High-alert Medications Research Articles

Effect of Evidence-Based Educational Intervention Regarding High Alert Medications on Clinical Patient Outcomes in Critical Care Units

Effect of Evidence-Based Educational Intervention Regarding High Alert Medications on Clinical Patient Outcomes in Critical Care Units

Intravenous Line Labels For High-Alert Drugs Administered To Critically Ill Patients: A Simulated Experimental Assessment.

Evaluate the effect of IV line labels on nurses' identification of high-alert medications in a simulated scenario of multiple infusions for critically ill patients. Randomised crossover simulation experimental study. A study was conducted on 29 nurses working in intensive care for over 6 months. They were given two critical scenarios in a simulated environment, one with labels and the other without labels, involving multiple intravenous infusions. The nurses had to identify the medications infused into the critical patients' intravenous lines and disconnect a specific line. The data were collected and analysed to evaluate the errors made by the nurses in identifying and disconnecting the medications and the time they spent carrying out the tasks. The Wilcoxon test was used to analyse the variation in outcome before and after the intervention. Approximately one-third of the study participants incorrectly identified the intravenous lines in both scenarios. There was no significant difference in the average number of errors between the scenarios with and without labels. However, the time taken to perform the tasks in the scenario with labels was 1 min less than in the scenario without labels, suggesting a potential efficiency gain. The labels on the intravenous lines allowed for quick drug identification and disconnection. The professionals performed similarly in correctly recognising the high-alert medication intravenous lines, in the scenarios with or without labels. The label can be used as a technology to prevent misidentification of high-alert medications administered to critically ill patients through intravenous lines, thereby enhancing medication safety in healthcare institutions. No Public Contribution.

Development and implementation of autoverification standardization in the adult and pediatric emergency department.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. This project utilized the guidance of the American Society of Health-System Pharmacists (ASHP) autoverification toolkit to refine our health system's approach to autoverification and contribute to the literature regarding appropriate use of autoverification technology in a pediatric and adult emergency department (ED). This single-center quality improvement study was conducted in an academic medical center ED that has 33 pediatric beds and 77 adult beds. A team consisting of clinical pharmacy specialists in emergency medicine, medication safety and informatics personnel, operational managers, and pharmacy leadership was identified to develop and implement autoverification best practices in the ED utilizing practices outlined within the ASHP autoverification toolkit. Before implementation of best practices, defined as the "preoptimization" state, autoverification took place for most medications available in the automated dispensing cabinets (ADCs). By anchoring the autoverification rule on ADC inventory, it was challenging to optimize both inventory practices and autoverification best practices. This project focused on redesigning the autoverification rules in the electronic health record, defined as the "postoptimization" state. In the postoptimization state, autoverification in the ED was updated to better align with regulatory standards. Autoverification metrics and the percentage of orders that autoverified vs required pharmacist verification were analyzed in the preoptimization and postoptimization states. This project utilized the guidance from ASHP's autoverification toolkit to refine our health system's approach to autoverification. High-alert medications (eg, insulin, extended-release opioids, digoxin) were taken off autoverification following implementation. Optimization of autoverification rules allows more orders for high-alert medications to be reviewed by a pharmacist.

Impact of a Bundle of Interventions on the Spectrum of Parenteral Drug Preparation Errors in a Neonatal and Pediatric Intensive Care Unit.

Background/Objectives: This study aimed to evaluate the impact of a bundle of interventions on the error rates in preparing parenteral medications in a neonatal and pediatric intensive care unit (NICU/PICU). Methods: We conducted a prospective interventional study in a NICU/PICU in a tertiary university hospital as a follow-up to a prior study in the same setting. A clinical pharmacist and a pharmacy technician (PT) analyzed the workflow of drug preparation on the ward, identified high-alert medications, and defined a bundle of five interventions, which include the following: Drug Labeling: 1. EN ISO-DIVI labeling; Training: 2. Standardized preparation process on the ward; 3. eLearning Program; 4. Expert Consultations; and Location of Preparation: 5. Transfer of the preparation of high-alert medications and standardized preparations to the central pharmacy. After implementing the bundle of interventions, we observed the preparation process on the ward to evaluate if the implementation of the interventions had an impact on the quality of the drug preparation. Results: We observed 262 preparations in the NICU/PICU. Each single step of the preparation process was defined as an error opportunity. We defined seven error categories with an overall error opportunity of 1413. In total, we observed 11 errors (0.78%). The reduction in the overall error rate from 1.32% in the former study to 0.78% per preparation opportunity demonstrated that the implemented interventions were effective in enhancing medication safety. Conclusions: This study provides evidence that a bundle of interventions, including standardizing drug labeling, enhancing training, and centralizing the preparation of high-alert medications, can reduce medication errors in NICU/PICU settings.

