Drug treatment in Urology

The final conference came about so quickly, it was on the 19th September 2011, . The theme of the conference was on drug treatments in Urology. We had an excellent program lined up for the day. As usual I conducted the pre- lecture survey, asking attendees about their knowledge on urology and some of the treatments provided in the area.
The first lecture was given by Brid Byrne from A&E in St. Michael's Hospital. Brid gave us a very comprehensive and detailed talk on the anatomy and the physiology of the urinary tract as you will read below
https://docs.google.com/present/edit?id=0AfiCRfy-aXfjZG45cGg0bl8xOTY5ZHc0YjN4dmg&hl=en_US

The second lecture was given by Mary Jacob, AMP Women's Health. National Maternity Hospital. The title of her presentation was "Nurse prescribing, continence /overactive bladder".  In her lecture she described the different types of bladder storage problems: overactive bladder, stress urinary incontinence and mixed incontinence. Mary described the symptoms and the treatments for over active bladder. How the medical management can be divided into either drug agents or behavioural modification. She completed her excellent presentation by describing the side effects of medications for urgency urinary incontinence. I have downloaded it below.
https://docs.google.com/leaf?id=0B_iCRfy-aXfjNzNlYTc1MTYtMGVjMy00ZmVhLTlkYTgtMzQ4NzFhNmY2Mzhj&hl=en_US

The next presentation was from Teresa Ronan Product specialist from Braun Company. Teresa discussed the two types of catheterisation: intermittent Catheterisation (being a clean procedure) and Indwelling catheterisation (being a sterile procedure). In her lecture she then described how the indwelling catheter was subdivided into urethral and supra-pubic catheterisation. She talked about the associated risks with the urethral and the supra-pubic infection - 44% of hospitalised patients develop urinary tract infections. She gave useful guidance on how to manage urinary tract infection and gave advice on catheter blockage and use of maintenance solutions. 
 https://docs.google.com/leaf?id=0B_iCRfy-aXfjMTExMmEyN2ItMzViYi00MGI2LTk1NWQtOTg5YTM2ZjYwNzM3&hl=en_US

 

The follow-on lecture after the coffee break was from Helen Forristal, Urology Cancer Nurse Specialist from St. Vincent’s University Hospital. She presented with Intravesical Treatments for Bladder Cancer. She described the stages of bladder cancer: Primary tumour to extended lymph node involvement to presence and the extent of distant metastases. She talked about the alarming report re- the CIS (Carcinoma in situ) where there is a high risk of disease progression, with an average 54% developing invasive disease in a  five year period. She then presented on the uses of Mitomycin C answeing questions e.g. When is Mitomycin C used? Why use Mitomycin? The side effect profile, the single dose Mitomycin C, the 4-8 week course Mitomycin C, the maintenance of Mitomycin C and lastly she talked about Patient Information.

Next Helen explained about the comparison of BCG – Bacillus Calmette Guerin with Mitomycin C. How BCG  is a live attenuated tuberculosis vaccine and that it has a neoplastic effect on the tumour.  How it should be considered for patient’s following a Trans Urethral Resection for the prophylaxis of tumour recurrence in patients with medium to high risk Ta and T1 bladder cancer. How it has been quoted that "BCG is said to be superior to Mitomycin C in reducing recurrence of bladder cancer".  Helan then talked about the use of BCG for the patient and the HCP. As well as the health and safety issues associated with BCG. 
https://docs.google.com/viewer?a=v&pid=explorer&chrome=true&srcid=0B_iCRfy-aXfjMGZkOWJiMjUtMGM2Yy00YWEwLWI3ZjItNDgxM2JjNDllZTc4&hl=en_US

Helen's second lecture was on hormonal treatment for Prostate Cancer. She talked of how prostate cancer is the most commonly diagnosed cancer amongst men in many industrialised nations. Rates of prostate cancer vary widely across the world. Although the rates vary widely between countries, it is least common in South and East Asia, more common in Europe, and most common in the United States. (American Cancer Society). She talked about the routine investigations from DRE (digital rectal examination), to TRUS guided biopsy to bone (if applicable). How Prostate cancer is hormone-dependent LHRH, luteinising hormone-releasing hormone LH, luteinising hormone ACTH and adrenocorticotrophin. Helen then discussed the Medical Endocrine Therapy Options: LHRH analogue, Anti-androgen and Oestrogen.  She gave a breakdown of the main side effects of these treatments. Helen completed her presentation on the importance of the holistic care of the patient.

