The problem with gentamicin: reducing administration and prescribing errors in neonates treated for early onset infection with gentamicin

2020 ◽  
pp. edpract-2019-318546
Author(s):  
Ashifa Trivedi ◽  
Elizabeth Lek ◽  
Sadhna Sharma ◽  
Shavindra Chellen
Keyword(s):  
Quality Improvement ◽  
General Hospital ◽  
Nursing Staff ◽  
Early Onset ◽  
District General Hospital ◽  
Moderate Level ◽  
Neonatal Unit ◽  
Prescribing Errors ◽  
Intervention Period ◽  
Low Level

We describe a quality improvement (QI) project to reduce the number of administration and prescribing errors with gentamicin on a local neonatal unit in a district general hospital, from January 2017 to August 2019. Baseline data collected showed seven errors in the first 16 months of the project (from 1999 doses). The aim of this QI project was to have no low-level, moderate-level or severe level harm errors in the intervention period. A number of interventions were carried out including a change to local guidelines and teaching sessions for staff. All Datix reports for gentamicin were reviewed as well as data collected from the pharmacy team for a further 16 months. One low harm error was reported in this period (from 1938 doses). Education of the medical and nursing staff has been a key intervention in reducing our gentamicin errors as well as changing the way we prescribe gentamicin.

scholarly journals A four-stage evaluation of the Paediatric Yorkhill Malnutrition Score in a tertiary paediatric hospital and a district general hospital

2010 ◽  
Vol 104 (5) ◽  
pp. 751-756 ◽  
Author(s):  
Konstantinos Gerasimidis ◽  
Orla Keane ◽  
Isobel Macleod ◽  
Diana M. Flynn ◽  
Charlotte M. Wright
Keyword(s):  
High Risk ◽  
General Hospital ◽  
Nursing Staff ◽  
Screening Tool ◽  
Nutritional Assessment ◽  
District General Hospital ◽  
Screening Tools ◽  
Lower Sensitivity ◽  
Tertiary Referral Hospital ◽  
Rater Reliability

Paediatric in-patients are at high risk of malnutrition but validated paediatric screening tools suitable for use by nursing staff are scarce. The present study aimed to assess the diagnostic accuracy of the new Paediatric Yorkhill Malnutrition Score (PYMS). During a pilot introduction in a tertiary referral hospital and a district general hospital, two research dietitians assessed the validity of the PYMS by comparing the nursing screening outcome with a full dietetic assessment, anthropometry and body composition measurements. An additional PYMS form was completed by the research dietitians to assess its inter-rater reliability with the nursing staff and for comparison with the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP) and the Paediatric Subjective Global Nutritional Assessment (SGNA). Of the 247 children studied, the nurse-rated PYMS identified 59 % of those rated at high risk by full dietetic assessment. Of those rated at high risk by the nursing PYMS, 47 % were confirmed as high risk on full assessment. The PYMS showed moderate agreement with the full assessment (κ = 0·46) and inter-rater reliability (κ = 0·53) with the research dietitians. Children who screened as high risk for malnutrition had significantly lower lean mass index than those at moderate or low risk, but no difference in fat. When completed by the research dietitians, the PYMS showed similar sensitivity to the STAMP, but a higher positive predictive value. The SGNA had higher specificity than the PYMS but much lower sensitivity. The PYMS screening tool is an acceptable screening tool for identifying children at risk of malnutrition without producing unmanageable numbers of false-positive cases.

A pilot study of tele-oncology in Scotland

1998 ◽  
Vol 4 (2) ◽  
pp. 113-119 ◽  
Author(s):  
Ian H. Kunkler ◽  
Paul Rafferty ◽  
David Foreman ◽  
David Hill ◽  
Maureen Henry
Keyword(s):  
Cost Effectiveness ◽  
Pilot Study ◽  
General Hospital ◽  
Nursing Staff ◽  
Patient Management ◽  
Pilot Trial ◽  
District General Hospital ◽  
Outpatient Services ◽  
Teleradiology System ◽  
The Uk

