• Prescribing errors
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DRUG-gle (Druggle)

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Context

The safety ‘huddle’ has been described as an intervention to improve quality of care, and taken up in various settings within healthcare. The ‘huddle’ includes as part of the S.A.F.E. project to improve situational awareness (rcpch.ac.uk/safe). While incepting the safety huddle on the paediatric ward, it was noted that a key member of the ward team is the pharmacist, and a specific medication-focussed safety ‘huddle’ could be a valuable intervention to reduce drug errors. We called it a ‘DRUG-gle (druggle)’.

Aims

The aim was to: • Alert the doctors and the nurses on the ward to common prescribing errors • To change behaviour over time to improve prescribing and reduce errors • For the team to understand the pharmacists' "interventions" written in green pen on the medication chart • Lead to a reduction in pharmacist "interventions" (changes to the prescription on the medication chart)

Description

Using the safety ‘huddle’ as a blue-print, a short, focussed discussion with the ward pharmacist was devised, called a DRUG-gle (Druggle). The aim is for the ward doctors, nurses and pharmacist to meet as part of the ward routine, usually after the ward round. One question was asked to the pharmacist: "What "interventions" have you made on the charts today?". Going through every "intervention", meaning every green pen correction on the prescription charts took time, so a focussed discussion of the top 3, intervention/s was shared. These were captured in order to share the learning with the wider team. A system of checking individual patient’s drug charts on the ward round has been described using the acronym “APT”. Is it Appropriate? – do we need to stop or change it? Is it the correct dose Prescribed?– can it be rationaled? Is the Timing OK? – is it ambulatory friendly?

Implementation

The DRUG-gle happens ad hoc with the lead consultant and the ward pharmacist. The interventions were translated into accessible, bite-sized, relevant learning points, formatted into a one-page 'DRUG-gle', sent to the team by e-mail. Markers of success (and measurements) would be: • Drug error reporting reduced (DATIX reports) • Pharmacist "interventions" reduced (monthly audit) • Confidence in prescribing skills (self assessment). Frequent change in junior staff may make the opportunity to have timely measurable impact reduced. Similarly to the safety huddle, measurement of value may lie in positive behaviours around situation awareness creating a positive safety culture around prescribing.

Suggestions for further implementation

Could extend to include patient/parent to discuss individual medications for specific children, particularly those on many medications. Could extend to other settings; within our service the Neonatal Unit would be viable to develop this to.

Challenges and learning

1. Time - on a full, busy ward it is difficult to fit in this to make it routine. Making it driven by the pharmacist would help as the doctors and consultants are changing daily and weekly. 2. Sharing – learning points can be uploaded into e-portfolio. Our Matron has developed a departmental quality and safety, audit and governance initiative newsletter called 'Paediatric Essential Learning'. Plan to make the 'DRUG-gle' leaning points a part of this. 3. Person dependant – It relies rests on a doctor and the pharmacist to drive it. Involve trainees to support process and information gathering.

Quality assurance/MHRA registration

Approved by the local team. Not published or presented (yet). Intent to submit abstract to RCPCH Conference 2016; work up for peer review submission in time. Other units 'DRUG-gling' as part of sharing on the SAFE project.