https://docs.google.com/viewer?a=v&pid=explorer&chrome=true&srcid=0B_iCRfy-aXfjM2FhZWRmZDEtN2M1MS00YjgwLTk4YmQtN2U5OGZmY2IyYTg4&hl=en_US

 

Mary spoke about benign prostate hyperplasia (BPH) and that this is a common condition affecting older men. BPH is commonly defined as a benign enlargement of the prostate gland due to an increase in cellular proliferation which can lead to a range of lower urinary tract symptoms (LUTS).

This condition has a very significant impact on the activities of daily living. She spoke about the assessment of these patient’s in the Uroflow Clinic, and follow up in the Urology Outpatient’s Department. The patient will have blood tests for PSA, U&E. Digital rectal examination and residual urine

volume is measured. The medical treatments currently available are,  Alpha Blockers, 5 Alpha Reductase Inhibitors, Combination therapy, and drugs for overactive bladder.

If medical therapy fails, surgery may be indicated.

https://docs.google.com/leaf?id=0B_iCRfy-aXfjOWIwYThkNjYtN2ExOC00ZDY2LWE2N2UtMjBmMDljNjFjZWZj&hl=en_US

Pain conference on the 19th August 2011.

The second last conference was held last Friday - 19th August. I must say we had an excellent line-up of presentations. To start the day, I discussed the objectives of the six conferences and how education on drugs is a necessity for nurses. Where medicines are prescribed by the doctor and dispensed by the pharmacist, but the responsibility for correct administration rests with the nurse!!

The first lecture of the day started off with Lynn O'Connor MSC, CNS Pain Management from the Beacon Hospital, Dublin. Her lecture was titled; "Medication choices related to assessment". Here Lynn discusses: how to consider the individuality of each patient/person in pain; How important it is to gain the best understanding possible of the intensity and nature of the patient's pain, the awareness of the WHO analgesic ladder. Lastly, to reassess the patient's pain management in order to determine the effectiveness of the analgesia.  

The second lecture was given by Maeve Kinsella MSC, H dip Pain Management BSc, CNM 1. Her lecture was on "The Classification of Pain", describing in her lecture - The definitions on; How pain happens; the classifications of pain and the nursing priorities.

The third lecture "Pain Assessment" Jeane Barber CNS Palliative Care RGN, RCN, RM. H. Dip Palliative Care, Dip Gerontology, BSc, and MSC. Her power point presentation will be posted at a later date. Just to add I have included Jeans' presentation today.

The following two lectures were given by Maire Murray Chief pharmacist, St. Michael's Hospital. Regrettably, she chose not to be videoed or have her slides posted on line (as was of course her right).

After lunch we had Dr. Maeve Nolan, D. Clinical Psych, Spinal Injury Team, National Rehabilitation Hospital. Her talk was on ‘The psychological impact of pain and psychological approaches to pain management'. Maeve discussed the Psychological impact of pain; Psychological with all that its complexity and then she discussed the approaches to treatment for chronic pain.

The next lecture I was proud to introduce my sister Elaine. Elaine CNS Acute Pain management, RGN, RCN, BSc and MSC in St. Vincent’s University Dublin 4. She lectured on ‘What is Acute Pain’? The Pain Pathway / Types of Pain. Acute Pain Management: The Multimodal approach: Acute Pain Pump, PCAs, Epidurals, Paravertebral Analgesia, Spinal / Intrathecal Analgesia.

The final lecture of the day was presented by Ann Duffy from the Clinical Risk Advisor, State Claims Agency. Clinical Indemnity Scheme. Ann talked about her role as a Clinical Risk Advisor, The CIS –‘who we are and what we do’, the STARS Web site, Medication incidents and lastly, open disclosure following an adverse event.

The last lecture was cancelled due to lack of time. Here I was going to do a brief version of the 'WHO' ‘Patient safety Workshop’ - learning from error. This is a video that shows a chilling event where after a drug error that has harmed a patient, (has occured), we as healthcare workers we ask, how did this happen? The objective of this workshop was to understand the extent of the problem that faces health-care workers and patients. 
  

