scholarly journals SP6 Building on the druggle: personalised feedback to improve and maintain good prescribing practice

2020 ◽  
Vol 105 (9) ◽  
pp. e3.2-e4
Author(s):  
Thomas Wyllie
Keyword(s):  
Patient Safety ◽  
Intensive Care ◽  
Neonatal Intensive Care ◽  
List Type ◽  
Feedback Session ◽  
Feedback Form ◽  
Prescribing Practice ◽  
Set Up ◽  
Personalised Feedback ◽  
Initial Results

BackgroundInspired by work from a number of other centres,1 2 a weekly ‘Druggle’ was set up on our 28 cot tertiary, level 3 neonatal intensive care unit in June 2018. The Druggle is a short pharmacist-led briefing in the clinical area involving doctors and nurses, focussing on prescribing and administration issues and errors. Over the first year a concurrent zero tolerance audit shows an improvement in prescribing practice, with an increased number of charts with zero errors (63% in June 2018, 95% in June 2019). Despite the improvements in prescribing practice, average attendance at the Druggle has fallen from 17 people per week to 7 over the year. It was decided to consider personalised feedback on prescribing as a potential new mechanism to improve and maintain prescribing standards.AimTo investigate if structured, personalised feedback to prescribers on a neonatal unit could be an innovative way of improving prescribing standards and patient safety. The project was set up to gain an insight into prescribers attitudes towards prescribing feedback and to see what impact that feedback might have on their attitudes after it had been carried out.MethodAll prescribers on the unit were invited to complete an online questionnaire which included questions on previous experience of feedback and attitudes towards structured, personalised prescribing feedback. Participants were also able to express their interest in participating in a feedback session.A selection of prescribers who had chosen to participate were then monitored and contacted to arrange a feedback session. This comprised of a short interview style session based on Pendleton’s rules for feedback3 in which pictures of their prescriptions were appraised and a structured feedback form completed by the pharmacist was reviewed. The feedback form was split into sections covering legibility, accuracy and completeness, with each section having a non-numerical scoring system, together with practical examples and suggestions for improvement.After the feedback session, prescribers were asked to complete a feedback response form which allowed them to express how useful they found the feedback, whether they felt it would change their practice and to give comments.ResultsThe initial questionnaire was completed by a wide variety of prescribers including different grades of doctor and advanced neonatal nurse practitioners (ANNPs) with a range of 0–15 years of neonatal prescribing experience. 45% of respondents had never received personalised prescribing feedback, and 90% of respondents said they would welcome it. Comments included a desire for positive feedback as well as suggestions for how to improve. Feedback sessions are still ongoing, and initial results of the post-feedback questionnaire are positive – mean score of 4.3/5 for usefulness of feedback to practice. Comments include ‘This has been the single most useful feedback for my prescribing practice to date’ – ST5 Doctor.ConclusionProviding personalised feedback to prescribers is welcomed and should be explored more widely. Initial results show that prescribers find personalised feedback useful and they can use it as a basis for reflecting on prescribing practice.ReferencesReece A, Hill A, Platt B, et al. G171 Improving situation awareness in prescribing: A medication safety huddle – the DRUG-gle (Druggle). Arch Dis Child 2016;101:A89.Bell C, Jackson J, Shore H. P3 S.a.f.e. – the positive impact of ‘druggles’ on prescribing standards and patient safety within the neonatal intensive care environment. Arch Dis Child, 2018;103:e2.Pendleton D, Schofield T, Tate P, et al. The consultation: an approach to learning and teaching. Oxford: Oxford University Press, 1983.

