1. Numbers and Nurses Scottish University of the Year 2017 Arlene Boyle
November 2018

2. What’s the Big Deal
London Trust rejects nurses over numeracy and literacy skills April 2016
Chief exec raises fresh concerns over nurse numeracy skills May 2017
NHS medication errors contribute to as many as 22,000 deaths a year, major report shows Feb 2018
patients expect that each healthcare professional involved in delivering their care is competent
prescribing or administering medicines includes the ability to calculate drug doses safely and accurately
almost half of the medication errors reported are related to the wrongly calculated dose or strength of medicine (NPSA)
A report analysing the NHS workforce has highlighted how one London trust rejected between 40% and 60% of band 5 nurse applicants because they did not meet the organisation’s standards for numeracy, literacy or compassion
NHS medication errors contribute to as many as 22,000 deaths a year, major report shows - The NHS makes hundreds of millions of prescribing errors and mix-ups which contribute to as many as 22,300 deaths a year, according to a major report commissioned by the Government.
Errors include failures to properly monitor patients on powerful drugs, poor communication between GPs and hospitals, and giving patients the wrong medication.
While the potential risk can be as low as giving the wrong strength inhaler, it can also mean that the medication for seriously ill patients in hospital is mixed up, with potentially lethal consequences.

3. Who Says Numeracy Is Important!
NMC 2007 – nurses need sound numeracy skills to practice – recent intro of Essential Skills Clusters – student nurses must demonstrate competency in numeracy skills to ensure can practice safely as nurse. – see page 25 of this document
The Independent Article
Thirty-six patients died and almost 2,000 suffered "moderate or severe harm" as a result of errors in the drugs prescribed and dispensed in hospitals, an official report has disclosed.
The blunders were among more than 41,000 "medication errors" recorded by all 173 NHS trusts in England between July 2005 and July The Healthcare Commission, the NHS regulator that published the figures, said hospitals had to do more to improve their handling of medicines.
In a league table of performance it ranked 18 trusts as "excellent" and 12 as "weak." The remainder were good or fair.
The National Patient Safety Agency, which collected the figures, said 80 per cent caused no harm to patients and 15 per cent caused "low harm." The remaining 5 per cent - 2,000 errors - caused moderate or severe harm.
"Our data shows that there were 36 deaths where medication mistakes were thought to play a part, though it should be understood that some of these patients were already very poorly and should be put in the context of the one million people who are seen by the NHS every day," the agency said.
A spokeswoman said there were no details of the patients who had been harmed or died.
"A typical case would be someone prescribed Warfarin, the blood thinning drug, for heart disease who was given a second drug without being asked what he was already taking. The interaction might cause a bleed which would be severe," she said.
Trusts listed as excellent included Airedale NHS Trust and Barnsley Hospital NHS Foundation Trust, both in Yorkshire, and Guy's and St Thomas's NHS Foundation Trust in London. Those listed as weak included South Warwickshire General Hospitals NHS Trust and the Royal Cornwall Hospitals NHS Trust.
NPSA
The Patient Safety Division aims to identify and reduce risks to patients receiving NHS care and leads on national initiatives to improve patient safety.
Through the National Reporting and Learning System (NRLS), the Patient Safety Division collects confidential reports of patient safety incidents from healthcare staff across England and Wales. Clinicians and safety experts help analyse these reports to identify common risks and opportunities to improve patient safety.
Feedback and guidance are provided to healthcare
organisations to improve patient safety. These include
alerts to address specific safety risks, tools to build a strong
safety culture and national initiatives in specific areas such
as hand hygiene, design, nutrition and cleaning.
The Patient Safety Division works closely with royal colleges, frontline staff and organisations, patient groups, strategic health
authorities, other NHS bodies, academic centres and
sectors beyond healthcare to promote patient safety.

4. NMC Standards for pre-registration nursing education 2018
On entry to progamme – student must have capability to develop numeracy skills required to meet programme outcomes Throughout programme – student must be supported to continually develop numeracy Ultimately the student must demonstrate the numeracy required to meet the needs of people in their care to ensure safe and effective practice NMC Standards of Proficiency for Registered Nurses – Platform 6 (of 7) “Improving Safety and Quality of Care”

5. Essential Skills Clusters:
For Entry to the Register:
Is competent in the process of medication-related calculation in nursing field involving:
• tablets and capsules
• liquid medicines
• injections
• IV infusions including:
unit dose and sub and
multiple unit dose
complex calculations
SI unit conversion

6. Importance of Numeracy Skills
Patient Safety
Accountability / professional integrity
Expanding professional roles
Scottish Patient Safety Programme (SPSP) - is a unique national initiative that aims to improve the safety and reliability of health and social care and reduce harm, whenever care is delivered.
As part of Healthcare Improvement Scotland's ihub, SPSP is a coordinated campaign of activity to increase awareness of and support the provision of safe, high quality care, whatever the setting.

