Now the event is complete three things stood out for me:
That this is a movement not just a conference
That between us we have the answers if we work together
The need for truth and reconciliation
Now the event is complete three things stood out for me:
In the meantime the event resources are here.
We’ll be updating these resources after the event to ensure it lives on and achieves real change.
From 2008 to 2014 my company ran education sessions on managing medicines in a mental health trust. In common with some other mental health trusts the provider also looked after paediatric community services. This is not a mental health service. It covers children with complex health needs including enteral feeding tubes, ventilation; epilepsy and rapidly changing medicines. Children under the care of this service may be taking in excess of 15 different medicines per day, have complex titration regimes, emergency drugs with associated care plans, plus numerous ‘as required’ (prn) medicines.
It is not unusual for children with complex conditions to be under the care of up to five different providers, and to move between three different providers in one day. For example, from a Home Care Service to the Special School, to a Short Break House, maybe also being seen in an Outpatient Clinic on the same day too. As a result parents frequently have to repeat the information on their child’s medicines every time they move to another service, or a new person is involved.
Where to start?
The idea for change came about because of concerns that the staff in Children’s Short Break Houses were not learning what they needed about children’s medicines, as the learning was geared to the majority of staff who worked in mental health. So a new learning package for children’s staff was commissioned.
Part of the work to design the learning package included a baseline assessment which was conducted with parents and staff. This soon revealed that training alone was not the answer. It showed delays in medicines information reaching GPs, workarounds for obtaining information in order to administer medicines in the houses and a general lack of confidence in the whole process.
As a result we looked at the whole system starting with the area where most concerns had been raised, which was having an up to date complete list of a child’s medicines available at all times (medicines reconciliation). The system in place for Short Break Houses involved paying a local GP (not usually from the child’s GP Practice) to write up a medicines chart for each child. The process was fraught with difficulties and delays and widely disliked by everyone directly involved.
So we set about looking for a new way to manage the lists of medicines with more training and more input for the staff in the services involved. We came up with a new (and much more robust) process for medicines reconciliation in the Short Break Houses. This was fully documented in a new policy, and involved cross checking by both the staff and the parents.
Just before this went live, we asked the parents to review and comment on it and they said
‘If you’re producing an accurate and up-to-date list of my child’s medicines, why keep it the Short Break House, can’t it go with my child?’
So the My Medicines chart, which travels with the child, was born.
What was involved?
The My Medicines process led to the design and production of a new chart which has to be signed and checked by the parents.
It resulted in 40 children with complex conditions being offered a hand held paper record of their medicines (produced and validated by clinicians), which they take around with them wherever they go.
The new process, which continues to evolve, means that the child’s GP is now directly involved in day to day medicines reconciliation (they weren’t before); the parents are always asked to check and sign the charts (they weren’t before); verbal messages about medicines are never taken, and incomplete (or missing) directions are rapidly rectified (never worked around).
Some specific benefits of the new process include:
• It has reduced the risks of error, by providing full and accurate information on children’s medicine across their entire pathway.
• It cuts out the need for parents to keep having to repeat what medicines their child is taking to different professionals and care agencies.
• It frees up medical and clinical time which was previously spent chasing missing information.
• It has reduced the number of third part handovers and transcribing of prescription information.
Looking back it’s hard to believe that the old ways of working, which caused so many difficulties (especially for front line staff), were carried out for so long. These risky practices, or similar, are believed to still be commonplace in England.
Revealing hidden incidents and near misses:
In the first month of the project we raised 17 medicines or near misses. Of these 11 related to problems with communication of information across the child’s pathway.
Resolving these has resulted in improved communication and engagement between different clinical groups and providers, and a desire from all quarters to take the project further. Previously many of these incidents were not logged or tracked across organisations. In some cases it was only due to the vigilance of the staff and parents that they were spotted and errors avoided.
Accepting the changes:
The project was well received by parents and staff, and resulted in improved communication and engagement between different clinical groups and providers. This included the Consultant Paediatricians (working for the secondary care provider), who were initially sceptical.
The project was less well received by the relevant medicines and prescribing committees, who were understandably concerned about who owned the My Medicines chart and had agreed its content. Explaining this was made more difficult because it is hard to get across the complexity of the arrangements, due to the critical nature of the children’s illnesses, in a committee setting.
I make no apologies for ensuring from the outset that it was the parents who owned the charts, which were designed by the project team (not a committee) to meet all best practice standards. It always worries me that when it comes to cross- organisational working the formal committees and systems in place can inadvertently act as a barrier to safety rather than promoting it. There is no doubt we had designed a safer process and my company was happy to take accountability for any associated risks.
As a legacy of the project, a Community Paediatric Pharmacist was appointed specifically to work with this group of children. So whatever evolves will now be based on inter-disciplinary thinking and working and will have clear safety parameters. I am grateful to the enlightened thinking of the leaders who commissioned this work and supported this novel approach.
Personal views of Steve Turner
Managing Director Care Right Now (CIC)
On Friday 13th March. Start time 12 noon – finish 2pm.
Please bring your own lunch. Tea, coffee and soft drinks will be provided.
It’s a pilot for a future education session focusing on a whistle stop tour of key theories and what they mean in practice:
What is ‘heuristic bias’?
What is ‘system 1 and system 2’ thinking?
What is ‘group think’ and why is this not good?
How can we use theory to make real clinical decisions better?
MD Care Right Now (CIC)
Health and Wellbeing Innovation Centre, Treliske, Truro, TR 1 3FF
Date of post: 1/2/15
Click on headings to go to link>>
For WORD Templates see link 1 above.
Formularies and sources of patient information:
…or download the BNF app which is free to NHS and Academic staff (needs Athens password). Search for ‘NICE BNF’ in google play. The app is updated monthly the hard copy yearly.
…or download the BNF app which is free to NHS and Academic staff (needs Athens password).
(also contains patient information leaflets [PILs]) Information sources aimed at patients (and staff):
Mental Health medicines information (trusts sign up to use it, also accessed by service users)
(Author’s’ opinion – most useful for the ‘behind the headlines’ section, especially if there is a new drug related health ‘scare’ or ‘innovation’ in the media. For specific drug information see the resources above this one).
Patient held medicines record (free to use):
Patient decision aids [PDAs]:
Worth a look. These are concise summaries on 2 sides of A4. (Includes headaches; urn=inary incontinence in women; high dose inhaled corticosteroids; long-acting insulin analogues; low dose anti psychotics; minocycline; NSAIDs; three day courses of trimethoprim).
Author’s note: check it is the most up to date source
Research, academic, finding out more details:
A bit hard to navigate but packed with useful information, e.g. Q&As
Some key reports and research:
Some CPD sources:
Large range of courses including adherence and psychology
How-to Guide: Prevent Adverse Drug Events by Implementing Medication Reconciliation
How-to Guide: Prevent Harm from High-Alert Medications
How-to Guide: Prevent Ventilator-Associated Pneumonia
Possibly useful. This is the NHS’s preferred tool for integrated care pathways. Click on ‘view health guides’
…and there’s these:
Everyone should read:
(from the NPCi legacy web site)
National Prescribing Centre 2010 It’s out of date but has some useful templates in the back…
(NPCi legacy site)
To suggest new resources or report a broken link email: email@example.com
Last updated 8/9/14
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Care Right Now
Health and Wellbeing Innovation Centre
T:+ 44 (O) 1872 248 327 M:07931 919 330