SP5 A study exploring the opinions and attitudes of medical staff towards pharmacist independent prescribing in a neonatal intensive care unit

2018 ◽  
Vol 103 (2) ◽  
pp. e1.45-e1
Author(s):  
Williams Lauren ◽  
McIntosh Trudi
Keyword(s):  
Intensive Care Unit ◽  
Patient Safety ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Patient Care ◽  
Medical Staff ◽  
Neonatal Intensive Care ◽  
Positive Impact ◽  
List Type ◽  
Independent Prescribing

AimExisting published literature supports the implementation of pharmacist independent prescribing (PIP). A positive impact on patient care1 has been reported, with an encouraging response from patients2 and other healthcare professionals when asked about their views. There have also been reported patient safety benefits from PIP in secondary care.3 There is a gap in the literature regarding the utilisation of PIP in neonatal practice. The views of neonatal pharmacists across the UK towards PIP have been considered4 but to date there has been no research published on the opinions of medical staff about PIP in Neonatal Intensive Care Units (NICU). This study aimed to explore the opinions and attitudes of medical staff towards PIP in NICU, identifying any barriers and facilitators to the current service.MethodSemi-structured interviews were conducted with a purposively selected sample of senior registrars and consultants working within NICU. An interview schedule was developed, assessed for content validity and then piloted with two initial interviews (total interviews=10). Interviews were digitally recorded then transcribed verbatim. Framework Analysis principles were applied to data analysis. Ethics approval was granted by Robert Gordon University.ResultsParticipants displayed a positive attitude towards PIP, stating that it has been beneficial to the overall service provided in NICU. Improved patient safety, shared workload for medical staff and increased efficiency in prescribing were cited as important benefits. Collaborative working as a multi-disciplinary team when making prescribing decisions for the patient was noted to be essential, as was ensuring junior medical staff still receive the prescribing experience required for them to be competent prescribers. Although medical staff reported no concerns with PIP, lack of a service at weekends and PIP being limited by multiple concomitant ward rounds were identified barriers. The interpersonal skills and knowledge displayed by neonatal pharmacist prescribers, acceptance by the medical team and positivity towards new developments shown by all staff were highlighted as important facilitators.ConclusionAll participants were fully supportive of the PIP service provided in NICU. Utilising the knowledge and skills of pharmacist prescribers has improved the efficiency and quality of prescribing in the unit and has had a positive impact on patient care.ReferencesLatter S, Blekinsopp A, Smith A, et al. Evaluation of nurse and pharmacist independent prescribing 2010. London: University of Southampton. http://eprints.soton.ac.uk/184777/2/ENPIPexecsummary.pdf [accessed: 2016 August 17].Tinelli M, Blekinsopp A, Later S, et al. Survey of patients‘ experiences and perceptions of care provided by nurse and pharmacist independent prescribers in primary care. Health Expectations 2013;18:1241–1255.Baqir W, Crehan O, Murray R, et al. Pharmacist prescribing within a UK NHS hospital trust: Nature and extent of prescribing, and prevalence of errors. Eur J Hosp Pharm 2015;22:79–82.Mulholland PJ. Pharmacists as non-medical prescribers; what role can they play? The evidence in a neonatal intensive care unit. E J Hosp Pharm 2014;21:335–338.

Atmung – Standardisierte Checkliste macht Intubation von Neugeborenen sicherer

2017 ◽  
Vol 22 (03) ◽  
pp. 124-125
Author(s):  
Maria Weiß
Keyword(s):  
Intensive Care Unit ◽  
Patient Safety ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Improve Patient Safety ◽  
Improve Patient

Hatch LD. et al. Intervention To Improve Patient Safety During Intubation in the Neonatal Intensive Care Unit. Pediatrics 2016; 138: e20160069 Kinder auf der Neugeborenen-Intensivstation sind besonders durch Komplikationen während des Krankenhausaufenthaltes gefährdet. Dies gilt auch für die Intubation, die relativ häufig mit unerwünschten Ereignissen einhergeht. US-amerikanische Neonatologen haben jetzt untersucht, durch welche Maßnahmen sich die Komplikationsrate bei Intubationen in ihrem Perinatal- Zentrum senken lässt.

scholarly journals Patient safety culture at neonatal intensive care units: perspectives of the nursing and medical team

2014 ◽  
Vol 22 (5) ◽  
pp. 755-763 ◽  
Author(s):  
Andréia Tomazoni ◽  
Patrícia Kuerten Rocha ◽  
Sabrina de Souza ◽  
Jane Cristina Anders ◽  
Hamilton Filipe Correia de Malfussi
Keyword(s):  
Patient Safety ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Safety Culture ◽  
Neonatal Intensive Care ◽  
Patient Safety Culture ◽  
Neonatal Intensive Care Units ◽  
Cronbach’S Alpha ◽  
Cronbach's Alpha ◽  
Professional Characteristics