The last task of the day is to collect the post survey and the evaluation sheets. I provided a survey questionnaire before and after the conference, this is to find out whether the education we provided on the day, was of value or not. I also provide an evaluation sheet, to get further information about the day. I must say I was toutched by the very positive feedback we got on the day. The attendees were delighted with the level of knowledge of the lectures and the smooth running of the day.


The Pain Agenda for the 19th August
https://docs.google.com/document/d/1Aeh_awoqcTc_0kKQJ5j_ym1vC51NKG0j0yhRfhvQLvw/edit?hl=en_US#

Medication choices related to pain assessment presentation.

https://docs.google.com/present/edit?id=0AfiCRfy-aXfjZG45cGg0bl85MDFobmM5dGdjZw&hl=en_US

Pain
https://docs.google.com/present/edit?id=0AfiCRfy-aXfjZG45cGg0bl84OTR6dnY4a2ZjcQ&hl=en_US

Clinical Indemnity Scheme.
https://docs.google.com/present/edit?id=0AfiCRfy-aXfjZG45cGg0bl82OTY4NTN3cHBnMg&hl=en_US

Acute Pain
https://docs.google.com/present/edit?id=0AfiCRfy-aXfjZG45cGg0bl81NjhmbXNneGRuNw&hl=en_US

Pain assessment
https://docs.google.com/present/edit?id=0AfiCRfy-aXfjZG45cGg0bl8xMDU1ZzZoNzRoZmg&hl=en_US

An Bord Altranais eNews for nurses and midwives Issue 2, August 2011

" If you have a query with regard to medication management or your scope of practice you can contact us at ezine@nursingboard.ie or telephone and speak to the Professional Officer for Standards of Practice and Guidance."

My reply:

A Quality Initiative to share.

I was reading the section on your website under the subsection “How can we help you” with regards to medication management. I feel there are many factors that can contribute to medication errors including heavy workload, distractions and interruptions. As nurses we have conducted several audits that highlight how nurses are constantly being disturbed or interrupted when administering medications. I feel that as a single administer of medications, I need to be absolutely sure about my calculations of medications I give to my patients.  I look at supermarkets and see how the person on the 'check out' while under pressure, can operate efficiently and effectively with the use of bar codes and a cash register. We as nurses do not have the luxury of technology and yet our calculations are far more important than giving back the correct change.

 I feel that when we do our drug calculations, we need to have the means to 'second check' - to be absolutely certain that our calculations are correct. In some occasions we are unaware of the errors we create. This is why I feel as a nurse we need to support each other. That's when I did some research about mobile applications on the market.  I consulted with a developer friend to produce a simple application for mobile phones called “Dosage Calc”. This can double-check a wide range of common calculations giving the nurse some reassurance.  It is worth mentioning that “Dosage Calc” and some other useful apps can be used in “Airplane mode” making interference with equipment very unlikely.

 I am proud to say that 'Dosage calc' mobile application, is the first Irish application that is developed by a nurse for the nurse. I sound like a sales person but it is free for nurses (no hidden agenda).  The app is currently available as a free download from the Android and iPhone market. I honestly feel that “Dosage Calc.”application can make a difference to the delivery of care. I would welcome any input from those nurses in your readership during the pilot phase.

  When researching my thesis on medication management for my MBS in Health and Safety at Work, it became evident that medication errors are an international problem. For example in England, there were 70,036 medication reported errors in one year June 2009-2010 according to the NHS. It is not clear, what percentage of errors remain unreported. 


As a Clinical Facilitator that is responsible for the career development of nurses, I read with great interest the article on 28^th March in The Irish Times dealing with data compiled by the State Claims Agency over a six year period. This indicated health workers are involved in up to 8,000 medication errors or near-misses per year in Irish hospitals of which over 7,000 are due to incorrect dosage.

Dealing with the underlying causes of error requires a concerted effort from every department in the hospital. However to concentrate on one area, a survey by the HSE in 2009 revealed that newly qualified nurses 2007  were concerned about their own skills with drug calculations. This is particularly relevant as single person administration is now very common for economic reasons. Medication administration is perhaps the highest risk activity a nurse can perform, as accidents can lead to devastating consequences for the patient and for the nurse's career.

 Unlike some other countries, there is reluctance in Irish hospitals to allow the use of mobile devices among some staff. (I have to say, when it comes to the use of mobile phones there seems to be one rule for nurses and another for the healthcare professions).  


