Room 421 May 14, 2019 oral abstract
Service Enhancement Presentation 16:15 - 17:30

Clinical Safety and Quality Service II

5S-Strategy to Reduce Fall Rate for High-Risk Groups
16:15 - 16:25
Presented by : K L CHAN

Introduction

Falls are serious cause of morbidity and costs, especially in Cancer Palliative Care. Most patients with these incurable diseases were aged, terminally-ill and highly stressful. Patients with bone metastasis or brain metastasis were extremely high risk. Cancer patients could suffer from more immense consequences of physical injuries, fractures, post-fall syndrome and functional decline. It was also followed by prolonged hospital stays, follow-up investigations and treatments; consequently, it increased the costs and risks significantly in health care system. To take comprehensive preventive measures, 5S-Strategy was launched.

Objectives

To reduce fall rate To minimize prolong hospital stay due to fall To enhance staff engagement To foster safety culture

Methodology

Systems Universal screening was performed for all patients upon admissions. The individual needs of screened patients would be addressed, such as assisted toileting round, morning warm water round, providing non-skid slippers, alarm pad and yellow vest, keeping bed at low level, and providing anti-slippery spray. All these rounds aimed at improving the observation level and preventing high risk activities for example toileting and filling warm water. Strategy Post-fall incident investigation of each fall is a necessary component and must indicate how a client was assessed and the specific strategies implemented for that patient to prevent further falls. The results for every new operation would be documented and announced. Shared Values High-risk patients and their relatives would be engaged through face-to-face discussions or phone call. Education would be given and consensus would be gained to achieve mutual understanding. When patients, relatives and clinicians had the same shared values and goals, patients would comply with instructions from the ward. Staff Multidisciplinary approaches, including physicians, nurses, physiotherapists, occupational therapists, were involved in the fall program. Repeated assessments would be conducted as conditions of cancer patients would deteriorate suddenly. Multidisciplinary approaches with repeated assessments can provide a quick response to change of conditions and timely prevention can be taken in advance. Skills Supporting staff was trained as the eyes of clinicians. Two workshops were provided by nurses annually. In each shift, supporting staff would be informed of the patients with high risks. As supporting staff had a high intensity of interaction with patients, they were able to enhance the observation level and provide assistance.

Results & Outcome

The fall rate decreased from 10.04 cases per 1000 episodes in 2012/13 to 4.89 cases per 1000 episodes in 2017/18. Causes of falls are multiple and hard to prevent all of them. The preventive measures should be from different angles and implemented by different people.

 

 

Standardized computerized printing of use-before date and auxiliary label for reconstituted medications during drug dispensing process in pharmacy setting
16:26 - 16:35

Introduction

Certain types of syrup medications, especially antibiotics, are freshly reconstituted in pharmacy upon receipt of prescriptions from physicians. Under previous practice, the use-before dates are manually calculated and filled on drug labels by dispensers after reconstitution. Auxiliary labels of “Refrigerate” are also stuck accordingly if appropriate. Information is thus checked by another dispenser and then pharmacist before issuing. Although there are information charts assisting colleagues in checking shelf life and storage condition of individual medications, the following challenges exist: 1. There is a range of medications that require fresh reconstitution. Effort is needed for colleague to check and calculate each time for the use-before dates and storage conditions. 2. Manual error may occur during calculation process. 3. Poor handwriting and/or diffusion of ink may lead to difficulty in reading information from the labels.

Objectives

This project aims to: 1. Improve medication safety through replacing manual written labels by automatic printing 2. Ensure patients will not be using an expired product due to incorrect use-before date 3. Optimize dispensing process and improve efficiency 4. Improve tidiness and neatness of dispensing labels for better readability by patients/carers or nursing staff when administering the drug

Methodology

To improve the current practice and quality of dispensing, a computerized program is designed to calculate and print use-before date and auxiliary label automatically from label printer after scanning barcodes which is originally printed on dispensing labels.

Results & Outcome

This project targets to achieve the following outcomes: 1. Elimination of wrong calculation or writing of use-before date and wrong labelling of “refrigerate” after medication reconstitution 2. Elimination of poor readability of manual writing of use-before date, so as to safeguard correct medication administration and patient safety 3.Reduction of pharmacy staff workload and optimization of dispensing process. Zero near miss of incorrect use-before date and refrigerate instruction was recorded since implementation in AHNH main pharmacy and TPH main pharmacy. Improvement of dispensing efficiency is evaluated by interviewing dispensing staff (pharmacists and dispensers) after implementation. All staff interviewed agreed new measure can reduce workload for manual calculation, reduce frontline stress and increase dispensing accuracy and efficiency. ​ Questionnaires were distributed to patient/carers and nursing staff. 100% of respondents are satisfied with the new measure. Most respondents agreed that new measure can improve tidiness of instruction, reduce mistakes and misunderstanding of information, and hence improve medication safety.

 

 

A three steps “SAFE model: Screening, Checking and Monitoring”, to prevent change of patient’s condition during training in physiotherapy department in Shatin Hospital
16:36 - 16:45

Introduction

There has been an increase in frequency of changes in patient conditions during training in physiotherapy department due to frailty, multiple comorbidities and more acute status of patients that may endanger patients’ safety. Patients’ safety is always first priority in delivering treatment to patients.