OBJECTIVE: to verify the assessment of the patient safety culture according to the function and length of experience of the nursing and medical teams at Neonatal Intensive Care Units.METHOD: quantitative survey undertaken at four Neonatal Intensive Care Units in Florianópolis, Brazil. The sample totaled 141 subjects. The data were collected between February and April 2013 through the application of the Hospital Survey on Patient Safety Culture. For analysis, the Kruskal-Wallis and Chi-Square tests and Cronbach's Alpha coefficient were used. Approval for the research project was obtained from the Ethics Committee, CAAE: 05274612.7.0000.0121.RESULTS: differences in the number of positive answers to the Hospital Survey on Patient Safety Culture, the safety grade and the number of reported events were found according to the professional characteristics. A significant association was found between a shorter Length of work at the hospital and Length of work at the unit and a larger number of positive answers; longer length of experience in the profession represented higher grades and less reported events. The physicians and nursing technicians assessed the patient safety culture more positively. Cronbach's alpha demonstrated the reliability of the instrument.CONCLUSION: the differences found reveal a possible relation between the assessment of the safety culture and the subjects' professional characteristics at the Neonatal Intensive Care Units.

scholarly journals A Neonatal Intensive Care Unit’s Experience with Implementing an In-Situ Simulation and Debriefing Patient Safety Program in the Setting of a Quality Improvement Collaborative

Children ◽  
2020 ◽  
Vol 7 (11) ◽  
pp. 202
Author(s):  
Mary Eckels ◽  
Terry Zeilinger ◽  
Henry C. Lee ◽  
Janine Bergin ◽  
Louis P. Halamek ◽  
...  
Keyword(s):  
Patient Safety ◽  
Intensive Care ◽  
Quality Improvement ◽  
Neonatal Intensive Care ◽  
Quality Care ◽  
Neonatal Resuscitation ◽  
Healthcare Team ◽  
In Situ Simulation ◽  
Implementation Phase

Extensive neonatal resuscitation is a high acuity, low-frequency event accounting for approximately 1% of births. Neonatal resuscitation requires an interprofessional healthcare team to communicate and carry out tasks efficiently and effectively in a high adrenaline state. Implementing a neonatal patient safety simulation and debriefing program can help teams improve the behavioral, cognitive, and technical skills necessary to reduce morbidity and mortality. In Simulating Success, a 15-month quality improvement (QI) project, the Center for Advanced Pediatric and Perinatal Education (CAPE) and California Perinatal Quality Care Collaborative (CPQCC) provided outreach and training on neonatal simulation and debriefing fundamentals to individual teams, including community hospital settings, and assisted in implementing a sustainable program at each site. The primary Aim was to conduct two simulations a month, with a goal of 80% neonatal intensive care unit (NICU) staff participation in two simulations during the implementation phase. While the primary Aim was not achieved, in-situ simulations led to the identification of latent safety threats and improvement in system processes. This paper describes one unit’s QI collaborative experience implementing an in-situ neonatal simulation and debriefing program.

scholarly journals Segurança do paciente em unidade de terapia intensiva neonatal: revisão integrativa/Patient safety in a neonatal intensive care units: integrative review

2020 ◽  
Vol 19 ◽  
Author(s):  
Vanessa Acosta Alves ◽  
Viviane Marten Milbrath ◽  
Nara Jací da Silva Nunes ◽  
Ruth Irmgard Bartschi Gabatz
Keyword(s):  
Patient Safety ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Neonatal Intensive Care ◽  
Integrative Review ◽  
Neonatal Intensive Care Units ◽  
Terapia Intensiva

