Medication Administration and Prevention of Errors
- : Brisbane City QLD 4000
The Australian Commission on Safety and Quality in Health Care (ACSQHC) has identified a range of areas as priorities, which have been included in the National Safety and Quality Health Service Standards (NSQHS Standards). These Standards are being implemented across public and private healthcare organisations and are used in accreditation. It is important that all nurses become familiar with these Standards, how they relate to minimising risk, and how they affect everyday practice. This seminar provides access to current information where the medication aspect of the Standard can be fully understood and discussed.
Need for Program
The Australian Commission on Safety and Quality in Health Care (ACSQHC) has identified a range of areas as priorities, which have been included in the National Safety and Quality Health Service Standards (NSQHS Standards). These Standards are being implemented across public and private healthcare organisations and are used in accreditation. It is important that all nurses become familiar with these Standards, how they relate to minimising risk, and how they affect everyday practice. This seminar provides access to current information where the medication aspect of the Standard can be fully understood and discussed.Purpose of Program
The purpose of this program is to offer an opportunity for all nurses to familiarise themselves with current best practice in regard to the safe handling of medicines.Learning Outcomes
At the conclusion of this program it is expected that the participants will be able to:
8:30am - Registration and Refreshments
9:00amMedicines - Warm Up - Test Your Knowledge
How up to date are you? Are you practicing safe medication administration? This introductory session will give you a chance to reflect on your practices and knowledge to set the scene for the two day seminar.
9:20amQuality Improvement - Standards for Healthcare
Over the last decades, healthcare quality and patient safety have been major targets for improvement. Australian Commission on Safety and Quality in Health Care (ACSQHC) has identified a range of areas as priorities and which have been included in the National Safety and Quality Health Service Standards (NSQHS Standards). These Standards are compulsory for the majority of public and private healthcare organisations and are used in accreditation. This session will explore the NSQHS Standards and their implications for nurses.
10:00amThe Facts about Medication Incidents
Medication incidents usually occur due to a breakdown in systems. The focus of this session is the NSQHS Standard related to medication safety. This interactive session will provide you with an opportunity to participate in identification of, and experiences with the many situations which impact on the safety of medication administration. For example:
- Wrong medication, frequency, route, time, patient; omissions
- Poor documentation - allergies, unclear orders
- Technology and what can go wrong
- Interruptions, tiredness
- Lack of education/competence
- Communication about medicines
10:30am - Morning Tea and Coffee
11:00amA Look at Best Practice Systems for Medication Safety
Medicine safety starts with mechanisms for safe prescribing, dispensing, supplying, administering, storing, manufacturing, compounding and monitoring of the effects of medicines. This session will look at:
- The role of the Therapeutic Goods Administration (TGA) and the Advisory Committee on Prescription Medicines
- A look at processes for a safe system within health systems – technology, labelling, storage
- Medicines Management pathway
- Managing high risk medicines e.g. insulin, potassium, chemotherapy, anticoagulants (PINCH)
- Antibiotic stewardship and the nurses’ role
- VTE prophylaxis
- Studies that have been undertaken into medication errors
12:00pmNear Miss or Sentinel Event?
Identifying and reporting critical incidents is essential for safety and quality in healthcare. Quality improvement requires an approach that includes:
- Understanding critical incidents
- Reporting incidents
- Root cause analysis
This session will examine compliance, and discovering what went wrong when an adverse event has occurred.
1:00pm - Lunch Break and Networking
2:00pmMaintaining Safe Practice – Case Scenarios 1
Using case scenarios, current principles and actions to maintain standards and safe practices will be identified in this topic:
- Contraindications and drug interactions
- Right dose, dosage adjustments
- Accurate calculations
- Technology safeguards
- Communication, questioning prescriptions
3:00pm - Afternoon Tea and Coffee
3:15pmTroubleshooting – Common Overlooked Problems
This final session of day one will bring to your attention some common, yet overlooked aspects of medication safety. Includes:
- Brand and generic name confusion
- Common problem food and drug combinations
- Treating adverse effects with more medications
- Poor consumer health literacy
4:00pm - Close of Day One of ProgramDay Two
9:00am - Commencement of Day Two
9:00amPatients Most at Risk: Who are the Most Vulnerable?
