Reducing Medication Incident by the Pointing and Calling Program in High Risk Medication Infusion by Syringe Pump

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Authors (including presenting author) :
Chiu PC, Mak KN, Ng TC, Chan TY, Ng JSC
Affiliation :
Palliative Care Service, Department of Medicine, Haven of Hope Hospital
Introduction :
In palliative care setting, high risk medications including strong opioids are frequently applied via syringe pump. The application process is meticulous and prone to distraction in the daily busy clinical setting which leads to serious medication incidents. Pointing and Calling (P&C) is a method in occupational safety for avoiding mistakes by pointing at important indicators and calling out the status. The “Pointing and Calling (P&C) Practice Program for Medication Administration via Continuous Subcutaneous Infusion (CSCI) by Syringe Pump” was implemented to control risk of medication incident in the palliative care ward in Haven of Hope Hospital since January 2018. A workgroup was formed through a Plan-Do-Check-Act (PDCA) cycle to develop the approaches to apply P&C for CSCI of medication by syringe pump. A series of promulgations activities were performed to guarantee its success and sustainability. These activities included briefing session, onsite demonstration and compliance supervisions.
Objectives :
To evaluate the effectiveness of the “The Pointing and Calling (P&C) Practice Program” in 1. enhancing the certainty of nurses in independent checking of syringe device, and 2. enhancing medication safety.
Methodology :
To assess the certainty of nurses in independent checking of syringe device, participants were asked to score the certainty using a ten-point Likert scale before and after the program. To evaluate the improvement in medication safety, the change in medication incident rate before and after the program was examined.
Result & Outcome :
Twelve registered nurses and enrolled nurses completed the training. Their compliance rate in P&C practice was found to be 99%. Before the program, participants rated 10/10 in certainty in 35 out of 101 times (34%) of independent checking. After the program, the number significantly increased to 70 out of 74 times (94.6%) of independent checking. The medication incidents dropped from two in 2017 to zero in 2018 after implementation of the program. P&C practice is a simple and effective method to enhance safety in high-risk medication administration by syringe pump.

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