Objetivo: identificar a produção científica, publicada de janeiro de 2008 a julho de 2019, sobre a segurança do paciente em Unidade de Terapia Intensiva Neonatal. Método: revisão integrativa, na qual se selecionou 24 artigos que atendiam ao objetivo e aos critérios de inclusão e exclusão com o auxílio do software End Note®. Nesses artigos, analisaram-se os dados referentes à autoria, objetivos, ano de publicação, método, resultados e nível de evidência. Resultados: elaboraram-se cinco categorias para apresentar os resultados: O profissional e a segurança do paciente; Comunicação e segurança do paciente; Gestão de qualidade e segurança do paciente; Cultura de segurança; e A família e a segurança do paciente. Conclusão: o processo de construção e incentivo à segurança do paciente se dá de forma similar nos cenários nacional e internacional. Os estudos apontam esforços emergentes para a construção da cultura de segurança, arquitetados sob estratégias de gestão de qualidade e segurança, melhoria das condições de trabalho e fatores profissionais, bem como a inserção da família como fator qualificador da assistência. Palavras-chave: Segurança do paciente. Neonato. Unidade de Terapia Intensiva Neonatal. Enfermagem.

scholarly journals P03 Preparing glucose infusions in neonatal intensive care: does it matter which method is used?

2020 ◽  
Vol 105 (9) ◽  
pp. e7.2-e7
Author(s):  
Adriece Al Rifai ◽  
Robyn Hart ◽  
Andrew Wignell
Keyword(s):  
Intensive Care ◽  
Glucose Concentration ◽  
Neonatal Intensive Care ◽  
Glucose Solution ◽  
Control Sample ◽  
Accurate Method ◽  
Glucose Infusion ◽  
List Type ◽  
Neurological Sequelae ◽  
Number Of Factors

AimsAdministering intravenous (IV) glucose is common on the Neonatal Intensive Care Unit. Bedside preparation of glucose solutions is often necessary, usually through addition of concentrated 50% glucose to a commercially available bag. Accuracy in the glucose concentration of locally prepared bags will be influenced by a number of factors: variable overages in IV fluid bags, method of preparation and imprecision of measurement during preparation. We aimed to assess the accuracy of three different methods of preparation which had been identified through a national survey.MethodsBags of 12.5%, 15% and 25% glucose were manufactured through the addition of 50% glucose solution to commercially available bags of 10% or 20% glucose. Three bags of each concentration, were manufactured by each of the methods below:Removal of fluid from base bag prior to addition of 50% glucose, taking into account published overage.Removal of fluid from base bag prior to addition of 50% glucose, not taking into account published overage.Addition of 50% glucose, without prior removal of fluid from base bag.Three 5 mL samples were then taken from each prepared bag and sent for analysis. Glucose concentration was measured using a quantitative spectrophotometric method. As a control, three 5 mL samples were taken from three bags each of commercially available 5%, 10% and 20% glucose infusion solutions and assayed as above.ResultsA total of 81 ‘test’ samples were sent for analysis along with 27 control samples. One 20% glucose control sample was lost in transport meaning that 80 samples were analysed. The median result for each concentration and method was calculated. For method a) where the intended final glucose concentration was 12.5%, 15% and 25%, the actual concentrations obtained were 11.2%, 13.3% and 22.9% respectively. For method b) where the intended final glucose concentration was 12.5%, 15% and 25%, the actual concentrations obtained were 12.4%, 13.4% and 22.0% respectively. For method c) where the intended final glucose concentration was 12.5%, 15% and 25%, the actual concentrations obtained were 12.1%, 13.8% and 20.3% respectively. For the 5%, 10% and 20% control solutions the median reported glucose concentrations were 5.1%, 10.3% and 19.9% respectively.ConclusionsIrrespective of method used and the intended strength, the measured glucose concentration was lower than that being aimed for. In some cases, the glucose concentration was only 80% of that intended. It is not possible to conclude that one method is superior in terms of accuracy. Although it might be possible from our results to suggest the most accurate method for each concentration, this is unlikely to be predictable as manufacturers quote overages as a range rather than an absolute value. In clinical practice, preparation of a glucose solution with a lower concentration than that expected may result in prolonged hypoglycaemia with potential neurological sequelae. An alternative to bedside manufacture of glucose infusion solutions is needed. This could include pharmacy compounding of glucose strengths not commercially available or ‘piggy-backing’ of 50% glucose onto an infusion of a commercially available strength, ideally supported by a glucose load calculator.

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