627 / Safety improvement of emergency medicine cabinets and resuscitation trolleys at primary health care centers

SPAIN
Classification of the PSP
Type of Patient Safety Practice Not Proven Effective
 
Clinical Practice (CP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Medication / IV Fluids
There is no specified text here There is no specified text here
Topic of the reported practice
Quality improvement project
Aim and the benefit of the Patient Safety Practice
 
In primary health care centers, medication for patients requiring in situ treatment is stored in emergency medicine cabinets and resuscitation trolleys. The purpose of this practice is to establish and diffuse to all centers general practices standards for the correct maintenance and supervision of this medication and to prevent the occurrence of medication mistakes that can affect the patient.
Description of the Patient Safety Practice
 
Rules are developed for conservation, placement, identification and control of expiration dates of medications in health care centers, to avoid incurring into a medication mistake that can affect the patient.

It provides that the person responsible for medication in the center must perform a monthly review that will be reflected in a specific form "Verification of the rules of use and maintenance of medication in health care centers."

Rules applicable to all those who make use of the medications from the health care center and for those responsible for its maintenance:

1. - The medicine cabinet should be placed in a clean, dry location and protected from direct light or heat, to avoid accelerated deterioration of medications.

2. - In the case of medication which is stored in boxes, it must be labeled with the active substance, dosage and pharmaceutical form. There will be a sufficient quantity of boxes for each active substance, dosage and pharmaceutical form, which will be alphabetically sorted by ACTIVE SUBSTANCE. Two presentations of the same active substance must not coexist in the same box (eg, amoxicillin capsules and sachets; amoxicillin 250 mg and 500 mg).There must not be unlabeled boxes containing any medication.

3. - Drugs that cannot be packed in a box due to its large size, will be arranged in a suitable container near the medicine cabinet and will be correctly identified.


4. - Conversion lists from active substance to trade name identifying photosensitive, thermolabile and psychotropic medications will be placed in a visible location next to the boxes

5. - The medicine cabinet will not contain medications not included in the catalog and not having been supplied by the Pharmacy Department of Primary Care. In no case labs free samples or medication from patients will be stored.

6. - Medication should not be located in the office, out of the medicine cabinet, to guarantee correct control and preservation.

7. - Expired medication must not remain in the medicine cabinet. Lots expiring first, should be placed ahead of the ones with later expiration dates in each box. Expired medication or medical devices will be removed from the medicine cabinet and placed in specific well-identified container for collection.

8. - Photosensitive medication must be protected from direct light. They must remain in their original boxes and if that is not possible, they must be covered with a protective element. Thermolabile drugs must be stored under refrigeration (2-8 ° C) in a refrigerator, which will have a maximum and minimum thermometer. The minimum and maximum reached temperatures will be checked daily at the beginning and at the end of the day, and registered at the temperature graph.

9. - Ophthalmic solutions must be labeled with the opening date. It is estimated that eye drops can be used without risk of contamination for 15 days when stored in the closed container.

10. - Some medications come in compact blisters. It must be kept in its original container and, when necessary, delivered to patients by installments. It will be checked that the separate units for delivery are identified in a perfectly clear and legible form with medication name, dose, lot number and expiration date.

11. - Special care must be taken to cut the medication to be delivered, keeping in the medicine cabinet the area where the expiration date appears and that this part will the last to be used.


Attachment of relevant written information and/or photos, as appropriate
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Effectiveness of the Patient Safety Practice
 
Degree of implementation of reported practice
Yes, fully
Level of implementation of reported practice
Regional or national level
Specific and measurable outcome for the reported practice were defined
Yes
A baseline measurement before implementation of the reported practice was obtained
Yes
A measurement after full implementation of the reported practice was obtained
Yes
Evaluation of a "positive" effect of the reported practice on Patient Safety
Effect not known or the intervention has not yet been evaluated
Type of before-and after evaluation
Quantitative
Enclosure of a reference or attachment in case of published evaluation's results
There is no specified text here
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Health care context where the Patient Safety Practices was implemented
 
Primary care
Community care facility
Transferability
 
Successful implementation of this Patient Safety Practice in other health care settings than above stated
No
Specification of implementation in another health care setting(s)
There is no specified text here
Successful implementation's level  of this Patient Safety Practice across settings
There is no specified text here
Involved health care staff
 
Physicians
Nurses
Health care assistants
Pharmacists
Clinical manager
Risk manager
Patient Involvement
 
Direct service user's involvement as integral part of this Patient Safety Practice
No
Specification of the service users or their representatives' involvement in the implementation of this Patient Safety Practice
There is no specified text here
Point of time in which service user or their reprasentatives' involvement takes place
There is no specified text here
Active seeking of service users' opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
There is no specified text here
Short description of the service users' level of involvement
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Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
No
List of sources where public information is accessible
There is no specified text here
Implementation of the Patient Safety Practice
 
Existing collaboration with other countries or international organisations related to implementation of this Patient Safety Practice
No
Problems encountering in the implememntation course of this Patient Safety Practice like lack of motivation, no management support, etc.
Not known or not relevant
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
There is no specified text here
List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
There is no specified text here
Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
Yes
Description of used incentives, if any.
Safety aspects collected in this safety practice are included in the organization’s strategies. The safety practice compliance is also an objective included in the 262 primary health care centers annual management contract and it’s linked to receive annual economic incentives.
Existence of support or approval by the clinical or hospital management or any other hihg level authority in the implementation process of this Patient Safety Practice
Yes
Costs of the Patient Safety Practices
 
Completion of cost calculation related to this Patient Safety Practice
No
Total number of person days required to implement this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total number of person days required for training as preparation for implementation of this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
There is no specified text here
Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice
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Contact information
 
Name: Dolores Martinez Patino
Country: SPAIN
Organisation: Gerencia de Atención Primaria, Madrid
E-mail: mmartinezp@salud.madrid.org
Phone: 0034913221501
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