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Changing practice

Using a campaign to promote safer medicines practice among healthcare professionals

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Safer medicines month was launched to alert nurses to essential aspects of medicines administration policy. This article discusses the campaign’s impact

Authors

Maxine Simmons, BA, RGN,is senior matron; Caroline Duffin, BPharm, MRPharmS, is principal pharmacist; Erica Ward, BA, is clinical governance facilitator; Martin Shepherd, MSc, BSc Pharm, MRPS, is head of medicines management, all at Chesterfield Royal Hospital NHS Foundation Trust.

Abstract

Simmons M et al (2010) Using a campaign to promote safer medicines practice among healthcare professionals. Nursing Times; 106: 45, early online publication.

The Chesterfield Royal Hospital NHS Foundation Trust has a work plan aimed at improving the safe administration of medicines throughout the hospital. This includes measures aimed at raising nurses’ awareness of the risks associated with the administration of medicines and initiatives aimed at improving safety. Last year, two focus groups were held with qualified nurses from across the hospital to find out how they felt that practice could be made safer and more effective for patients. It was suggested that an educational campaign be organised to highlight best practice and to encourage nurses to think differently about medicines administration. This paper summarises the content and outcome of the campaign.

Keywords Medicines, Clinical risk management, Focus groups

  • This article has been double-blind peer reviewed

 

Practice points

When running a safer medicines campaign:

  • Design the campaign to limit the impact on clinical practice, to maximise attendance, and to focus on short, key messages.
  • Give short, 20 minute presentations to highlight key aspects of medicines management policy, and in particular the “five rights” of safe medicines administration practice.
  • Use a list of “nevers” drawn from incidents that are known to have occurred repeatedly in your hospital.

Introduction

In recent years, attention has focused on the burden of risk generated in acute hospitals by the inaccurate administration of medicines. The National Patient Safety Agency has drawn attention to specific problems that reoccur in acute hospitals involving medicines (National Patient Safety Agency,2009). These include:

  • Patients receiving the incorrect medicine;
  • The administration of oral liquid medicines using parenteral syringes;
  • The omission of medicines without clinical rationale;
  • Incidents involving poor communication or documentation.

The Chesterfield Royal Hospital NHS Foundation Trust has an established track record of effective clinical risk management, particularly in relation to medicines. This is reflected in the close working relationship that exists between nurses of all levels and the hospital pharmacy service. The trust has also developed innovative approaches to educating and assessing nurses’ knowledge of medicines using e-learning (Hare et al, 2006).

Over the last 18 months, the trust has developed a work plan aimed at improving the safe administration of medicines throughout the hospital. The plan includes a range of measures that are aimed at raising nurses’ awareness of the risks associated with the administration of medicines and initiatives aimed at improving safety. 

In October 2009, two focus groups were held with qualified nurses from across the hospital. The groups encouraged nurses to comment on a wide range of issues relating to medicines administration, to determine what problems they faced and how they felt that practice could be made safer and more effective for patients.

One of the suggestions from these focus groups was to organise an educational campaign to highlight best practice and to encourage nurses to think differently about medicines administration.  A campaign was subsequently organised and took place during May 2010.

Safer medicines month

The main objectives of the campaign were to increase understanding among nursing staff of the burden of risk generated by medicines as illustrated by incident reports, and to raise their awareness, and hence compliance with key areas of medicines management policy.

The campaign was underpinned by encouraging nurses to “change one thing” in their practice to improve the safety of medicines administration in the hospital. It was organised by the hospital pharmacy service, patient safety team, and directorate senior matrons and matrons.

When organising the campaign we were mindful of the practical constraints that existed in releasing large numbers of nurses to attend full day, or even half day educational events such as study days. With this is mind we designed the campaign to limit the impact on clinical practice, to maximise attendance, and to focus on short, key messages.

The campaign consisted of three elements.

Lunchtime briefings

Twice-weekly drop in sessions were arranged in the trust lecture theatre where a short, 20 minute presentation was undertaken to highlight key aspects of medicines management policy, and in particular the “five rights of safe medicines administration practice. These are: right patient; right drug; right dose; right time and right route.

