Pharmacy Technician led model to reduce the rate of omitted medicines

Transcription

1 Pharmacy Technician led model to reduce the rate of omitted medicines By Fleur Baylis Lead Pharmacist Patient Safety Brighton and Sussex University Hospitals NHS Trust

2 Outline NPSA alert Missed doses Trust Audit CQUIN target Intervention & Re-audit Evaluation & Lessons Learnt

3 2 elderly care wards Background Weekly analysis of 10 drug charts from each ward The following data collected: drug name frequency and route of administration Number of doses expected Number of doses missed Omission details (time, date, code)

4 Initial audit results 22% doses omitted- average across 2 wards CQUIN: Reduce omissions by 50%

5 What did the results tell us? blank Patient refused

6 Targeted interventions Review of ward stock A list of critical drug classes, and the respective risks of missing doses.

7

8 Targeted interventions Review of ward stock A list of critical drug classes, and the respective risks of missing doses. A flow chart for locating drugs not on the ward.

9 Targeted interventions Review of ward stock A list of critical drug classes, and the respective risks of missing doses. A flow chart for locating drugs not on the ward. Contact details for pharmacy out-of-hours

10

11 Targeted interventions Review of ward stock A list of critical drug classes, and the respective risks of missing doses. A flow chart for locating drugs not on the ward. Contact details for out-of-hours pharmacy services. Raise the issue of prescribing standards

12 Targeted interventions Review of ward stock A list of critical drug classes, and the respective risks of missing doses. A flow chart for locating drugs not on the ward. Contact details for out-of-hours pharmacy services. Raise the issue of prescribing standards Weekly feedback

13 Weekly Feedback

14 Percentage omitted doses Medication Omissions Weekly Audit Bristol 20.0 Fleming&Lis % omission target /10/ /11/ /11/ /12/ /01/ /02/ /03/ /03/2011 Week ending (date)

15 Breakdown of omissions rates by time of day Time of Day

16 Use of a ward based technician to support drug rounds Ward service to start at 8:00 am Observe practice and behaviours Facilitate medication administration Daily chart review Timely access to medicines Prompt medicines reconciliation Medicines advice and information

17 Percentage omitted medications 34.3% 24.7% 17.6% 19.6% 17.5% 12.6% 7.7% 8.9% 10.3% 5.6% Percentage of regular prescribed medicines not documented as administered to patient 35% 30% 25% Targeted Interventions Implementation of ward technician Ward 1 20% Ward 2 15% 10% 11.5% omission target 5% 0% Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Month

18 Statistics Intervention Reduction Statistical analysis of reduction Relative risk Initial targeted Interventions 5.4% (95% CI %); (p<0.0001) 0.72 (95% CI ); Implementation of ward technician 6.5% (95% CI %). (p<0.0001) 0.53 (95% CI ).

19 Pharmacy Technician Viewpoint Poor prescribing. drug name illegible, no frequency, no times circled. Drugs timings not given practical consideration. Nurses forgetting to sign drug charts Drugs not being transferred from previous wards. New medication(s) not communicated to nursing staff Lack of understanding of pharmacy systems e.g. chart endorsements Nil-by-mouth inappropriate withholding of medication. Lack of qualified nursing staff Nurses not revising refusal of medicines e.g. for once daily medications Drug charts not being rewritten before prescription runs out.

20 Ward feedback (the ward technician) is helpful in anticipating the things that are needed (the ward technician) was very helpful to support staff especially new staff (the ward technician) was very useful in prompting and assisting with medication delivery the technician was able to talk to patients about their drugs, if a new drug had been started

21 Key messages Awareness of omitted drugs has a significant impact Sustained impact by introduction of technician Use success story to highlight the issue Bedside handover now includes missed doses review Established MDT Medicines omissions group Continue to keep it on the Trust priority post CQUIN Next: Rollout across the trust

22 References & Thanks Missed Doses Do you have a problem? Baha, Z., Showler, C., Ireland A., Renshaw M. (2010) available With Thanks to: Jat Harchowal Chief Pharmacist Catherine Showler Lead Pharmacist Patient Safety Sue Finall Pharmacy Technician Mark Renshaw Deputy Chief of Safety Matt Tribe Medical Student Puja Shah Pre-registration pharmacist