Since the release of the application on the Android market alone, got 4338 downloads in the last 3 months.  The top four countries that are showing interest are: 1st United States, 2nd Brazil, 3rd Philippines and 4th India. I feel as a nurse we need to progress with technology. After all, if we entrust our nurses to have the responsibility to administer medication we have to have the respect for nurses to use their professional judgement with mobile phones. 

 Mobile applications are used widely in the USA as “point of care”. Instant access to evidence based information at the bedside. As a practicing practitioner I welcome this aspect of practice. We must also consider that our patients are more informed and knowledgeable about their own conditions. As professional nurses we have to keep up-to-date with the advancements in medicine. I welcome your feedback.

Kind regards

Suzanne Clear www.clinicalsafety.blogspot.com

Drug treatment for Diabetic Disorders

On the 19th July last we held a conference which was focused on nurses working with patient with diabetic disorders. The aim of the conference was to raise awareness of different aspect in diabetes. To share good practice in relation to the support offered by the diabetic nursing team to community and acute healthcare settings.
 The conference addressed the following themes:
  1. Insulin therapy - covering areas that are frequently asked by nurses I.e. choosing injection regimens/ devices; correct injection techniques; the safe disposable of used sharps; self examination of injection sites and lastly but important, the complications and how to avoid them.

2. Hypoglycaemia - what is involved; the risk factors; classification; signs and symptoms; the treatment of hypo's and again lastly but equally important -  prevention of hypoglycaemia.

3. Treatment of type 2 Diabetes Mellitus. How the cornerstone treatment of diabetes mellitus (DM) is diet and exercise. DM is a progressive condition that will progress to the need for oral hypoglycaemic and in time insulin. How with careful exercise and monitoring of diet will delay the progression of the condition.

4. Knowing what to eat is one thing but to be brought by the hand (not literally) through the supermarket is a fantastic idea. The do's and don't of shopping gave us very practical advice.

5. The importance of foot care opened our eyes into the world of podiatry. A service that is relatively new but with such a demand from patients there is plans a foot for further development the service.

6.  I invited Ann Duffy from the Clinical Indemity organisation to talk about the state claims agency. Ms. Duffy talked about the reporting system,  "The STARS (data base) web site". The types of medication incidents that have been reported and more about the need for open disclosure following adverse events.

The mode of presentation was mostly by PowerPoints and a discussion group.  You are invited to download the following presentations.
https://docs.google.com/leaf?id=18-ivZSJ5lQZdhD-PI4gbetjGs4TUZHtaD-pmBQeOleF3GOm2xyW2k0tG_vU9&hl=en_US
The agenda for the 19th July 2011.

https://docs.google.com/document/d/1cXA_cdp9J4Z2mP5rcDpqCCkuvOKxXHZy2jkc_JBHYJA/edit?hl=en_US#

0AfiCRfy-aXfjZG45cGg0bl81MDhkc3I4c2poYw&hl=en_US

https://docs.google.com/present/edit?id=0AfiCRfy-aXfjZG45cGg0bl8zODJoY2I0cnRjMw&hl=en_US

https://docs.google.com/present/edit?id=0AfiCRfy-aXfjZG45cGg0bl8yMDJkenhwYzZmYg&hl=en_US


https://docs.google.com/present/edit?id=0AfiCRfy-aXfjZG45cGg0bl8xMjhjd3JycHMzcg&hl=en_US


The feedback from the conference was very positive. A big thank you for all that made the day possible.

Avoiding drug errors

I have an improved video presentation dealing with the avoidance of drug errors, please feel free to comment because I would be very interested in your comments . I am heading off to Southampton University www.southampton.ac.uk/alps to give a presentation. The presentation is an initiative to assist in the avoidance of drug errors http://www.youtube.com/watch?v=hefDdpVVDq8  . Again all comments welcomed!!

The lucky person who got the prize....

MENCHU LIM is the winner of the survey for the Respiratory study day. Click on this link be get a glimpse of the lucky person. Congratulations

https://docs.google.com/document/d/1Np-bolRdBH2NMzRI1CcKhDPNTMglk-v5zcEquG4-5-8/edit?hl=en_US#

By having access to better resources (information technology) does it provide better care?

