Nurses in medicines management, pharmacy services and ward management at Leeds Teaching Hospitals NHS Trust introduced a new system so that experienced patients with cystic fibrosis (CF) had more involvement in their intravenous (IV) therapy in hospital.
Where to look
Experienced patients within the CF unit were very concerned that when they were inpatients, they had little involvement in their IV therapy. This was an unwarranted variation in the approach to person-centred care, as at home they were managing their own IV therapy. Staff were spending huge amounts of time during their shifts in a clinical room preparing IVs and not seeing the patients. The ward averages 70 IVs per day for ten patients, all in source isolation rooms.
What to change
People with CF who would readily do their own IVs in the community didn’t have the same autonomy when in hospital. Their routines would be changed to fit prescribing and administration routines, and large portions of nurses’ working days were in a treatment room, rather than delivering care. Nurses recognised a need to change practice, to benefit both them and their patients.
How to change
CF patients were surveyed to test their appetite for being the ‘second checker’ for their IV therapy and were mainly positive about the idea.
Working with the ward nursing management team, the Project Nurse and Head of Nursing for the Trust’s Medicines Management and Pharmacy Services implemented a new process in which experienced CF patients:
- Identify, check and watch the reconstitution of their medicines;
- Are involved in the positive patient identification process;
After this process, the medication is administered. To support the change, the nurses created new documentation, including a consent sheet, information about the process and responsibilities for the patient if they are involved in it.
Opportunities are now being sought to implement a similar process in other parts of the Trust, such as for long-term parenteral nutrition and oncology patients.
Better outcomes – There have been no adverse medication incidents since the new process, which truly engages the patients in their own care, was introduced. Indeed, there have been some anecdotal reports of a patient stopping an incident by identifying incorrect medication or medication they were allergic to.
Better experience – Patients are empowered to take an active role in their care. Working together, doses are given safely and appropriately at times that suit the patient. A post-implementation survey has shown that both staff and patients are very positive about the new process. Patients have reported that they have their autonomy back, no longer feel guilty about taking nurses’ time, and are more confident around their medications if they are fairly new to IVs at home.
Better use of resources – Resources are utilised more efficiently, releasing more time for other nursing care and assessment. Nurses have more patient contact time, because multiple IVs can be drawn up and administered at once. This process is also using patients’ current skill sets to improve safety.
Challenges and lessons learnt for implementation
Initially, some ward staff were sceptical about potential risk and the responsibility they were taking on. It was important to communicate clearly and explain the mitigations in place. Earlier engagement with staff might have averted some of the anxiety about what was a significant change in working practice.
Find out more
For more information contact:
- Alexander Jones, Project Nurse, Medicines Management and Pharmacy Services, firstname.lastname@example.org