7. NMC Misconduct Referrals The Following Referrals Were Received 1 Jan – 31 March 2017
Allegation
 Number of allegations received
Behaviour or violence
 44
Communication issues
 24
Criminal proceedings
 56
Dishonesty
 40
Employment and contractual issues
 27
Information access  5
Investigations by other bodies
 12
Management issues
Motor vehicle related
 26
NMC registration and proceedings
 20
Not maintaining professional boundaries
 11
Other allegations  9
Other crimes and offences
 14
Patient care
 136
Prescribing and medicines management
 126
Record keeping
 53
Registrants health
 58
Sexual offences
 15
Social Media  6
Total
 706
Investigations, not the number proven.
Misconduct covers a variety of issues:
Ask the students what they think about these issues.

8. The School of Nursing and Health Sciences
Currently:
Must obtain appropriate numeracy qualification prior to acceptance
Each year of course has numeracy / drug calculation assessments included (formative and summative) e.g. online numeracy tests, OSCEs each year, Medicine Administration workbook years 1 and 3

9. Where do we use numbers in nursing?
Measuring pulse and respirations – NEWS chart
Drug calculations –
conversions eg milligrams to micrograms
Number of tablets to administer
Amount of elixir to administer
Fluid balance calculations
Nutritional assessment
Intravenous fluid / drug requirements/rates
Administration – off duty, bed management
Understanding, verifying and applying research etc.

10. Medicines Administration

11. Measuring Pulse and Respirations

13. Body Mass Index Formula: Weight in kg the height in m2
Eg: weight = 70kg
Height 1.6m x 1.6m =2.56
70/2.56 = 27.3
BMI = 27
BMI calculation

14. Mrs Brown’s Daily Intake
Lunchtime –orange juice
(150 mls)
8am and 3 pm
cup of tea (150 mls)
5.30 pm glass of water
(200 mls)
Bedtime Hot Chocolate
(150 mls)

15. Intravenous (IV) Fluids
She also required Intravenous fluids = 2 bags (500mls each)
She is also receiving Intravenous antibiotics 200mls twice per day

16. OOPS – it’s got to go somewhere!
6.30 am – 320 mls
9 am – 250 mls
10.15 am – 380 mls
11.25 am – 200 mls
(looks like she’s had a water tablet!!)
2.30 pm – 275 mls
6.00 pm – 390 mls
9.30 pm – 250 mls
Total = 2065 mls

18. Intravenous Fluid Drip Rates
Formula:
Drip rate =
volume x drops/ml length of delivery (time)

19. So for example: A 100 ml bag of fluid has to be given over 40
minutes. The number of drops per ml is 20,
what is the drip rate?
Drip rate = volume x drops/ml length of delivery (time in minutes)
= x = 50 drops per minute 40

20. Metric Conversions Converting milligram to micrograms
Converting millilitres to litres etc
Some examples:
What is 785mg in grams?
To convert mg to grams – divide by 1000 as there are 1000 mg in a gram = 0.785g
How many millilitres (ml) are in 1.25 litres?
To convert litres to millilitre, multiply by 1000 as there are 1000 ml in a litre = 1250ml

21. A Real Life Example A typical prescription would read:
Paracetamol 1G every 4-6 hours for pain (maximum of 4G per 24 hours)

22. You are calculating a patient’s Body Mass Index (BMI) and his weight is 75.4kg, what is his weight in grams?
0.754g g
754000g
75400g
7540g

23. To convert kg to grams – multiply the kg by 1000 75
To convert kg to grams – multiply the kg by kg x g Answer D

24. A patient loses 0. 054kg of weight per day
A patient loses 0.054kg of weight per day. How many grams does he lose in 2 days?
1080g
108g
1.08g
1008g
10.8g

25. Covert kg to grams 0.054kg x 1000 = 54g 54g x 2(days) = 108g Answer B

26. Drip rate length of delivery (time in minutes) volume x drops/ml
A 100ml bag of intravenous saline has to be delivered over 2 hours. The drops per ml is 20. What is the drip rate?
Drip rate
volume x drops/ml
length of delivery (time in minutes)

27. Drip rate = volume x drops/ml length of delivery (time in minutes)
Drip rate = 100 x = 17 drops per minute
120

28. ANY QUESTIONS