June 2009, the NPSA (National Patient Safety Agency) received reports of 27 deaths, 68 severe harms and 21 383 other patient safety incidents relating to omitted or delayed medicines’.1 The Trust’s Medicines Code states that ‘critical’ medicines should be administered within one hour of the prescribed times, and all other medicines within 90 min.2 ‘Critical’ medicines relevant to NICU (Neonatal Intensive Care Unit) patients include injected antibiotics, anticoagulants, anticonvulsants, aminophylline infusions and strong opioid analgesics. The aim of this audit was to establish what proportion of medicines prescribed for patients on NICU were given outside of this policy.MethodData was downloaded for all NICU inpatients from the electronic prescribing system, ICCA, from 1/4/16 to 30/6/16 inclusive. It was then analysed using Excel. The data shows details of all regular drugs prescribed, the scheduled administration time and the time that the nurses recorded that the drug had been administered. Once only, when required and drug infusions longer than 4 hours were all excluded from this data capture. Scheduled doses of antibiotics that were intentionally delayed whilst awaiting levels, e.g. vancomycin and gentamicin, were excluded before data analysis.ResultsIt was found that over the 3 month period, 137 different patients were administered 10 642 regular doses of 51 different medications. 5.86% of these were classified as ‘delayed’ according to Trust policy. 97.6% of these delayed ‘critical’ medications were antibiotics, accounting for over 45% of the total delayed doses.Meropenem was found to be the antibiotic most frequently delayed, with over one quarter of all doses prescribed being administered more than 1 hour after the scheduled time. The delay in administration ranged from 65 mins to 6 hours. Ceftazidime was the next most frequently delayed, occurring 22.7% of the time, range 2.75 to 3.75 hours.The time of day when most drug delays occurred was between the times of 15:00 and 15:59, accounting for 8.2%. The percentage for each hourly time slot varied from 2.1% to 8.2%. Throughout the week, the percentage of delays on an individual day ranged from the most on Saturdays, 17.9%, to the least on Wednesdays, 9.6%.ConclusionsDelays in administering medicines can have significant detrimental effects for patient safety. Trust policy dictates that ‘critical’ medicines should be administered within 1 hour of the prescribed times.2 It can be seen from the results above that the administration of medications were delayed 5.86% of the time, with antibiotics accounting for over 45% of these delayed doses. The administration of meropenem was delayed over 25% of the time.ReferencesNational Patient Safety Agency. Rapid Response Report 009. Reducing harm from omitted and delayed medicines in hospital2010.Holmes, G. Chapter M09 policy for the administration of medicines [policy document]2016. University Hospitals Bristol NHS Foundation Trust.

scholarly journals Acceptability and use of glaucoma virtual clinics in the UK: a national survey of clinical leads

2018 ◽  
Vol 3 (1) ◽  
pp. e000127 ◽  
Author(s):  
Patrick J G Gunn ◽  
Joanne R Marks ◽  
Leon Au ◽  
Heather Waterman ◽  
Paul G D Spry ◽  
...  
Keyword(s):  
Patient Safety ◽  
Usual Care ◽  
National Survey ◽  
Lower Risk ◽  
Response Rate ◽  
Model Of Care ◽  
Patient Acceptability ◽  
Risk Patients ◽  
The Uk ◽  
Question Survey

ObjectiveThe purpose of this paper is to describe the findings of a national survey that aimed to estimate the proportion of Hospital Eye Service (HES) units using glaucoma virtual clinics, to determine how these services differ and to gauge clinicians’ views and opinions on the safety and acceptability of this model of care compared with usual care.Methods and analysisThis 12-question survey was disseminated nationally to 92 clinical lead consultant ophthalmologists using SurveyMonkey.ResultsThe response rate was 45.7%. There were 21 out of the total 42 respondents (50.0%) who were based at an NHS Trust where glaucoma virtual clinics were already being used and a further 9 (21.4%) were planning to establish one. Clinical leads largely rated efficiency and patient safety to be at least equivalent to usual care (92.9%) and 81.0% perceived glaucoma virtual clinics to be acceptable to patients. The main reasons for not running glaucoma virtual clinics were insufficient staff (71.4%) and inadequate space (47.6%). The majority of those running virtual clinics used this model of care for ‘lower risk’ patients such as ocular hypertensives (90.5%) and glaucoma suspects.ConclusionGlaucoma virtual clinics are employed by a large proportion of HES units, with many seeking to develop such services. Clinical leads largely rate efficiency, patient safety and the perception of patient acceptability to be at least equivalent to usual care.

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