Resident Medical Officers Training Program in Patient Safety Brisbane, Australia

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Resident Medical Officers Training Program in
Patient Safety - Brisbane, Australia

• John Wakefield

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(No Transcript)
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Aim

• Systems approach to error - incident reporting
  and analysis
• Graded assertiveness
• Medication history
• Prescribing associated processes
• Heparin and warfarin
• Insulin
• Potassium
• Discharge
• prescription
• communication and counselling

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Medication Safety - Why Bother?

• Patient harm from adverse drug events occurs in
  1.6 of admissions to Australian hospitals
  (QAHCS, Wilson, MJA 1995)
• 50 of harm from ADEs originates in failures in
  either prescribing decision or transcription of
  order into a format for nurses to administer
  (Bates, J Gen Int Med, 1995)
• Junior medical staff, generate the greatest
  proportion of prescriptions (in house data PAH)
• Interns perceive that they are not as well
  prepared to prescribe at beginning of intern year
  (Rego, UQ, 2001)

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Risk Awareness
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Risk Awareness of Medical Staff

• Prescribing is not perceived as important
• Culture change needed from a task to a high risk
  intervention
• Absence of self awareness of errors
• (Dean et al Lancet 2002)

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Medicines Management System
DOCTORS
Decision to prescribe
50 of Harm (Error rate 2.5 - 10)
10 of Harm (0.01 0.5 error rate)
40 of Harm (5-15 error rate)
NURSES
PHARMACY
From Bates et al 1995
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Why Medication History Taking?

• 5-20 of medical admissions are drug related
  (Roughead, MJA, 2000)
• Important to identify what the patient was
  actually taking prior to admission
• Compare this with what patient should be on
  identifies
• treatment gaps
• possible drug related problems
• Helps to understand nature of illness and its
  responsiveness to treatment

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Aims

• Identify key issues
• communication skills
• what patient is actually taking prior to
  admission
• assessment of compliance
• limitations of different information sources
• How these medications (or lack of) may have
  precipitated this admission

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Methodology

• Provide background
• Show first video of medication history taking in
  ED
• Critique communication style and content
• Determine what patient is taking
• Show second video
• Repeat above
• Compare the two medication lists

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Patient History

• PC Increasing SOB, PND
• O/E BP 190/90, pulse 89 SR, JVP 8-9 cm, chest
  bi-basal crackles, peripheral oedema
• ELFT Creatinine 0.19 (prev 0.13, 3m ago) Hb
  135, K 5.0
• NIDDM (10 yrs), HT (20 yrs) CRF, MI, (3 yrs) LVF,
  RA.
• Lives alone, grumpy, stoic chap
• Diagnosis - LVF, CXR confirms

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Communication Skills Style

• What is good about the interview?
• What could have been done better?
• Any limitations of the technique?

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Consider Content

• What important information is revealed?
• What important details were not sought?
• What extra questions would you use?
• What questioning style would you use?
• What do you think patient was taking?
• What medication-related factors might have
  contributed to this admission?
• Other information sources you can use?

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Interactive Skill Stations in Safety Self
Assessment of Awareness

• Methodology
• 6 skill stations
• Safety scenario played out in each one
• Followed by detailing of individuals by
  pharmacist/physician/nurse
• Self assessment of ability to identify the safety
  issue

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Risk Awareness Related to Nursing
Experience(able to identify risk and prevent
harm) n420
RNS