George Eliot Hospital NHS Trust
Medication Safety Thermometer
Elizabeth HollandClinical Audit & Effectiveness Nurse
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
September we used the 3 page tool from Haelo
October I adapted the input sheet from Haelo to test
Number
Valid Clinical Reason e.g low BP
Outstanding Reconciliation
Med Not Avail
Route Not Available (e.g NBM, IV line tissued)
Patients Absent at Meds Round
Patient Refused Dose Not Doc
Other (put code) Anticoag Opiate Insulin
Anti-effective Anticoag Opiate Insulin
Anti-effective VTE bleed Admin Vit K INR >6
Admin of Naloxone
Resps below 12bpm
Common comp
Admin of Flumazenil
Common comp
Admin 10-50% IV Dextrose, glucagon
STEP 1 STEP 2
Patient IDGender
1.1Age 1.2
Allergy Status
1.3
Reconciliation 1.4
Meds Prescribed
1.5
Omissions in last 24 hrs 1.6a Omitted dose critical meds 1.6b High risk meds 1.7 Anticoags 2.1 Opiates 2.2 Injectable Sedatives 2.3 Insulin 2.4
Version 1 – same method as GEH Safety Thermometer
Found it over complicated even using the 3 page guide as reference
Version 2!
I decided to go back to one form per patientPrinted double sided to cut down on paper
Tested in November on 3 wards – 5 patientsUsed 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
Ward: Hospital Number:
Gender Patient's genderM
F
Age Patient's age<18 19-40
41-69 >70
Is the allergy status documented? Inc NKDA on kardexY
N
Was medicine reconciliation for all medicines started within 24 hrs of admission
Pharmacist has been involved
Y
No - patient within 24hrsN
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
5-15 >15
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
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
Opiates IV/SC Sedatives
Insulin
If YES proceed to Section 2
AnticoagHeparin, LMWH, Warfarin & NOACs Y
Any bleed or any kind of VTE
Administration of Vit K, Protamine or clotting factors e.g. Octaplex
Potential for bleed, interactions with other medicines NINR greater than 6 or APTT ration greater than 4
Opiates
Common complications of Opiates include sedation, respiratory depression & confusion
YAdmin of Naloxone
Reps rate below 12bpm
N
Injectable Sedatives Midazolam, Lorazepam,, diazepam, clonazepam Y
Common complications Admin of FlumazenilCommon complications of over sedation include hypotension, delirium, respiratory depression, reduced GCS N
Insulin
Symptoms of hypocaemia including anxiety confusion, extreme hunger, fatigue, irritability, sweating or clammy skin, trembling hands
YCommon complications (capillary blood sugar <4mmol/L) or symptoms of hypoglycaemia
Admin of reversal agent for hypoglycaemia (10-50% IV Dextrose, Glucagon)
NDiabetic Ketoacidosis (DKA) or Hyperosmolar Hyperglycaemisc State (HHS)
Auditor (print name):
Date:
Version 4!
Collection form Libby Style!
Alterations to make it suitable for other organisations
The collection form has now been developed into a tool for the Acute and community to test in January 14
Next steps?
Sharing resultsThe Band 7 on Elizabeth observed the first collection and asked to see their results. Pharmacist assisting the collection also interested in findings.
Ward DashboardsTo make the data look the same as classic Safety Thermometer I have put ward level data in a dashboard to share