Effect of Training Program on Nurses Knowledge and Performance in Dealing with High Alert Medications

Effect of Training Program on Nurses Knowledge and Performance in Dealing with High Alert Medications

DDIs involving high-alert medication common in paediatric intensive care

DDIs involving high-alert medication common in paediatric intensive care

Drug-Drug Interactions Involving High-Alert Medications that Lead to Interaction-Associated Symptoms in Pediatric Intensive Care Patients: A Retrospective Study.

Children treated in a pediatric intensive care unit (PICU) often receive several drugs together, among them drugs defined as high-alert medications (HAMs). Those drugs carry a high risk of causing patient harm, for example, due to a higher potential for interactions. HAMs should therefore be administered with caution, especially in a PICU. The objective of the current study was to identify drug-drug interactions involving HAMs that increase the risk of interaction-associated symptoms in pediatric intensive care. In a retrospective study, we analyzed the electronic documentation of patients hospitalized for at least 48 h in a general PICU who received at least two different drugs within a 24-h interval. We assessed potential drug-drug interactions involving HAM on the basis of the two drug information databases UpToDate and drugs.com. Furthermore, we analyzed whether symptoms were observed after the administration of drug pairs that could lead to interaction-associated symptoms. For drug pairs involving HAM administered on at least 2% of patient days, and symptoms observed at least ten times after a respective drug pair, we calculated odds ratios, 95% confidence intervals, and p-values by using a univariate binary logistic regression. Among 315 analyzed patients, 81.3% (256/315) received drugs defined as high-alert medication for pediatric patients. Those high-alert medications were involved in 20,150 potential drug-drug interactions. In 14.0% (2830/20,150) of these, one or more symptoms were observed that could be a possible consequence of the interaction, resulting in 3203 observed symptoms affecting 56.3% (144/256) of patients receiving high-alert medication. The odds ratios for symptoms observed after a drug-drug interaction were increased for eight specific symptoms (each p ≤ 0.05), especially hemodynamic alterations and disturbances of electrolyte and fluid balance. The odds ratio was highest for decreased blood pressure observed after the administration of the drug pair fentanyl and furosemide (OR 5.06; 95% confidence interval 3.5-7.4; p < 0.001). Increased odds ratios for specific symptoms observed after drug-drug interactions resulted from eight combinations composed of eight different drugs: digoxin, fentanyl, midazolam, phenobarbital, potassium salts and vancomycin (high-alert medications), and the diuretics furosemide and hydrochlorothiazide (non-high-alert medications). The resulting drug pairs were: potassium salts-furosemide, fentanyl-furosemide, vancomycin-furosemide, digoxin-furosemide, digoxin-hydrochlorothiazide, fentanyl-phenobarbital, potassium salts-hydrochlorothiazide, and midazolam-hydrochlorothiazide. In a cohort of PICU patients, this study identified eight specific drug pairs involving high-alert medications that may increase the risk of interaction-associated symptoms, mainly hemodynamic alterations and electrolyte/fluid balance disturbances. If the administration of those drug pairs is unavoidable, patients should be closely monitored.

