THE OPIOID WORKING GROUP: AN INTERDISCIPLINARY WORKING GROUP TO IMPROVE THE CORRECT PRESCRIPTION AND APPLICATION OF OPIOIDS IN THE HOSPITAL SETTING (submitted in 2019)
European Statement
Patient Safety and Quality Assurance
Author(s)
Imke Willrodt, Delia Bornand, Jimena Ramos, Stojan Petkovic, Giulia Mohr, Anne Leuppi-Taegtmeyer
Why was it done?
Due to critical incidents involving opioids reported internally at the University Hospital Basel in 2018, there was an urgent need to evaluate underlying reasons for these events. The Opioid AG was established with the aim to mitigate risks for the correct prescription and application of opioids, and therefore to improve patient safety.
What was done?
The Opioid Working Group at the University Hospital Basel is an interdisciplinary working group including representatives from different professions (physicians, nurses, pharmacists) and departments (medical, surgery, gynaecology, emergency, pain therapy, palliative care, pharmacology and toxicology, patient safety and information technology).
How was it done?
The thorough analysis of root causes for the critical incidents revealed prescribing and application errors, such as non-observance of kidney failure, pharmacodynamic interactions of opioids with other prescribed drugs, inadvertent overdosing – in particular with liquid drug formulations, or patient mix-ups.
What has been achieved?
Consequently, the following steps are being taken to address these risks: 1. Optimisation of the prescribing software including opioid prescription templates, links to existing opioid unit conversion tables for liquid forms of diamorphine, morphine, hydrocodone and oxycodone (milligrams to millilitres) as well as clearer display of “as required” opioid prescriptions on the patients’ electronic drug charts. 2. Preparation of Standard Medication Preparation Schemes for nursing staff of the emergency department. 3. Development of an additional label (concentration, patient initials, date of reconstitution, date of expiry of reconstituted solution) for parenteral diamorphine. 4. Improvement in detailed written instructions for the correct preparation, labelling, application and disposal of intravenous and oral drugs (to include opioids). 5. Evaluation of a hospital opioid safety self-assessment tracking tool.
What next?
A comprehensive evaluation will take place, 6 months after the implementation of all measures. We will use the number of naloxone prescriptions on the wards as a key performance indicator to measure the success of this project. The reported critical incidents involving opioids will also be assessed before and after the implementation of all measures.
This evaluation will help to identify open questions, potential gaps and further needs for improvement to be addressed by the interdisciplinary team.
A ROBUST LEAN METHOD FOR IMPROVING THE MEDICATION MANAGEMENT PROCESS
European Statement
Patient Safety and Quality Assurance
Why was it done?
Hospitals are facing strong economic constraints and increasing requirements in terms of quality and safety of care. To address these difficulties, a solution could be to reorganise processes and relocate resources through the use of industrial engineering Business Process Improvement approaches such as Lean.
What was done?
An original Lean method for business process improvement was designed and tested in an acute general medicine department in order to improve the mediation management process.
How was it done?
A Lean method for the hospital setting was elaborated based on a triangulation between literature data, semi-structured interviews and a case study. This method, relies on 5 operational activities (Understand the process, Measure, Analyse, Improve, Implement) and 6 support activities (Establish top management support, understand the environment, Organize a project team, Manage change, Monitor and continuously improve). A multidisciplinary project team (nurses, head nurses, pharmacists, physicians, pharmacy technicians, nurse’s aide) was then formed to experiment this method in the acute general medicine ward.
What has been achieved?
This project allowed improving the efficiency and quality of the medication management process. Medication errors at admission and risk for medication errors during administration were reduced (46% vs 12%), non -value added activities during administration were eliminated (25 minutes/nurse/day saved), ward stock management was streamlined (double bin system) and medication delivery was secured. More than 80% of the stakeholders surveyed (45) considered that the changes made to the process improved their working conditions (no impact for the others) and all the participants to the project team were satisfied or very satisfied with the project. The team now meets once a month to continuously improve the process.
What next?
The top management of the hospital has decided to promote this method and is currently creating and training a specific improvement team to support other improvement projects in the hospital.