Objectives

To derive a systematic, practical and sustainable system to minimize the occurrence of change of patient condition in physiotherapy department

Methodology

Root cause analysis was conducted for the “change of patient condition” data (10 cases happened for 15148 patient attendances) in first 10 months in 2017. It included patient’s medical record review and staff interview. Major information reviewed including screening of patients’ medical history, any checking and monitoring of vital signs for those patients. Major causes were postural hypotension (60 %) and poor blood pressure (BP) control (10%). Practice of monitoring of vital signs was inconsistent amongst different therapists. In addition, focus group was formed with physiotherapist team in-charge in different specialties, to gather opinions on safety measures. A three steps “SAFE” model: Screening, Checking and Monitoring” was implemented in January 2018. Step 1 “Screening” was a procedure that using standardized screening checklist, which included contra-indications and precautions for screening of medical conditions and unstable vital signs. All physiotherapists needed to conduct this procedure. Step 2 “Checking” was checking patients’ vital signs (using reference range from screening checklist) before training in physiotherapy department. Staff needed to sign a checking record, with regular audit by senior staff. Step 3 “Monitoring” was monitoring of vital signs during training if the patients’ vital signs was within borderline range (regarded as precautions in screening checklist).

Results & Outcome

After implementing the procedures of “Screening” and “Checking”, percentage of patients cancelled due to unstable vital signs was 2.2% (482 out of 21909 patients booking) in 2018. Unstable vital signs included fever (58.5%), unstable BP (27.8%) and unstable pulse rate (3.7%). Together with the measures of “Monitoring”, the occurrence rate of change of patient condition in physiotherapy department showed a marked decreasing trend (decrease 64.1%) from 0.92 incidents per month in 2017 (out of 18178 yearly attendances) to 0.33 incidents per month in 2018 (out of 21424 yearly attendances). Staff evaluation questionnaire showed that all staff agreed that the 3 steps “SAFE model” could increase staff awareness on patients’ safety and decrease occurrence of change of patient condition in physiotherapy department. Continuous data collection and evaluation, and regular safety measures review are necessary to enhance patients’ safety in future.

 

 

M&G Nurse Coordinator e-Handover System
16:46 - 16:55
Presented by : Wa Sing LAM

Introduction

Effective communication is a driver of performance for clinical team and helps the timely and relevant information is provided to Nursing Management Team. SharePoint is typically associated with web content management and document management systems, it is actually a much broader platform of web technologies, capable of being configured into a wide range of solution areas. By using SharePoint to create an electronic platform – “Nurse Coordinator e-Handover System”, this platform provides DOM/WMs/NOs/APNs to easy access for monitoring daily Medicines & Geriatrics ward operation, quality and safety via workstations and home computers, also this platform helps the Nursing Management team get information and give response effectively.

Objectives

The objectives of the project are: (a) To enhance efficiency in clinical management (b) To enhance communication between DOMs/WMs/NOs/APNs even working area or home (c) Provide update, timely and relevant information to Nursing Management team (d) Data can be retrieved for evaluation and statistics

Methodology

The I2E2 (i.e. Inspiration, Infrastructure, Education and Evidence) strategies are adopted for facilitating the implementation of the project: (a) Review the existing workflow of Nursing Coordinator handover method (b) Develop an electronic platform (c) Conduct training and competency assessment (d) Prepare for the rollout of the project to meet operational need (e) Collect staff feedback (f) Assess the readiness for implementation and provide timely feedback (g) Monitor the utilization

Results & Outcome

With the collaboration from DOMs/WMs/NOs/APNs, the project was successfully rollout on 4Q2018, at least 200 records are documented. The concept of M&G Nurse Coordinator e-Handover System was supported by Nursing Management Team. This platform facilitated communication and improve work efficiency. Positive feedback and suggestions from Nursing Management Team on enhancing the system are followed up for further improvement. In conclusions, an innovative and good quality information could provide staff Timely, Relevant and Efficiency clinical area.

 

 

Hospital-wide Evidence-based Practice Change to Ventrogluteal Intramuscular Injection by Nurses
16:56 - 17:05
Presented by : W M LING

Introduction

Dorsogluteal (DG) region, the upper outer quadrant, of buttock is a common site for intramuscular injection by nurses. In December 2016, the Medical Council of Hong Kong recommended changing to the ventrogluteal (VG) site. Therefore, an evidence-based project group was established under our Nursing Services Division to follow up this issue.

Objectives

The group aimed at (i) examining the evidence for the VG site; (ii) formulating the evidence-based strategies for promoting the practice change among our nurses; and (iii) implementing the action plan of change and evaluating its effectiveness.

Methodology

The Johns Hopkins Nursing Evidence-based Practice Model was adopted. Apart from reviewing the evidence for VG site, the project also covered the: (a) optimal locating method of VG site; (b) occupational and health issues concerned; and (c) optimal method for facilitating the change. Hospital-wide nurses training was conducted, especially for senior nurses who had never learned the VG injection skill before. As informed by the evidence, simulated practice was incorporated, a new poster was designed for work places, and a video clip was produced for on-going education. Participants were required to pass the skill assessment in simulation setting. Their knowledge gain, attitude change and performance would be evaluated. Incidence of patient injury and staff needle stick injury would also be captured.

Results & Outcome

Thirty identical training sessions were conducted from December 2017 to October 2018 for nearly 860 nurses. No incidence of patient injury and staff needle stick injury was reported so far. After training, the nurses’ mean knowledge score increased from 2.98 to 5.58/6 (p< 0.001, paired t-test). Proportion of nurses willing to use VG rose from 19.3% to 95.6% (p< 0.001, McNemar's test). Among the 691 nurses who used to choose DG site, 654 of them (94.6%) were willing to change to VG. The strongest motivator was the knowledge of the benefits of VG over DG. Conversely, difficulty of the VG skill perceived was the most common barrier for change. Analysis by the logistic model also revealed that more experienced the nurses, less likely they would choose VG. But they tended to be more willing to change after training in our cohort. These results are promising. Clinical audit will be conducted later to verify the actual clinical behaviour.

 

 

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