Polypharmacy and high-alert medications in patients with nasally placed feeding tube on admission and at hospital discharge: Multicenter cross-sectional study

BackgroundPolypharmacy and the use of high-alert medications in patients with nasally placed feeding tube (NPFT) increase the risks of drug related problems. ObjectiveCharacterize drugs prescribed to patients with NPFT and compare the rates of polypharmacy and high-alert medication use at admission and hospital discharge. Design and settingMulticenter cross-sectional study with 327 participants. MethodsData of patients with NPFT were obtained from the medical records and recorded in an electronic data collection tool. Mean number of drugs, polypharmacy and number of high-alert medications prescribed on admission and at discharge were compared using Wilcoxon or McNemar's tests. Generalized Estimating Equations analyzed the relationship between polypharmacy and high-alert medications according to age and time point. Primary reason for hospital admission, level of consciousness, severity of comorbid diseases and patient care complexity were also assessed. ResultsMost patients were male, older people, hospitalized for circulatory system diseases and had at least one comorbidity. On admission, a significant number of patients were alert (59.9%), at high risk for death (43.1%) and high dependent on nursing care (35.4%). Additionally, 92% patients were on polypharmacy on admission, versus 84.7% at hospital discharge (p = 0,0011). The occurrence of polypharmacy was independent of age (p = 0.2377). >17% of all drugs prescribed were high-alert medications, with no statistically significant difference between admission and discharge (p = 0,3957). There was no statistical evidence that the use of high-alert medications increases with age (n = 0,5426). ConclusionsThese results support the planning of multidisciplinary qualified actions for patients using NPFT.

Analysis of an Academic Medical Center’s Corrective Action Plan in Response to Fatal Medication Error Using the Institute for Safe Medication Practices’ Hierarchy of Effectiveness

Neuromuscular blocking agents (NMBAs) are high-alert medications that require special handling, necessitating a robust process that prevents medication error, identifies near misses, and ultimately protects patients from harm. One patient at a large academic medical center (AMC) was given vecuronium, a neuromuscular blocking agent, instead of midazolam, and died as a result. Thus, AMC was tasked by the Centers for Medicare &amp; Medicaid Services (CMS) to make a list of actions to prevent a subsequent incident. When assessing AMC’s corrective action plan in comparison to the Institute for Safe Medication Practices’ hierarchy of effectiveness of risk-reduction strategies, it was revealed that 76% of strategies were of low leverage, 16% were of medium leverage, and 8% were of high leverage. In this context, AMC’s corrective action plan should have integrated more system-based interventions, which include medium- or high-leverage strategies, rather than relying heavily on initiatives dependent on human action. Despite the lack of these systemic tools, CMS granted approval for the plan. Overlooking these systemic tools may amplify patient harm and negatively impact workforce satisfaction and efficiency. Moreover, the absence of a “just culture” also plays a role in patient harm. Therefore, recognizing that medication errors in healthcare are predominantly attributed to human error highlights the importance of fostering a just culture that advocates for system accountability to enhance patient safety.

Reducing insulin omission errors among patients with diabetes mellitus in general surgical wards: a best practice implementation project.

Omission of insulin, a high-alert medication with one of the highest locally reported errors, could lead to severe hyperglycemia, which could result in coma or death if not treated timeously. This study aimed to identify, evaluate, and implement strategies to reduce the occurrence of insulin omission errors in diabetic adult patients requiring insulin. This project followed the JBI Evidence Implementation Framework and conducted context analysis, strategy implementation, and evaluation of outcomes according to evidence-based quality indicators. The JBI PACES and JBI GRiP situational analysis tools were used to support data collection and implementation planning. There was one evidence-based criterion and five sub-criteria, with a sample size of 22 patients. There was increased compliance with best practices to reduce interruptions and distractions from baseline audit (50%) to follow-up audits 1 (45.4%) and 2 (31.8%), and no insulin omission incidences during the implementation period. In the post-implementation analysis, there were notable improvements in compliance with strategies related to nurses; however, reduced compliance was observed related to patients. Key barriers to implementation included patients still disturbing nurses despite the nurses wearing the medication vests and patients forgetting instructions not to disturb nurses during medication administration. Strategies to improve compliance included ensuring coverage in each cubicle during insulin preparation and administration, tending to patients' needs prior to insulin administration, and use of posters as reminders. There was an overall increase in compliance with best practice to reduce interruptions and distractions and no insulin omission incidences related to interruptions and distractions during the implementation phase. http://links.lww.com/IJEBH/A219.

