George Eliot Hospital NHS Trust Medication Safety Thermometer Elizabeth Holland Clinical 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

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 patient Printed double sided to cut down on paper Tested in November on 3 wards – 5 patients Used 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 gender M F Age Patient's age < >70 Is the allergy status documented? Inc NKDA on kardex Y N Was medicine reconciliation for all medicines started within 24 hrs of admission Pharmacist has been involved Y No - patient within 24hrs N 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 >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 numberReason for omission Omitted doses a critical medicine Number of omissions of a critical medicine AnticoagOpiate InsulinAnti-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) AnticoagWarfarin OpiatesIV/SC Sedatives Insulin If YES proceed to Section 2 Anticoag Heparin, 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 N INR greater than 6 or APTT ration greater than 4 Opiates Common complications of Opiates include sedation, respiratory depression & confusion Y Admin of Naloxone Reps rate below 12bpm N Injectable Sedatives Midazolam, Lorazepam,, diazepam, clonazepam Y Common complications Admin of Flumazenil Common 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 Y Common complications (capillary blood sugar <4mmol/L) or symptoms of hypoglycaemia Admin of reversal agent for hypoglycaemia (10-50% IV Dextrose, Glucagon) N Diabetic 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 results The Band 7 on Elizabeth observed the first collection and asked to see their results. Pharmacist assisting the collection also interested in findings.

Ward Dashboards To make the data look the same as classic Safety Thermometer I have put ward level data in a dashboard to share