34th International Symposium on Intensive Care and

Critical Care 2014, Volume 18 Suppl 1 http://ccforum.com/supplements/18/S1

M E E T I N G A B S T R AC T S

34th International Symposium on Intensive Care and Emergency Medicine Brussels, Belgium, 18-21 March 2014 Published: 17 March 2014 Publication of this supplement has been supported by ISICEM.

P1 Minimising prescribing errors in the ICU DJ Melia, S Saha Queen’s Hospital, Romford, UK Critical Care 2014, 18(Suppl 1):P1 (doi: 10.1186/cc13191) Introduction We aimed to audit the prescribing practice on a busy 14-bedd general ICU, and develop standardised practices and tools to improve safety. Prescribing errors occur as commonly as in 10% of UK hospital admissions, costing 8.5 extra bed days per admission, and costing the National Health Service an estimated £1 billion per annum [1]. The majority of these mistakes are avoidable [2]. Methods We audited the daily infusion charts of all patients in three separate spot checks, over 1  week. We assessed all aspects of prescriptions that make them legal and valid, in accordance with national guidance [3]. New procedures were introduced, which included a standardised prescription sticker, with common, preprinted, infusion prescriptions on (noradrenaline, propofol, and so forth), and education on using the new prescription stickers. A month later the audit process was repeated. Results We assessed 129 prescriptions in the first round, and 111 after intervention, demonstrating a 70% improvement in safe prescribing. Only 24% of prescriptions initially fulfilled best practice criteria, improving to 94% afterwards. We also reduced the number of infusions running without prescription, 7 (6%) versus 24 (19%). See Figures 1 and 2. Conclusion Our audit supports the need for standardised prescribing practices within critical care, especially when dealing with potentially harmful vasoactive/sedative drugs. With a small, cost-effective intervention (£20 for 6,200 stickers), we improved prescribing accuracy, and thus patient safety in intensive care.

Figure 2 (abstract P1). Accuracy of prescriptions after intervention.

References 1. 2.

3.

Vincent et al.: Adverse events in British hospitals. BMJ 2001, 322:517-519. Building a Safer NHS for Patients: Improving Medication Safety [http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/ Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/ DH_4071443] Safe Prescribing [http://www.medicalprotection.org/uk/england-factsheets/ safe-prescribing]

P2 The Limpet controlled drug cabinet alarm and camera M Mariyaselvam, D Pearson, P Moondi, P Young Queen Elizabeth Hospital NHS Trust, Kings Lynn, UK Critical Care 2014, 18(Suppl 1):P2 (doi: 10.1186/cc13192)

Figure 1 (abstract P1). Accuracy of prescriptions before intervention.

© 2010 BioMed Central Ltd

© 2014 BioMed Central Ltd

Introduction The theft and tampering of controlled drugs (CDs) remains a prevalent patient safety issue. Sadly there are numerous reports of critical care staff stealing CDs for personal use or financial gain and notably there have been some cases where CDs have been substituted for other medications in order to delay detection of the theft. This creates both the hazard of medication errors and potentially exposes patients to opioid intoxicated healthcare workers. As most critical care staff have access to CDs, when drugs are found to be missing it can be difficult to identify the perpetrators. Therefore the implementation of a deterrent which also improves the methods of detection is warranted. Methods The Limpet, a device which incorporates a proximity sensor and a camera unit, was installed within the CD cupboard of the critical care unit. Whenever the cupboard was accessed the date and time were recorded and a photograph was taken to identify the staff member. Mock thefts were subsequently undertaken by a designated staff member at random times. This allowed testing of the product to determine the number of times the ‘thief’ was correctly identified.