Parenteral nutrition in clinical practice: International challenges and strategies.

Parenteral nutrition (PN) is an established therapy when oral/enteral feeding is not sufficient or is contraindicated, but nevertheless PN remains a complex, high-alert medication that is susceptible to errors that may affect patient safety. Over time, considerable progress has been made to make PN practices safer. The purpose of this article is to address ongoing challenges to improve the PN use process from prescription to administration and monitoring, and to outline practical aspects fostering the safety, quality, and cost-effectiveness of PN, as discussed at the International Safety and Quality of PN Summit. Opportunities to improve the PN use process in clinical practice include the promotion of inter-disciplinary communication, vigilant surveillance for complications, staff education to increase competency, and more consistent use of advanced technologies that allow automated safety checks throughout the PN process. Topics covered include considerations on PN formulations, including the value of intravenous lipid emulsions (ILEs), trends in compounding PN, the current and future role of market-authorized multi-chamber PN bags containing all 3 macronutrients (amino acids, glucose/dextrose, and ILE) in the United States and in Europe, and strategies to cope with the increasing global problem of PN product shortages. This review outlines potential strategies to use in clinical practice to overcome ongoing challenges throughout the PN use process, and ultimately promote PN patient safety.

Alteplase- and Tenecteplase-Related Errors and Risk Mitigation Strategies in the Treatment of Acute Ischemic Stroke: A Study of Event Reports From 52 Hospitals

Background: Alteplase and tenecteplase are thrombolytic agents used to treat patients with acute ischemic stroke (AIS). Despite the convenient bolus dosing of tenecteplase, its off-label use for AIS creates new patient safety challenges that are understudied. Methods: The study was conducted in two parts. In Part I, we queried the Pennsylvania Patient Safety Reporting System (PA-PSRS) database for event reports involving alteplase and tenecteplase that were submitted between 2017 and 2022. Based on results from Part I, in Part II we narrowed the query to reports submitted in 2021–2022 and applied inclusion criteria to identify reports that described a medication error involving the use of alteplase or tenecteplase to treat AIS. In Part II, all reports were reviewed and coded for stages of the medication-use process, associated factors, and event type. Results: Part I results (N=858) showed a decrease in reports of alteplase events and an increase in reports of tenecteplase events. In Part II (N=92), 52% of reports involved alteplase and 48% involved tenecteplase. Wrong dose was the most frequently coded event type for both medications at a combined 48%. Several tenecteplase-related events were attributed to unfamiliarity with the medication, confusion between indications, and incorrect use of the electronic health record (EHR) or failure to use the EHR, whereas many errors unique to alteplase occurred during the multistep calculation, preparation, and administration processes. Conclusions: Safety events involving alteplase and tenecteplase in the treatment of AIS are diverse. We present a list of potential strategies to prevent and mitigate errors involving these high-alert medications and encourage providers to adopt those that are meaningful to their workflow and practice setting.

Individualized parenteral nutrition guideline: the challenge of trace elements

Parenteral nutrition (PN) is one of the pharmacological therapies that makes it possible to save lives previously condemned to death. PN entered clinical practice in the mid-1960s and was one of the most important advances in medicine after the discovery of anesthetics, antibiotics, and antisepsis methods. PN, however, is not without risks, as it is considered a high-alert medication that involves a significant risk of harm when used incorrectly. PN is the most complex existing pharmacological preparation with 20 to 40 active ingredients, the process of its application being transdisciplinary and its safety dependent on individual competence and reliable performance in each of its stages. The correct, individualized, and safe prescription of trace elements represents one of the biggest challenges in this process.

