# Presentation: 412023

## Resident Medical Officers’ Training Program in Patient Safety  - Brisbane, Australia

- John Wakefield

## Slide 2

## Aim

- Systems approach to error - incident reporting and analysis
- Graded assertiveness
- Medication history
- Prescribing & associated processes
- Heparin and warfarin
- Insulin
- Potassium
- Discharge
- prescription
- communication and counselling

## Medication Safety - Why Bother?

- Patient harm from adverse drug events occurs in 1.6% of admissions to Australian hospitals (QAHCS, Wilson, MJA 1995)
- 50% of harm from ADE’s originates in failures in either prescribing decision or transcription of order into a format for nurses to administer (Bates, J Gen Int Med, 1995)
- Junior medical staff, generate the greatest proportion of prescriptions (in house data PAH)
- Interns perceive that they are not as well prepared to prescribe at beginning of intern year (Rego, UQ, 2001)

## Risk Awareness

## Risk Awareness of Medical Staff

- Prescribing is not perceived as important
- Culture change needed from a task to a high risk intervention
- Absence of self awareness of errors
- (Dean et al Lancet 2002)

## Medicines Management System

- Decision to
- prescribe

***50% of Harm ***
***(Error rate 2.5 - 10%)***

***10% of Harm***
***(0.01 – 0.5% error rate)***

***40% of Harm***
***(5-15% error rate)***

- From Bates et al 1995

_**DOCTORS**_

_**NURSES**_

_**PHARMACY**_

## Why Medication History Taking?

- 5-20% of medical admissions are drug related (Roughead, MJA, 2000)
- Important to identify what the patient was actually taking prior to admission
- Compare this with what patient should be on identifies:
- treatment gaps
- possible drug related problems
- Helps to understand nature of illness and its responsiveness to treatment

## Aims

- Identify key issues:
- communication skills
- what patient is actually taking prior to admission
- assessment of compliance
- limitations of different information sources
- How these medications (or lack of) may have precipitated this admission

## Methodology

- Provide background
- Show first video of medication history taking in ED
- Critique communication style and content
- Determine what patient is taking
- Show second video
- Repeat above
- Compare the two medication lists

## Patient History

- PC: Increasing SOB, PND
- O/E: BP 190/90, pulse 89 SR, JVP 8-9 cm, chest bi-basal crackles, peripheral oedema
- ELFT: Creatinine 0.19 (prev: 0.13, 3m ago) Hb 135, K+ 5.0;
- NIDDM (10 yrs), HT (20 yrs) CRF, MI, (3 yrs) LVF, RA.
- Lives alone, grumpy, stoic chap
- Diagnosis - LVF, CXR confirms

## Communication Skills & Style

- What is good about the interview?
- What could have been done better?
- Any limitations of the technique?

## Consider Content

- What important information is revealed?
- What important details were not sought?
- What extra questions would you use?
- What questioning style would you use?
- What do you think patient was taking?
- What medication-related factors might have contributed to this admission?
- Other information sources you can use?

## Interactive Skill Stations in Safety & Self Assessment of Awareness

- Methodology:
- 6 skill stations
- Safety scenario played out in each one
- Followed by ‘detailing’ of individuals by pharmacist/physician/nurse
- Self assessment of ability to identify the safety issue

## Risk Awareness Related to Nursing Experience(able to identify risk and prevent harm) n=420

- RNS

- Risk Awareness Related to Nursing Experience(able to identify risk and prevent harm) n=420