Critical Care 2014, Volume 18 Suppl 1 http://ccforum.com/supplements/18/S1

Results Mock thefts were successfully accomplished on six occasions over a 4-week period. On each occasion the Limpet photographed the ‘thief’ and recorded the date and time of access. Therefore, in the event of a real theft it would be possible to quickly and easily indentify the culprit. Conclusion When CDs are missing it can be extremely stressful for the staff involved. Those who have access to CDs may feel unfairly scrutinised and the potential for false accusation exists. Investigating the theft of CDs is costly and usually involves pharmacists, managers and the police. Until the issue is resolved, potential suspects are usually suspended from work, leading to disruptions in patient care. The utility of the Limpet in modifying staff behaviour by reducing the number of occasions and the duration of time that open drug cupboards are left unattended, has previously been demonstrated [1]. By providing the facility to determine exactly who accessed each CD cupboard at which time, this initial study has shown the benefits of the Limpet as a tool for detecting theft. Therefore the installation of the Limpet mitigates the difficulties of investigating CD theft and is likely to prove an effective deterrent. Reference 1.

The Limpet drug cabinet alarm: technology for safer drug stewardship [abstract and poster presentation]. Presented at International Forum on Quality and Patient Safety; April 16-19 2013; London.

P3 Role of pharmacist in multidisciplinary pediatric intensive care rounds: a retrospective descriptive study S Tripathi, K Graner, K Fryer, G Arteaga Mayo Clinic, Rochester, MN, USA Critical Care 2014, 18(Suppl 1):P3 (doi: 10.1186/cc13193) Introduction Multidisciplinary rounding practices in the ICU have now become the standard of care in most institutions. Few objective data are available, however, on the value each individual member of the team brings to the patient care. In our institution, pediatric pharmacists have been an integral part of the PICU rounds since 2002, although their role has evolved over the course of years. This study was undertaken with the primary aim of identifying the impact of pharmacist involvement in PICU rounds, with respect to changes in therapy. Methods Since January 2003, pharmacists have recorded their clinical interventions and outcomes of those interventions in an institutionally developed Pharmaceutical Care database (P-Care). An intervention is defined as any recommendation the pharmacist makes to the patient care team regarding a change in the patient management or medication therapy. P-Care is designed to assist the pharmacist to optimize medication therapy, identify medication-related problems, decrease medication costs, improve pharmacist efficiency and document pharmacist workload. Data concerning pharmacists’ interventions were extracted from the P-Care database in yearly increments via a reporting functionality that is available in the P-Care system. This study was exempted for review by the Mayo Clinic IRB. Results From 1 January 2003 through 31 December 2012 pharmacists made 24,207 clinical interventions in the PICU and 19,252 of those interventions resulted in changes in medication therapy or therapy monitoring. Interventions that were accepted by the team involved 10,361 (53.8%) drug dosing regimen changes, 292 (1.5%) drug interactions or incompatibility, 969 (5%) drug monitoring suggestions, 1,665 (8.7%) drug routes/methods of administration, 3,895 (20.2%) drug selections, and 2,070 (10.8%) medication profile/order clarifications. As the pharmacist role on the PICU multidisciplinary rounds has evolved, the number of interventions has increased from 1,643 in 2003 to 3,799 in 2012. Of the 19,252 interventions that were implemented, 304 were deemed to be of potentially life-threatening consequences, 10,767 had a moderate impact, and 8,181 had minimal impact on patient outcome. Conclusion To our knowledge this is the largest reported data on pharmacist’s involvement in pediatric intensive care. This can serve as background knowledge on implementing measures on novel methodologies to integrate pharmacists in intensive care practice.

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P4 Improvement in the identification and management of inadvertent hypothermia in the critically ill: an audit cycle J Barnes, R Darke, A Irving, S Wright Freeman Hospital, Newcastle upon Tyne, UK Critical Care 2014, 18(Suppl 1):P4 (doi: 10.1186/cc13194) Introduction The purpose of this study was to assess our practice in identifying and managing inadvertent hypothermia and whether this could be improved by education and introduction of a protocol. Hypothermia is associated with multiple physiological abnormalities including reduced myocardial contractility, peripheral vasoconstriction, increased infection risk and impaired coagulation [1]. Inadvertent hypothermia may therefore be an avoidable risk factor in the critically ill. The UK National Institute of Clinical Excellence has issued guidance for avoidance of inadvertent hypothermia (temperature