Knowledge about Administration and Regulation of High Alert Medication among Nurses in Oncology Department

Background: High alert medications (HAMs) are associated with a higher risk of causing significant patient harm when used in error. Understanding the administration and regulation of these medications within oncology settings is critical due to the complex nature of cancer treatment regimens and the severity of potential medication errors. Objective: To assess the knowledge of nurses regarding the administration and regulation of high alert medications in an oncology department of a tertiary care hospital. Methods: A descriptive cross-sectional study was conducted among 133 registered nurses in the oncology department of Jinnah Hospital, Lahore. Data were collected using a structured questionnaire designed to evaluate nurses' knowledge of HAMs. Participants included both male (29.3%) and female (70.7%) nurses, with varying educational backgrounds and work experiences. Statistical analysis was performed using SPSS version 25, focusing on descriptive statistics such as frequencies, percentages, means, and standard deviations. Results: The results revealed moderate knowledge levels among nurses with significant gaps in critical areas. Only 20.3% correctly identified the protocol for fast IV push of 1:1000 epinephrine in mild allergic reactions, and 33.8% mistakenly believed that 10% calcium gluconate and 10% calcium chloride were interchangeable. Additionally, 44.4% incorrectly used 'Amp' or 'Vial' for dose expression instead of 'mg' or 'gm', and 53.4% failed to recognize the importance of distinctive labeling on look-alike drugs. Conclusion: The study highlights the need for enhanced educational programs and standardized protocols to improve the safe administration and regulation of HAMs in oncology settings. Strengthening nurses' knowledge and practices regarding HAMs is essential to reduce medication errors and improve patient outcomes.

Implementation of a pharmacovigilance system to detect adverse events and improve medication appropriateness in a hospital in Indonesia

Background: The growing elderly population has led to an increased occurrence of adverse drug reactions (ADRs) due to the various drugs they are prescribed, posing the problem of potential drug interactions. The application of causality instruments combined with trigger tools and the competency of healthcare professionals has yielded better results in detecting ADRs. Objective: To evaluate the implementation of a pharmacovigilance system to detect ADRs, potentially inappropriate medications, and potential prescription omissions. Methods: An observational, descriptive, prospective study was conducted over six weeks at one of the largest hospitals in Indonesia. The pharmacist and the physicians collaborated in reviewing patient medication records using the pharmacovigilance system. Results: The study enrolled 144 patients. The 163 positive triggers identified helped detect 28 Adverse Drug Events (ADEs) caused by at least one high-alert medication. These ADEs occurred in 25 patients. Additionally, 62 potentially inappropriate medications and 41 potential prescription omissions were detected. Conclusion: The pharmacovigilance system could reduce the frequency of ADEs caused by medications used in elderly patients.

Variables Leading to Usage of Alteplase Versus Heparin Lock in Patients With Tunneled Catheters in Hemodialysis Care Project Centers, Saudi Arabia.

A hemodialysis tunneledcatheter is one option for vascular access used with hemodialysis patients; however, catheter complications such as thrombosis are still inevitable. To prevent thrombosis formation, a catheter-locking solution is instilled between dialysis sessions. Heparin is used as a default locking solution in our Hemodialysis Care Project centers, while arecombinant tissue plasminogen activator (rt-PA) such as alteplase is used to treat suspected catheter thrombosis. This study aimed to identify the clinical factors, catheter brands, and hemodialysis variables that influence the choice of use for alteplase versus heparin, for those patients with tunneled catheters, and reduce overprescribing of high-alert medication alteplase. A retrospective medical chart review study was conducted involving 230 patients with tunneled catheters; the first group of 133 patients used alteplase regularly three times a week, while the second group of 97 patients completed at least one year using the same catheter access with heparin lock only. Multivariate logistic regression and logistic regression analysis showed a significant association (p < 0.05) between different variables. Results suggest that overweight and hyperlipidemia patients are more likely to use alteplase. Patients using brand-name catheters such as Hemostar/Vas-cath (BD, Franklin Lakes, NJ) are less likely to use heparin than those using Medcompcatheters (Medcomp, Yuma, AZ). In addition, patients having a history of angioplasty would be less likely to have heparin than no angioplasty. Moreover, if the patient's fluid removal were equal to or less than 2 kg, they would be more likely to use heparin and vice versa. The study postulates that identified variables affect whether alteplase or heparin is used in hemodialysis tunneled catheters, and may be useful to increase awareness, improve practices, or judiciously control the use of alteplase within Saudi Arabia and globally.