A list of “nevers” was also created drawn from incidents that were known to have occurred repeatedly in the hospital:

  • Never administer a medicine without confirming the identity of the patient;
  • Never administer an oral liquid  medicine using a parenteral syringe;
  • Never omit a medicine without documenting the reason;
  • Never administer a medicine without checking that the drug , dose and route are correct;
  • Never administer a medicine without checking if the patient is allergic.

These sessions used a role-play scenario based on two nurses administering prescribed medicines to a hospital inpatient. The role play was designed to highlight commonly occurring shortcomings in the drug administration process.

Awareness raising sessions at handover

Pharmacists and ward pharmacy technicians arranged to attend handover sessions two to three times a week on each ward to highlight key learning points from medicines administration incidents that had taken place on the ward.  Where possible these were linked to aspects of policy and good practice.

Newsletters

Each week a newsletter was issued highlighting a different key message derived from the “five rights” of drug administration practice for distribution in both paper and electronic form.  In addition, key messages from the campaign were emphasised through the distribution

of publicity material including post it notes, pens and calculators that carried the key campaign message ( Fig 1.)

Evaluation

During the four-week campaign, 231 nurses attended the lunchtime briefing sessions. The number of nurses who attended ward-based briefings by ward pharmacists were: week 1, 106; week 2, 103; week 3, 78 and week 4, 73. Attendance by specialty and by band is illustrated in Table 1.

The evaluation sought to gain information on:

  • Speciality and experience of nurses attending;
  • Value of the sessions;
  • Whether or not the sessions were pitched at the right level;
  • Which areas nurses would change their practice as a result of the sessions.

Changing practice

Some 102 nurses indicated that they would change practice as a consequence of the campaign. Of the staff that said they did not learn anything that made them want to change their practice (116), the vast majority (86%)still found the session useful, often citing it as a helpful refresher.

Of the staff who said they did learn something to make them want to change their practice, the things they intended to change included:

  • Use of special oral syringes (staff not previously aware of their purpose);
  • Checking patient identity using the correct procedure at all times, even for long-term patients who are known to staff;
  • Generally, more concentration or attention when administering medicines;
  • Documenting the reason for omitting a medicine;
  • Use of Intranet or contacting other areas when medicines out-of-stock;
  • Familiarising self with medicines management policy;
  • Checking allergies;
  • Do not assume patient has taken their medicines;
  • Familiarising self with checking procedure or being more thorough with checks;
  • awareness of antibiotic allergies.

The majority (92% /n=206) of staff who answered the question found the session useful (Fig 2).

Some 84% of staff thought that the level of the session was pitched “about right”.  A number of evaluations from the early sessions included feedback that the session was too easy, and so at the beginning of subsequent sessions the facilitator explained that the session aimed to refresh knowledge and give reminders, rather than impart new knowledge. 

Conclusion and recommendations

The campaign appears to have had considerable success in attracting large numbers of nurses to attend briefing sessions, and in alerting them to aspects of practice where shortcomings are common.  Many nurses have clearly been engaged by the campaign and have indicated they will change their practice as a result. It can be argued that the impact of the campaign might be reflected in a reduction in medicines related incidents. However, this pre-supposes that incident reporting is an accurate reflection of incident rate, which cannot be assumed to be the case. We also suspect the campaign may lead to an increase in incident reporting as a consequence of nurses being more aware of medication safety issues.

Given the apparent achievements of the initiative, the trust has recommended that the campaign be repeated on an annual basis. It is also considering using a similar campaign methodology to raise awareness of other clinical aspects of care, such as nutrition.

The pharmacy service is to make arrangements for the key messages from the campaign - the “five rights” - to feature in all aspects of future medicines management training and education.  This will be encouraged by the on-going use of promotional materials. 

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Readers' comments (1)

  • dont we as registered nurseshave an obligation to our patients to safetly dispense their medication to them in the right form and do we not promise in our code of conduct to practice the "rights" of giving medication. this should be second nature without having this sort of initiative thrown at us, do the powers that be not realise that we are already bogged down by the new initiatives and documentation that managers give the front line nurses without going on the wards and delivering this themselves. its getting beyond a joke and alot of nurses are at the end of their tether isn't it a wonder why so many are on long term sick leave with stress related illnesses, when did nursing stop becoming caring and started to be secretarial, we all need one to cope with the amount of paperwork we have to do, whens it going to end?

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