How far has healthcare come for nurses? Do we see a time when we will laugh and say, "remember when mobile phones were banned from hospitals because of the interference with radio frequency cardiac monitors". I feel nurses in Ireland are getting more and more interested in new and emerging technology and how it can be applied to our working practices. Nurses are asking me - what are apps? I think the best way to describe an app is a piece of software program designed for smart phones and other computing devices, such a the one we designed to double check drug calculations (Dosage Calc).

 I found as a Clinical facilitator and when I read many articles about medication management, how nurses are anxious when it comes to drug calculations on the ward or in the classroom (as an examination MCQ's). Calculations of drugs is a skill that can create stress and worry for many. The fear is when the calculation are incorrect, this will lead to a drug error.

This is one of the main reasons in developing our App.Dosage Calc. to give the nurse more assurance when she/he double check their calculations- it removes the nagging feeling. We wanted to design an easy and simple application that is reliable and accurate. We advise users to use the "flight mode" to ensure it will not interfere with cardiac monitoring of the hospital.  I would like you to take time out and review this application. Just google: Dosage Calc.- Sekos

 Drug administration errors have been shown to be frequent and serious. There are many reasons for drug errors. Some drug errors can occur at any of the following stages: from when the doctor prescribes the drug, to the pharmacist that dispenses the drug to lastly the nurse who administers the drug to the patient.

According to Kopp et al (2006) reports from his study on medication errors, that a lack of drug knowledge was the cause of 10% of errors and slips and memory lapses were responsible for 40% errors at the administration stage. As a clinical facilitator I find these figures not surprising, (Colera et al 1998) found that nearly a third of communications were interrupted, with an interruption rate of 11 per hour.

What is interesting is how (Moss et al 2008) in their summary states, how nurses who are administering many drugs and multiple drugs at the same time; how they are often interrupted: and rarely seek information regarding correct administration, even when this information is readily available. This is where I feel is the future of mobile clinical references are becoming a necessity to access current and evidence-based information at the ward level (at the point of care). What are your feeling on this subject??

References

Kopp, B. Erstad, B. Allen, M. Theodorou, A. Prestley, G. (2006). Medication errors and adverse drug events in an intensive care unit: Direct observation approach for detection. Critical care Medicine.34(2): 415-425

Moss, J. (2005) Technological system solutions to clinical communication errors. Journal of Nursing Administration 35(2)

RESPIRATORY CONFERENCE NOTES

Hi everyone, sorry for the delay in getting the power points published. I have one more power point that I am waiting for,  Dr. S. Ryan, Respiratory Consultant, has promised that she will forward on her power point to me when she has the time.

I was very happy with the pre/post survey results from the conference. The findings were very positive. Its looks like we had a very attentive group and by the results ye all benefited from the day. Thank you again for taking part in the survey. If you have any comments - good or bad, please reply by using the comment box provided on the blog.

Oh, the winning ticket was number 83.

Now here are the power points presentations that were promised.
A list of Conference from April to September 2011 :  https://docs.google.com/document/d/1HimjaqYqlPq3JuCvKwhmrvewMkGPGAv-mJDQGAshXsM/edit?hl=en_US#

The anatomy and physiology of the Respiratory system:
https://docs.google.com/present/edit?id=0AfiCRfy-aXfjZG45cGg0bl8zOGNoZ3RyNGRy&hl=en_US

Oxygen therapy:
https://docs.google.com/present/edit?id=0AfiCRfy-aXfjZG45cGg0bl8yMWNqZnJ6N2Zr&hl=en_US

Pulmonary Tuberculosis:
https://docs.google.com/leaf?id=0B_iCRfy-aXfjM2QyODJjN2YtODUxNy00NDg2LTk3ZmUtYjhmODkyOGVkYTc5&hl=en_US

Medication used in Respiratory conditions:
https://docs.google.com/leaf?id=0B_iCRfy-aXfjYjYyYjE3OTMtZmJmOC00NThhLWE4ZDEtZjIzYmExMWI2Yjlh&hl=en_US

Nutrition in chronic lung disease:
https://docs.google.com/present/edit?id=0AfiCRfy-aXfjZG45cGg0bl8xMTR3aGhmZzVjag&hl=en_US

COPD;
https://docs.google.com/leaf?id=0B_iCRfy-aXfjMGExNzljYmItMTQwNi00OTlmLWIxZGEtMGM5ZTZlYjRhY2I3&hl=en_US

Getting ready for the Respiratory Conference day on the 19th May 2011.