A pilot study of tele-oncology linking a cancer centre with a rural district general hospital was carried out; it involved patients, physicians, surgeons, radiologists and nursing staff. Its purpose was to complement the existing on-site outpatient services, providing oncological advice on non-clinic days. During the six months of the trial, 18 videoconferences were conducted. Their median duration was 17 min range 7-40 . Eight videoconferences involved patients directly. Acceptability of videoconferencing to doctors, nurses and patients was assessed by a questionnaire. Patients and staff found the technique acceptable and were satisfied with the results. The addition of a teleradiology system to teleconsultations was found to be important when decisions on patient management were taken. Following the success of this pilot trial, larger studies of tele-oncology in the UK with measures of cost-effectiveness are needed.

scholarly journals Reducing Prescribing Errors in Paediatric Patients by Assessment and Feedback Targeted at Prescribers

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Michael Eisenhut ◽  
Blanche Sun ◽  
Sarah Skinner
Keyword(s):  
General Hospital ◽  
Medical Errors ◽  
District General Hospital ◽  
Common Type ◽  
Prescribing Errors ◽  
Emergency Admissions ◽  
Wrong Dose ◽  
Written Assessment ◽  
Prescribing Medication ◽  
The Impact

Prescribing errors are the most common type of medical errors and can result in harm particularly in young children. Doctors were enrolled in a programme of written assessment in prescribing skills and individualized feedback. Pharmacists audited the impact. The setting was the paediatric wards and neonatal unit of a District General Hospital. 16 doctors were tested and received feedback. A total of 110 errors were identified in this test, out of a 51 were classified as major including wrong dose and frequency, and prescribing medication the patient had an allergy to. Audit of impact of this intervention revealed a reduction of errors from 47 to 21, and patients affected from 19 to 11 per 100 () emergency admissions compared to an audit before the intervention. An intervention combining a comprehensive multifaceted assessment and detailed feedback can lead to reduction of prescribing errors in paediatric trainees.

scholarly journals Multidisciplinary, patient-centred approach to improving compliance with venous thromboembolism (VTE) prophylaxis in a district general hospital

2020 ◽  
Vol 9 (3) ◽  
pp. e000680
Author(s):  
Melanie Nana ◽  
Cherry Shute ◽  
Rhys Williams ◽  
Flora Kokwaro ◽  
Kathleen Riddick ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Quality Improvement ◽  
Clinical Practice ◽  
Venous Thromboembolism ◽  
General Hospital ◽  
District General Hospital ◽  
Educational Material ◽  
Standards Of Care ◽  
Vte Prophylaxis ◽  
Hospitalised Patients

Hospital-acquired venous thromboembolism (VTE) accounts for an estimated 25 000 preventable deaths per annum in the UK and is associated with significant healthcare costs. The National Institute for Health and Care Excellence guidelines on the prevention of VTE in hospitalised patients highlight the clinical and cost-effectiveness of VTE prevention strategies. A multidisciplinary quality improvement team (MD QIT) based in a district general hospital sought to improve compliance with VTE prophylaxis prescription to greater than 85% of patients within a 3-month time frame. Quality improvement methodology was adopted over three cycles of the project. Interventions included the introduction of a ‘VTE sticker’ to prompt risk assessment; educational material for medical staff and allied healthcare professionals; and patient information raising the awareness of the importance of VTE prophylaxis. Implementation of these measures resulted in significant and sustained improvements in rates of risk assessment within 24 hours of admission to hospital from 51% compliance to 94% compliance after cycle 2 of the project. Improvements were also observed in medication dose adjustment for the patient weight from 69% to 100% compliance. Dose adjustments for renal function showed similar trends with compliance with guidelines improving from 80% to 100%. These results were then replicated in a different clinical environment. In conclusion, this project exemplifies the benefits of MD QITs in terms of producing sustainable and replicable improvements in clinical practice and in relation to meeting approved standards of care for VTE risk assessment and prescription. It has been demonstrated that the use of educational material in combination with a standardised risk assessment tool, the ‘VTE sticker’, significantly improved clinical practice in the context of a general medical environment.

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