Medicines Safety

1. Medicines Safety Essential Information for all staff involved in prescription, administration and assisting patients with medicines Debbie Knight Dept Head of Nursing and Midwifery Education July 2012

2. Learning Objectives To introduce you to information available to support practice e.g. Trust policies and how to access Trust medication guidelines and protocols. To learn from examples of good practice and adverse incidents to reduce the risk of errors. To learn about recent medicines management strategies to improve safety Page 2

3. Page 3 Information to support you in practice Management of Medicines Policy Procedure for the Administration of Medicines Controlled Drugs & Management Policy Injectable Medicines Policy Competency for Administration and also Assisting in the giving of Medicines NMC & HPC Code of Conduct & Standards for Medicines Administration The dosage interactions, formulation, route, side effects of the medicine prescribed. BNF!

4. What Does Administering Medicines Involve? Confirming identification by checking the patient’s first and surname, case note number and date of birth against the prescription chart - 4 Identifiers Having the ability to give the right patient

5. The Right Medicine Check-

6. The Right Dose Check-

7. The Right Route ?

8. Group Exercise

9. Routes for Administration

10. The Right Time Timeliness – drug round time v patient need/prescription time A missed dose occurs after 25% of the prescribed frequency has elapsed Sign once the patient has taken the medicine

11. Involve the Patient • Have you informed the patient about their medicines? • Has the patient consented to taking their medicines? • Do you know about the Guideline for Self Administration of Medicines • Make sure the patient is transferred between wards with their medicines!

12. A Quiz

13. Page 13 National Overview • Medication incident reports are those which actually caused harm or had the potential to cause harm involving an error in the process of prescribing, dispensing, preparing, administering, monitoring or providing medicines advice. • Over 90 per cent of incident reported to the National Reporting and Learning Service (NRLS) are associated with no harm or low harm. • The most frequently reported types of medication incidents involve: • wrong dose • omitted or delayed medicines • wrong medicine

14. Anticoagulants Warfarin overdose and inappropriate monitoring NPSA Alert 18 Opiods Overdose = respiratory depression or under dose = poor pain control Insulin Wrong dose, omitted medicine and wrong product Injectable sedatives Midazolam dosages inappropriate for the patient Page 14 National Campaigns Reducing Harm from High Risk Medicines

15. No Needless Medicines Errors To reduce incidents of needless medication errors and their consequences We will be monitored on • 10% reduction in medication incidents that result in moderate/sever harm or death -based on previous year • Allergy status – 100% adult patients with allergy status documented on the drug chart • Medicines Reconciliation – aim for 100% adult patients have reconciliation of their medicines completed by pharmacy within 24hrs of admission • INR monitoring – monitor INR greater than 5

16. Page 16 Reducing Harm from Medicines People should be given the medicines they need when they need them, and in a safe way

17. Missed doses Insulin errors Allergy status Page 17 Learning from Adverse Incidents Our Key issues

18. Top 10 drugs stated in adverse incident forms for omitted medicines Drug not stated – 27% Enoxaparin – 14% Insulin – 6% Warfarin – 5% Morphine – 4% Paracetamol – 3% Heparin – 3% Tazocin – 2% Asprin – 2% Co-amoxiclav – 2% Missed Doses of Medicines

19. Insulin AdministrationA High risk medicine Did you Know • All opened insulin should be discarded after 30 days of opening • All opened insulin should be dated with the day of opening (and ideally an expiry date) • Insulin administered to more than one patient should be made available in multi-use vials NOT pen cartridges • Never omit insulin in a type 1 diabetic • All insulin must be prescribed in units – not using ‘u’ • Talk to patients about their diabetes management. They often know best A useful e-learning package can be found at: www.diabetes.nhs.uk/safe_use_of_insulin/elearning_course

20. What’s new! Changes to Medicines Policy and anaphylaxis treatment box • Section 5.1.4. Student nurses change to training programmes • Section 6.4.5.3. Storage of emergency meds - salbutamol inhaler, GTN spray allowed to be stored unlocked for self administration • Section 6.7.1. Nurse to be competent to level 2 before solo checking • Section 6.7.14. Discharge medicines to be checked when discharging patients • Section 7.7.15. Staff not allowed to use hospital stock for own use • IVs needing second check added to IV policy • Storage of drugs needed for anaphylaxis adrenaline 1in1000 (1ml) ampoules for injection, chlorphenamine 10mg in 1ml injection & hydrocortisone sodium succinate 100mg injection

21. Page 21

22. Back to Practice • Look up policies and procedures • Find your departments copy of the medication safety bulletin and • Stop, check and be safe