audit conference

audit conference
audit conference

Tuesday, August 23, 2011

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

Medication choices related to pain assessment presentation.


Clinical Indemnity Scheme.

Acute Pain

Pain assessment

    Wednesday, August 10, 2011

    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 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 28th 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