High Alert Medication Mitigation Strategies (HAMMS): A rapid realist review for assessing what works, how, and in what circumstances in a full service Irish acute hospital

Abstract Introduction All medications have the potential to cause harm; however, some are prone to cause more serious harm than others - titled “high-alert medications”. High-alert medications are identified from national/international consensus and from local patient incidents. Safeguarding of high-alert medications through mitigation strategies is complex and can represent a multi-faceted approach; international consensus, public guidance and local data inform interventions to reduce the risk of error. Realism can explore complex interventions, whereby rapid realist reviews are used when the evidence is required for a local intervention, and the results are not required to be relevant in other situations. Aim This rapid realist review aimed to present an evidence-informed approach of high-alert medication mitigation strategies within an acute hospital, how they work, why and the specific circumstances they work in. Methods Realist methodologies explores the context (C) of strategies/interventions (I) and the mechanisms (M) by which they operate to impact outcomes (O), which in this case is to reduce the risk of errors associated with high-alert medications. Audit data and stakeholder discussion informed the development of an initial programme theory. A rapid literature review across four databases was then conducted to test the initial programme theory, where evidence of how interventions work to reduce errors in specific contexts was extracted using Microsoft Excel®. Papers from initial rapid reviews and iterative searches were assessed by relevance and rigour through NVivo12® software, until theoretical saturation of the programme theory was reached, and the development of a modified programme theory occurred. Results Thirty-two papers were included in the final synthesis. Specific to the institution, employing redundancies, standardisation, warning labels and automation were the most commonly applicable interventions related to mitigating the risk of high-alert medications. Governance, confidence, limiting access and engagement, among other adaptive and responsive mechanisms are needed to facilitate these interventions. Influence is spread across organisational, ward and individual perspectives for increasing access to information. Based on audited data, insulin medication management represented a specific area for focus; therefore, a list of ten recommendations were drawn up using guiding principles from realist findings. Conclusion A suite of high- to low-leverage strategies related to high-alert medications, applied within specific contexts, could be adopted within the institutions current infrastructure. Further research is needed to evaluate the adoption of the strategies to determine their success and validate the data. Rapid realist reviews are useful methods in capturing complex interventions within specific institutions in a time-sensitive manner.

A prospective re-audit on insulin prescribing and administration practices in a university teaching hospital

Abstract Introduction Insulin is a high-alert medication which can cause significant patient harm if used inappropriately and has been identified as a significant medication safety concern in Galway University Hospitals. The first hospital-wide insulin review[1] was conducted in 2022 to evaluate insulin prescribing/administration practices and identify/develop quality improvements inclusive of: -The appointment of a senior pharmacist with a special interest in diabetes (June 2022), -An updated insulin record (November 2022; previous edition June 2019), -Development/implementation of a bespoke local eLearning module for the safe use of high-alert medications including insulin (March 2023), and -Continuous education on appropriate use for healthcare staff and patients/carers. Aim The aim was to conduct a similar insulin study to assess performance since the previous review, and develop further quality improvements as needed. Methods This study was conducted over one day in June 2023 on 24 wards by 26 interprofessional data collectors. Inclusion criteria comprised inpatients prescribed and/or administered insulin for the previous 72 hours. Exclusion criteria comprised non-admitted patients, short stay wards, critical care, maternity, and psychiatry. The protocol and tool were approved by the local Clinical Audit Committee, piloted with four inpatients, and communicated to all data collectors prior to commencement. Generated data were anonymous and securely stored. Data analysis was carried out using Excel by three independent researchers to confirm reliability of results. Results In total 557 inpatients were reviewed, of which 21% (116/557) had diabetes and 10% (56/557) were prescribed insulin. Nearly three-quarters (73%; 41/56) were prescribed a meal-time supplement, whilst 68% (38/56) were prescribed regular insulin – of which 63% (24/38) comprised prescribing errors, an improvement from 78% (32/41) in 2022. Administration errors comprised 84% (32/38) of records, similar to the 88% (36/41) error rate observed in 2022. Approximately one-fifth (21%; 8/38) of insulin orders were not signed by a prescriber, compared to 12% (5/41) the previous year. More than nine out of ten prescribers clearly documented the correct insulin name, dose, and administration times, and 71% (27/38) documented a medical council registration number, bleep, or name for contact purposes, compared to 59% (24/41) the previous year. Failure to document administration times was noted in 42% (16/38) of instances compared to 46% (19; n=41) the previous year. Insulin was not double-checked by a second independent individual in 21% (8/38) of cases, compared to 29% (12; n=41) in 2022. Conclusion Results have identified an overall practice improvement. Building on recent interventions implemented and incorporating newer strategies will aid in enhanced insulin use. An updated version of the insulin record has been implemented due to the recent discontinuation of the referenced perioperative fluid and the introduction of non-referenced blood ketone monitors. High leverage strategies such as ePrescribing is a current consideration to standardise practices. Conducting a study over a longer period may identify further trends. Strengths include study robustness, interprofessional collaboration, and transferability to other hospitals. Disseminating results and promoting benefits should encourage Irish hospitals to participate in a standardised national annual review to optimise patient care.