Dear diary:
In the process of getting everything ready for the 19th May. Speakers not only are organised but are really excited about the day.  They have put a lot of work into their presentations. My presentation is centered around drug errors. Although much has been written on the severity of drug errors, there is very little research in the nursing literature, specifically examining methods of dealing with poor medication calculation and the mathematical skills of nurses.

As we know the doctor prescribes the drug, the pharmacist dispenses the drugs and finally the nurse is responsible for administering the medication to the patient. Each nurse is accountable for the preparing, checking and administering, updating her/his knowledge of the medications (too numerous to estimate), monitoring the effectiveness of the treatment, reporting adverse reactions and teaching patients. And yet administering medication is just part of the nurses workload. The nurse has to function in a busy, understaffed, under resourced  department with very little financial reward. Tell me, would this workload have anything to do with staff retention? Here am I rambling again - I am just passionate about the whole process where nurses are administering medication and yet I feel there is very little support for that nurse!!

Getting back to the 19th May, I hope you will enjoy the day. I hope it will be as successful as the day we had for the cardiac conference on the 19th April 2011.

Can I just add that, yes,  I did promise to post up the power point presentations from our successful respiratory conference held last Thursday 19/5/11 - some of the lectures wanted to make some ammendements to thier presentations so, I should be able to post the complete conference notes on Friday the 27th May 2011.

Oh yes, I will have the winning ticket results to our fantastic prize also on that date....Good Luck 

19th April 2011 Drug Treatment for Cardiovascular Disorders

Greetings again,

Thank you for coming to our conference in St. Michael's Hospital.  

It was great to see you in the flesh, up to then it is all done by emails. I hope the conference brought benefit to everyone, most of all to our patient’s.The subject matter of this conference is of paramount importance. From the successful conference held last year 2010 "Setting standards for medication Management", there has been a demand to provide education in the area of medication administration.

It will be very interesting to see will these coming conferences be as successful as the Cardiac conference we had on Tuesday. Thank you for completing your evaluation sheets. They are very important because this is for the benefit of all nurses. yes, I sound pretentious but why not put our resources together and work together to help each other. 

I hope you will come back and visit us in May -Respiratory, June - Gastric, July- Diabetes, August - Pain and September - urology.  

I am including the power point presentations from the conference as promised.

    Acute Coronary syndrome
https://docs.google.com/leaf?id=0B_iCRfy-aXfjZGY3NmVhYTMtMDRjNC00NmNiLWFiYTMtNmE5ZGQxNWJkMGI2&hl=en

Medication Management pre and post Angiography.

https://docs.google.com/leaf?id=0B_iCRfy-aXfjMmZlY2I3NDAtNjNhZC00ZmIwLWJmNjgtNzQ2YWU0YTFmMmY0&hl=en
    
    Cholesterol Medication
https://docs.google.com/leaf?id=0B_iCRfy-aXfjNDMyMmM5MzgtMjRkYy00ZGU0LWJmYmItN2U0ZDQ4ZGQ4ZjE2&hl=en

    Cardiac arrest   
https://docs.google.com/leaf?id=0B_iCRfy-aXfjODA2OTA3YTEtODg0My00YWRkLTgyYzYtOTRkMzE1ZWViZGEw&hl=en
  
Atrial fibrillation
https://docs.google.com/leaf?id=0B_iCRfy-aXfjMmFlZTg3Y2QtMWIzZi00M2Q1LWJiNWItOTg3M2NiOWU3NGZi&hl=en

As soon as I get Ms. Bronagh Travers presentation I will down load it.


The winning ticket drawn is Number 5 !!!
 Can the winner contact me on the St. Michaels email address. Can you forward - on a picture of yourself for the web site?? congratulations >>>>

My letter to The Irish Times

The Irish Times - Monday, March 28, 2011

Health staff involved in up to 8,000 drug errors a year

CARL O'BRIEN

HEALTH WORKERS are involved in up to 8,000 medication errors or near-misses in Irish hospitals each year, new figures indicate.
I just could not resist writing to the Geraldine Kennedy - editor to express my views.....

