Interprofessional collaboration improving hospital-wide processes can have significant benefits for the release of nursing time.

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Background High-risk drugs are involved in serious medicines errors. Studies have identified a range of contributory factors including lack of training. The MMU Hospital developed a E-learning programme ‘A Guide to High-risk Drugs’ to enable teaching; incorporating an inbuilt evaluation tool to assess the learning outcome. PurposeTo evaluate the learning from undertaking an e-learning programme on high-risk drugs. To ascertain if the programme is suitable for different types of institutions. To identify user knowledge deficits. Materials and Methods The programme was trialled in two different hospitals. The MMUH, a 600 bed acute hospital and Peamount Hospital, a 380-bed rehabilitation and continuing care hospital. The participants were qualified Doctors, Nurses and Pharmacists. All 170 participants undertook 20 pre-assessment questions followed by the programme then the same questions in a post-assessment. Results from each institution and discipline were analysed. Results 29 Interns completed the programme at the MMUH and 11 SHOs/Registrars in Peamount. A mean pre-assessment score of 58% (MMUH) and 56% (Peamount) increased to a post score of 83% in both hospitals. MMUH Nurses (n = 38) yielded an improvement, 48% to 73%; and Peamount Nurses (n = 40), 39% to 65%. MMUH Pharmacists (n = 20) improved from 83% to 94%. Individual questions were further analysed to ascertain if there were particular drugs causing difficulty. Analysis showed that a question on potassium chloride yielded low pre-assessment scores of 21% and 39% respectively for MMUH Doctors and Nurses and 45% and 20% for Peamount. Although both disciplines improved, this demonstrated a need for further training with this drug. Conclusions The e-learning programme showed a significant increase in user knowledge, in both hospitals, for all disciplines. These results are very encouraging given the differences between the institutions, grades of staff and experience. The results do not stem from a ‘specific teacher effect’ and therefore are reproducible in multiple sites. No conflict of interest.

BackgroundDrug prescribing and administration is one of the primary interventions for influencing patient health.1 When interrupted once during drug administration, the risk of error increases by 12.7%.2 In February 2013, nursing staff spent, on average, 135 min undertaking the 08.00 oral drugs round. Lean methodology has been successfully used in healthcare for process improvement so it was employed to review the timing and safety of the drug administration round.PurposeTo review the drug administration round using Lean methodology to:eliminate non-necessary steps;reduce the time taken;reduce interruptions;provide a safer environment.Material and methodsA surgical ward was the study ward. A ‘process map’ of the drug administration round was generated, with each step analysed for the value added. Areas for improvement were identified and rated in terms of impact and feasibility.The time taken to complete the 08.00 drug round and interruptions encountered were recorded 7 days pre-implementation, 3 weeks post-implementation and then at defined intervals for follow-up.ResultsThe improvements introduced as a result of Lean analysis were;a ‘do not disturb’ campaign to reduce interruptions;re-organisation of the drug trolley;checklist for preparing the drug trolley prior to rounds;use of a coloured flag to identify stocking requirements or any drug chart issues; anda standardised process to communicate stock requirements between pharmacy and nursing.The project was rolled out in May 2013, with re-audits in September 2013, July 2014 and November 2014.The average 08.00 drug round timing decreased by 63 min per day.The time variation for drug round completion decreased by 14 min per round.Total interruptions have increased from the baseline study.Ward clinical pharmacists indicated that the drug supply process has improved along with communication between nursing and pharmacy.ConclusionLean methodology was successfully employed to reduce the time taken to complete the oral drug administration round. Interruptions during drug administration have also reduced. This demonstrates that Lean methodology can increase efficiency and safety in the healthcare setting.References and/or AcknowledgementsMaxwell S, Walley T. Teaching safe and effective prescribing in UK medical schools: a core curriculum for tomorrow’s doctors. Br J Clin Pharmacol 2003;55:496-503Institute for Safe Medication Practices, Medication Safety Alert 2013;18(2)No conflict of interest.

BackgroundParenteral nutrition (PN) is an invasive, specialised form of nutritional therapy for the prevention or treatment of malnourishment in vulnerable patients. In 2016 there was a 47% rise in PN usage, leading to workload increase and time pressures for pharmacists and dietitians working on order and supply processes.PurposeThe Pharmacy Department and Department of Clinical Nutrition and Dietetics collaboratively reviewed the PN ordering process, to remove bottlenecks and delays, and simplify communication.Material and methodsA multidisciplinary group worked through a Plan, Do, Study, Act (PDSA) cycle:The group brainstormed ideas to remove bottlenecks and streamline communication.Individual solutions were determined and trialled on an incremental basis to determine success before adding another.Prospective data was collected from September to November 2016, pre- and post-interventions trialled.Data were circulated among users on a daily basis for review.Improvements were collaboratively agreed and implemented.ResultsInitial process involved dietitians sending paper prescriptions to the Pharmacy Department through a pneumatic chute system, followed by pharmacist review, order generation and bleep back to dietitians for detail verification.Updated process involves dietitians electronically ordering PN via an existing hospital ordering system, freeing up time for dietitians and pharmacists.Data analysed using Excel® shows a 57% reduction in PN supply time in the pharmacy, from 7 to 3 min per bag (mean of 100 bags supplied per week).The dietitians and pharmacists both report improved time management and satisfaction with process updateConclusionIntroduction of a streamlined dietitian electronic ordering process for PN has led to a saving of 400 min of pharmacist time (0.18 Whole Time Equivalent) per week. The updated process has led to the capacity to accommodate the increase in service use. Furthermore, it has led to improved relations between pharmacists and dietitians, more time for communication on patient safety and stock management, and less reliance on a person-dependent manual process which previously contributed to delay and staff stress.No conflict of interest