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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

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