As the Australian population ages and multiple chronic diseases are prevalent, people are more likely to be prescribed complex combinations of medicines. This causes a number of risk factors to emerge, which include, but are not limited to:
- Adverse drug interactions – what are the most common?
- Ensuring there is a seamless continuum of care between hospital-residential care facility and discharge back to the community
- Poly-pharmacy and the appropriate use of medicines
- A look at medicine delivery systems – e.g. which containers are best used for those with arthritis?
This session will include a series of case scenarios to challenge your skills.
10:30am - Morning Tea and Coffee
11:00amThe Importance of Auditing
Audits are necessary for analysing areas of risk. All nurses need to understand the significance of audits especially as healthcare is moving increasingly towards data driven practices. In this interesting session you will find out:
- How should a medicine audit be performed?
- Which staff should be involved?
- How are parameters for the audit set?
- What documentation is essential?
- The time an audit can take to perform
This practical session will include examples of medication risk audits.
12:00pmSlip-Sliding Away - Medicines and Falls
The link is not always made between falls and medications. As there is a known morbidity associated with falls it is essential that you as a nurse, are very familiar with this particular area of risk. In this special short session we will look at the correlation between a person falling to the ground and typical medicines that could be implicated.
- A review of the evidence that associates medicines with falls
- What drugs are associated with falls
- What can be done to prevent this?
- Rules for prescribing
12:30pm - Lunch Break and Networking
1:30pmCase Scenarios 2 – Prevention
This interactive session will use several case scenarios to analyse and identify strategies and protocols to prevent a broad range of problematic situations that you may encounter in day-to-day activities. It will draw on the content of the seminar and include examples of:
- Right route etc.
- Swallowing difficulties - which medications can be crushed?
- Pregnancy and breastfeeding – special considerations
- Older people
- IV infusions
2:15pmCase Scenarios 3 – Action to Take When an Error Occurs
In this interesting case scenario you will be taken through two situations where a drug error occurs. You will be shown what action should be taken and when. Speed of detection and immediate action will be highlighted as will the necessary documentation. Session includes:
- Identifying the error
- What is the immediate action to take?
- What patient notification should occur and when?
- Who else should be notified
- How should you communicate with the person who administered the medicine?
- What documentation should be made?
This session will also look at how this relates to the audit which will now need to be performed to prevent a recurrence of the incident.
3:00pm - Afternoon Tea and Coffee
The internet is a hive of all sorts of information about medicines. However, it is important that nurses refer to sites that are absolutely credible. This short session will enable you to:
- Find the most credible sites quickly
- Ensure they relate to Australian standards and guidelines
3:30pmWrap Up – So What Have You Learned?
This session will follow up on the quiz presented at the beginning of day one and will include a final discussion as an opportunity to test your learning.
4:00pm - Close of Seminar and Evaluations
Anne Leversha is a Senior Lecturer at Monash University in the Faculty of Medicine, Nursing and Health Sciences and the Faculty of Pharmacy and Pharmaceutical Sciences. Her experience includes Director of Pharmacy at Latrobe Regional Hospital, Traralgon, where she has been a practising clinical pharmacist. She was a member of the Victorian Medicines Advisory Committee and is a Fellow of The Society of Hospital Pharmacists of Australia (SHPA) and a trained shpaclinCAT (clinical competency assessment) evaluator. She is also the chair of the Australian Clinical Education Preparation Program Management Team, which developed and provides an online program. Anne has presented and conducted seminars and workshops in national and international conferences and forums. She has published on topics including: improving medication safety, with articles on high risk medicines alerts, drug allergy documentation and clinical pharmacist interventions; the rural pharmacy workforce; pharmacists’ contribution to medical education and rural issues in pharmacy education.