A prospective audit on adult thromboprophylaxis and therapeutic anticoagulation prescribing and administration practices in Galway University Hospitals

Abstract Introduction Anticoagulants are high-alert medications that can cause significant patient harm if used inappropriately.[1] These preparations have been identified as a significant medication safety concern in Galway University Hospitals and are one of the most frequently reported medication incidents in Ireland.[2] A key performance indicator agreed by the local Medication Safety Subgroup and Drugs and Therapeutics Committee was to conduct an anticoagulation audit against local guidelines to identify patterns and develop quality improvements. Methods A prospective audit was conducted over six weeks from September to November 2022 by five interprofessional data collectors using a data collection tool and accessing drug records and clinical notes. Development of the tool was guided by national[1] and local guidelines as well as design input from local expert specialist doctors and pharmacists. Adult inpatients on all wards receiving thromboprophylaxis (after 24 hours of admission) or therapeutic anticoagulation were included. Paediatrics and psychiatry were excluded. The protocol and tool were approved by the local Clinical Audit Committee, piloted with three inpatients, and communicated to all data collectors prior to commencement. Generated data were anonymous and securely stored. Data analysis was carried out by two independent researchers to confirm reliability of results. Results A total of 242 inpatients were audited on 26 wards: -Patients prescribed thromboprophylaxis (52%; 126/242). -Patients prescribed therapeutic anticoagulation (26%; 63/242) -Patients not prescribed anticoagulants (22%; 54/242) Most patients (92%; 216/234) did not have a thromboprophylaxis risk assessment form completed/signed. Nineteen patients (35%; n=54) not prescribed thromboprophylaxis or therapeutic anticoagulation should have been prescribed anticoagulation. High compliance with guidelines (&amp;gt;80%) included: i) anticoagulants prescribed in correct section of drug record, ii) appropriate agents prescribed, iii) correct dose and frequency, iv) few dose delays and omissions, and v) indication mostly documented. Low compliance with guidelines (&amp;lt;35%) included: -Patient height and weight not documented: unable to calculate creatinine clearance to determine accurate dose. -Incorrect administration times for once daily therapeutic dosing (should be in morning to facilitate surgery next day) and twice daily dosing (mostly 8am and 10pm = gap of 14 hours and 10 hours). Conclusion Results have identified varying levels of compliance with local anticoagulation guidelines. To date, there has been continuous targeted education and training on appropriate anticoagulation use for doctors, nurses, and pharmacy staff inclusive of the development and implementation of a new bespoke eLearning module for high-alert medications (which includes the appropriate use of anticoagulants specific to Galway University Hospitals). High leverage strategies, such as electronic prescribing, is a current consideration to standardise practices. Strengths include study robustness, interprofessional collaboration, and transferability to other hospitals. Perhaps reducing the scope in a re-audit which will be conducted in 2024 to identify any improvements in medication safety and patient care with these agents may allow for further in-depth analysis.

Traditional Health Education Versus Clinical Supervision Model: Effect on Pediatric Nurses' Adherence to High Alert Medication Safety

Traditional Health Education Versus Clinical Supervision Model: Effect on Pediatric Nurses' Adherence to High Alert Medication Safety