Madam, - As a Clinical Facilitator that is responsible for the career development of nurses, I read with great interest the article on 28^th March dealing with data compiled by the State Claims Agency over a six year period. This indicated health workers are involved in up to 8,000 medication errors or near-misses per year in Irish hospitals of which over 7,000 are due to incorrect dosage.

                                                                                 

When researching my thesis on medication management for my MBS in Health and Safety at Work, it became evident that medication errors are an international problem. For example in England, there were 70,036 medication reported errors in one year June 2009-2010 according to the NHS. It is not clear, what percentage of errors remain unreported.

Dealing with the underlying causes of error requires a concerted effort from every department in the hospital. However to concentrate on one area, a survey by the HSE in 2009 revealed that newly qualified nurses were concerned about their own skills with drug calculations. This is particularly relevant as single person administration is now very common for economic reasons. 

Medication administration is perhaps the highest risk activity a nurse can perform, as accidents can lead to devastating consequences for the patient and for the nurse's career.

There are many factors that can contribute to errors including heavy workload, distractions and interruptions.

As one approach to this, I have consulted with a developer friend to produce a simple application for mobile phones called “Dosage Calc”. This can double-check a wide range of common calculations giving the nurse some reassurance. I would welcome any input from those nurses in your readership during the pilot phase. The app is currently available as a free download from the Android market and will very shortly be available on iPhone and Blackberry.

Unlike some other countries, there is reluctance in Irish hospitals to allow the use of mobile devices among some staff. However it is worth mentioning that “Dosage Calc” and some other useful apps can be used in “Airplane mode” making interference with equipment very unlikely.

Health staff involved in up to 8,000 drug errors a year.

I came across this article that you might find very interesting- Fresh data from the State Claims Agency include figures of medication errors over a six year period.
   http://www.irishtimes.com/newspaper/ireland/2011/0328/1224293220594.html
Its only the tip of the iceberg I suspect.

New Mobile App for Nurses

Hi everybody, I am all excited I have made my first ever you tube presentation. This was on the subject of dosage calculations. I also demonstrated a brand new mobile app to support my colleagues in this area.

By the way you can find out how to install this app on your phone by visiting DosageCalc.
The app is free during the pilot and I am very interested in any feedback to make it even better.

A new Directive to create a safe working environment

A new Directive to create a safe working environment A new framework agreement between the European Social Partners in the hospital and healthcare sector, signed on 17 July 2009, has become law making it a directive: 2000/54/EC. The purpose of this directive is to permit member states to create a safe working environment regarding sharp instrument handling without dictating the means of achieving this goal. Now the European member states have three years to implement the requirements set out by the directive. One of the most common and serious risks to healthcare workers in Europe are injuries caused by needles and other sharp instruments.In Europe it has been estimated that there was a staggering 1,200,000 incidences of needle-stick injuries.  These injuries represents a high cost for health systems and society in general.  It was because of concerns about these figures and the life-threatening risks faced by healthcare workers from contaminated needles, that the European social partners came together to give legal effect to the Framework Agreement. This new agreement was signed by HOSPEEM (The European Hospital and Healthcare Employers' Association, of which the HSE is a member) and EPSU (The European Public Services Union, which covers all of the 27 Member States.). As far back as June 1989 a Council Directive introduced measures to encourage improvements in Safety and Health for the workforce. This set out general preventive  measures and introduced risk assessments.  The first function of a risk assessment, is to determine whether the work activity being assessed should be  classified as a high, medium or low risk.  In a high risk procedure, the work must be ceased immediately, proper controls put in place and these controls and the assessment of the risk documented. The 1989 directive has also assisted in the setting up of safety statements and policies. It also  encouraged the organisation of risk prevention, training and monitoring. The Directive also advocated the use of PPE (personal protective equipment) where risks can be reduced or eliminated. It stipulates, any medical device placed on the market must be CE marked to demonstrate its conformity to safety regulations. Following on from this, the 2000/54/EC Directive encores every hospital in the EU to have an incident reporting system where accidents and 'near misses' should be recorded. A system where the incidents are classified to types and the number of sharp incidents. This process of reporting will focus on the whole system approach and not based on an individual blame. To  conclude, the overall objective of this 2000/54/EC Directive is to provide, so far as is reasonably practicable, a safe and healthy work environment for all medical workers. To promote employee participation through improved quality and training. To make employees aware of the importance in the assessing and the prevention of risks.  Further information is available from www.hospeem.eu.