George Eliot Hospital NHS Trust Medication Safety Thermometer Elizabeth Holland Clinical Audit

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George Eliot Hospital NHS TrustMedication
Safety ThermometerElizabeth HollandClinical
Audit Effectiveness Nurse
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George Eliot Hospital NHS Trust is a District
General Hospital in Nuneaton 320 Beds including
Maternity 1,580 staff Took part in the testing
of Safety Thermometer Started M.S.T in September
on one medical ward Elizabeth 27 beds December
2 medical wards Melly Elizabeth
2 surgical wards Victoria Alexandra January
1 medical ward Bob Jakin
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September we used the 3 page tool from Haelo
October I adapted the input sheet from Haelo to
test
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Version 1 same method as GEH
Safety Thermometer Found it over complicated
even using the 3 page guide as reference
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Ward Hospital Number Ward Hospital Number Ward Hospital Number Ward Hospital Number
Gender Patient's gender M M
Gender Patient's gender F F
Age Patient's age lt18 19-40
Age Patient's age 41-69 gt70
Is the allergy status documented? Inc NKDA on kardex Y Y
Is the allergy status documented? Inc NKDA on kardex N N
Was medicine reconciliation for all medicines started within 24 hrs of admission Pharmacist has been involved Y No - patient within 24hrs
Was medicine reconciliation for all medicines started within 24 hrs of admission Pharmacist has been involved N No - patient within 24hrs
How many regular medicine are prescribed? Not inc PRN, Stat doses, IV fluids, O2, food supplements or devices. Different doses of the same medicine count as one medicine 0 1-4
How many regular medicine are prescribed? Not inc PRN, Stat doses, IV fluids, O2, food supplements or devices. Different doses of the same medicine count as one medicine 5-15 gt15
Omitted dose of regular medication in the last 24hrs? Exclude Food supplements O2 insert number of omissions using available info e.g. 3 omissions as pt refused 2 route not available Insert number Reason for omission
Omitted doses a critical medicine Number of omissions of a critical medicine Anticoag Opiate
Omitted doses a critical medicine Number of omissions of a critical medicine Insulin Anti-effectives
Has the patient received any of the following medicines in the last 24hrs Anticoags (Heparin, LMWH excluding VTE proph, Warfarin NOAC's) Opiates (exclude oral codeine dihydrocodeine IV or SC sedatives, Insulin) Anticoag Warfarin
Has the patient received any of the following medicines in the last 24hrs Anticoags (Heparin, LMWH excluding VTE proph, Warfarin NOAC's) Opiates (exclude oral codeine dihydrocodeine IV or SC sedatives, Insulin) Opiates IV/SC Sedatives
Has the patient received any of the following medicines in the last 24hrs Anticoags (Heparin, LMWH excluding VTE proph, Warfarin NOAC's) Opiates (exclude oral codeine dihydrocodeine IV or SC sedatives, Insulin) Insulin Insulin
If YES proceed to Section 2 If YES proceed to Section 2 If YES proceed to Section 2 If YES proceed to Section 2
Anticoag Heparin, LMWH, Warfarin NOACs Y Y
Any bleed or any kind of VTE Heparin, LMWH, Warfarin NOACs Y Y
Administration of Vit K, Protamine or clotting factors e.g. Octaplex Potential for bleed, interactions with other medicines N N
INR greater than 6 or APTT ration greater than 4 Potential for bleed, interactions with other medicines N N
Opiates Common complications of Opiates include sedation, respiratory depression confusion Y Y
Admin of Naloxone Common complications of Opiates include sedation, respiratory depression confusion Y Y
Reps rate below 12bpm Common complications of Opiates include sedation, respiratory depression confusion N N
  Common complications of Opiates include sedation, respiratory depression confusion N N
Injectable Sedatives Midazolam, Lorazepam,, diazepam, clonazepam Y Y
Common complications Admin of Flumazenil Common complications of over sedation include hypotension, delirium, respiratory depression, reduced GCS N N
Insulin Symptoms of hypocaemia including anxiety confusion, extreme hunger, fatigue, irritability, sweating or clammy skin, trembling hands Y Y
Common complications (capillary blood sugar lt4mmol/L) or symptoms of hypoglycaemia Symptoms of hypocaemia including anxiety confusion, extreme hunger, fatigue, irritability, sweating or clammy skin, trembling hands Y Y
Admin of reversal agent for hypoglycaemia (10-50 IV Dextrose, Glucagon) Symptoms of hypocaemia including anxiety confusion, extreme hunger, fatigue, irritability, sweating or clammy skin, trembling hands N N
Diabetic Ketoacidosis (DKA) or Hyperosmolar Hyperglycaemisc State (HHS) Symptoms of hypocaemia including anxiety confusion, extreme hunger, fatigue, irritability, sweating or clammy skin, trembling hands N N
Auditor (print name)      
       
Date      
Version 2! I decided to go back to one form
per patient Printed double sided to cut down on
paper Tested in November on 3 wards 5
patients Used 3 page tool as reference
guide General comments from ward manager, sister
pharmacist were positive Amendments have been
made to Version 2 after discussions at the Webex
with Haelo
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Version 4! Collection form Libby
Style! Alterations to make it suitable for other
organisations
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The collection form has now been developed into a
tool for the Acute and community to test in
January 14
Next steps?
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Sharing results
The Band 7 on Elizabeth observed the first
collection and asked to see their results.
Pharmacist assisting the collection also
interested in findings.
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Ward Dashboards
To make the data look the same as classic Safety
Thermometer I have put ward level data in a
dashboard to share
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Elizabeth.Holland_at_geh.nhs.uk