NFQ level 8: Introduction of an Information Technology Strategy to Mitigate and Minimise Drug Errors: Patient Safety, Quality Improvement & Risk Management, Assignment, RCSI, Ireland

Introduction

Patient safety is paramount in healthcare today, Health Information and Quality Initiative (HIQA 2012). The World Health Organisation (WHO 2018) in collaboration with the Global Patient Safety Collaborative, identified safety as one of the most important factors in healthcare delivery worldwide. Safety can be defined as preventing harm, and as outlined in the Quality of Practice: Principle 3 Nursing and Midwifery Board Ireland (NMBI 2014), nurses and midwives are at the centre ofpatient care and play a pivotal role in delivering safe, quality equitable care.

To ensure the care delivered is of optimum quality, it must be safe, patient–centred, beneficial
and efficient Health Service Executive Quality Framework (HSE 2016). Safety and risk are interlinked (HSE 2017). Identifying the risk, or the possibility of harm, addressing the risk and managing the risk are everyone’s responsibility.

Medication errors were identified as the most prevalent risk worldwide today in our healthcare system (Frush et al., 2015). Kavanagh (2017) supports this and agrees that medication errors are a notable cause of harm to patients. Promoting medication safety in the healthcare setting therefore is crucial in reducing the risk of medication errors and the risks associated to our patients (HIQA 2016).

Background

The author works in an acute seventeen-bedded neonatal-infant ward in an acute paediatric hospital. This unit cares for a very vulnerable cohort of patients, with ages ranging from 30 weeks gestation to two years, and weights ranging from 1.8kgs up to 10kgs. All medications ordered in paediatrics, are based on the patient’s weight and gestational stage. Nursing staffs often have to do multiple calculations when checking medications, and doses are often miniscule which increases the risk of drug errors impacting on patient safety.

In this assignment the author will discuss the introduction of a tablet computer in March 2015. The tablet is located in our treatment room containing the hospital formulary application (APP). The easily navigated hospital specific formulary APP is an electronic document comprising of a standardised list of paediatric medications with the most up to date information. The App contains four sections, drug dosages, guidelines and protocols, general information and parental nutrition. The App is updated and edited every month by the pharmacy department.

This App was available for healthcare staff working in our hospital with smartphones since 2014 and could be purchased for six euro. However senior management or ward managers did not approve of staff carrying their mobile phones on their person during work hours. Nursing staffs were concerned about breakages, parent’s perceptions, infection control issues and the temptation to check messages and emails during working hours. Prior to the introduction of the tablet computer, a variety of information sources were used in the hospital and on our ward to check medications.

These included a pharmacy folder, British National Formulary (BNF) and a hardback 2010 published hospital formulary that contained out of date information. The Swiss cheese metaphor Reason (2000), explained system failures and its barriers.

The failings and barriers in our system were the absence of standardised medication information and the absence of up to date medication policies. This was identified as a weakness with the potential to cause harm to our patients and their families (Brady et al., 2009). The introduction of this tablet meant that healthcare staff had only one source for retrieving the most up to date information on medication.

Medication management was standardised ensuring best outcomes for patients, reducing risks and increasing nurse efficiency. Quality and safety initiatives are vital in our work environment to reduce or prevent adverse events (Rafter et al., 2016).

This main body of the assignment will focus on the implementation of the electronic tablet initiative, its importance, and how it has improved the quality of care for our patients on the ward. The author will first address the importance of safe medication management, focusing predominately on the paediatric sector.

Reference List

1. Health Information and Quality Authority (2012). National Standards for Safer
Better Healthcare. Available at: http://www.hiqa.ie/standards/health/saferbetter-healthcare (Accessed 30th October 2018).
2. World Health Organisation (WHO) Global Patient Safety Collaborative (2018)
Available at: http://www.who.int/patientsafety/partnerships/GPScollaborative/en/ (Accessed 30th October 2018).
3. Nursing and Midwifery Board of Ireland (2013) Code of Professional Conduct
and Ethics for Registered Nurses and Registered Midwives. Available at: https://www.nmbi.ie/NMBI/media/NMBI/Code-of-Professional-Conductand-Ethics-Dec-2014_1.pdf (Accessed 2nd November 2018).
4. Health Service Executive (2016) Framework for Improving Quality in our
Health Service. Available at: https://www.hse.ie/eng/about/who/qid/framework-for-qualityimprovement/ (Accessed 2nd November 2018).
5. Health Service Executive (2017) Integrated Risk Management Policy Part Two. Available at: https://www.hse.ie/eng/about/qavd/riskmanagement/risk-13 management-documentation/hse-integrated-risk-management-policy-part-2-risk-assessment-and treatment.pdf (Accessed 3rd November 2018)
6. Frush K. & Krug S. (2015) Pediatric Patient Safety and Quality Improvement.
McGraw-Hill, China.
7. Kavanagh C. (2017) Medication governance: preventing errors and promoting
patient safety. British Journal Of Nursing 26 (3), 159-165.
8. Health Information and Quality Initiative (2016) Guide to the Health Information and Quality Authority’s Medication Safety Monitoring Programme in Public Acute Hospitals. https://www.hiqa.ie/reports-andpublications/guide/guide-medication-safety-monitoring-acute-hospitals ( Accessed 31st October 2018).
9. Reason J. (2000) Human Error: models and management. British Medical Journal 320(7237), 768-770.
10. Brady M., Malone M., Fleming S. (2009) A Literature Review of the individual and system factors that contribute to medication errors in nursing practice. Journal of Nursing Management 17, 679-697.