1026 / Electronic monitoring to reduce medication errors and harm in oncology therapy

SPAIN
Classification of the PSP
Type of Patient Safety Practice Not Evaluated
 
Clinical Practice (CP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Medical devices / Equipment
Patient identification There is no specified text here
Topic of the reported practice
Quality improvement project
Aim and the benefit of the Patient Safety Practice
 
One of the recommendations to reduce medication errors and harm in oncology therapy is to use the “five rights”: right patient, right drug, right dose, right route, and right time. There are a number of factors (many patients, labor interruptions, complexity of treatment protocols, variety of routes, use of mechanical or vascular access devices) that may interfere with a nurse’s ability to complete these functions. Because of this it is easier to follow the clinical practice rules to produce these outcomes than to have the duty to achieve them.
Description of the Patient Safety Practice
 
The clinical practice has an interdisciplinary design, focused on the patient with care provider integration and workflow.
Patients come to the day care hospital and receive information on clinical practice to keep them involved in the process. Workflow is explained and doubts are clarified. Nurse fit the wristband to patient checking that is the right one through two questions. Every time the nurse administers a mixture, scans the wristband and the label of the bag by using a mobile device (PDA). The software SAVE® matches patient-drug and ensures the compliance of the “five rights”. If an incidence is detected the system will alert the care provider to avoid the mistake.
Nurses register symptoms, clinical signs, clinical observations or assessment performed during administration from the PDA (in situ). Information is available to any health provider.
The monitoring screen provides any care provider with real-time information about the administration status of all patients. This promotes communication between professionals.

We spend 3 months to meet the meaningful use of the administration system by scanning the barcode:
- Implementation of Oncofarm ® software and installation of WIFI in the Oncology Day Care Unit (technological compliance requirements) (one month)
- Adaptation of the database and the usual workflow of nurses (one month)
- Test period. Design changes and improvements (one month)
Attachment of relevant written information and/or photos, as appropriate
2014031402574822106_WP4_Triptico explicativo al paciente.pdf
Patient leaflet PASQ.pdf
Lecture_National Royal Academy of Pharmacy.pdf
There is no specified text here
Effectiveness of the Patient Safety Practice
 
Degree of implementation of reported practice
Yes, fully
Level of implementation of reported practice
Unit or ward level
Specific and measurable outcome for the reported practice were defined
Yes
A baseline measurement before implementation of the reported practice was obtained
No
A measurement after full implementation of the reported practice was obtained
Yes
Evaluation of a "positive" effect of the reported practice on Patient Safety
The evaluation showed improvements in Patient Safety outcomes
Type of before-and after evaluation
Both/mixed (qualitative and quantitative)
Enclosure of a reference or attachment in case of published evaluation's results
Seguridad del paciente Oncológico: Innovación tecnológica en la cadena terapéutica. RANF. ISBN 978-84-938172-2-0. Ano 2011
There is no specified text here
Health care context where the Patient Safety Practices was implemented
 
Hospital
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
Patient Involvement
 
Direct service user's involvement as integral part of this Patient Safety Practice
Yes
Specification of the service users or their representatives' involvement in the implementation of this Patient Safety Practice
Patient(s)
Point of time in which service user or their reprasentatives' involvement takes place
During the application of the Patient Safety Practice
During the evaluation of the Patient Safety Practices
Active seeking of service users' opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
Yes
Short description of the service users' level of involvement
Consultation, such as asking for information
Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
Yes
List of sources where public information is accessible
PSP leaflet created by the health care staff involved
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.
Yes
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
Other
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
No
Description of used incentives, if any.
There is no specified text here
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
Yes
Total number of person days required to implement this Patient Safety Practice
Clinical staff: 20
External consultants: 6
Support staff: 6
Managerial staff: 0
Others: 0
Not relevant: 0
Total number of person days required for training as preparation for implementation of this Patient Safety Practice
Clinical staff: 16
External consultants: 4
Support staff: 4
Managerial staff: 0
Others: 0
Not relevant: 0
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
30.000
Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice
0
Contact information
 
Name: Alicia Herrero Ambrosio
Country: SPAIN
Organisation: Hospital Universitario La Paz (Madrid)
E-mail: aherreroa@salud.madrid.org
Phone: 34-917277396
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