Elizabeth Holland, Clinical Audit and Effectiveness Nurse at George Eliot Hospital NHS Trust, discusses using the Medication Safety NHS Safety Thermometer and how it has impacted her trust.
What services do you provide at George Eliot Hospital NHS Trust?
We are an acute hospital trust in Nuneaton with around 320 beds including maternity. We took part in the original Safety Express which is how we ended up being involved in the ‘Classic’ and now the Medication Safety NHS Safety Thermometer.
How did you first start working with the Medication Safety Thermometer and what were the challenges?
My Director of Nursing brought it to my attention and said that I was the perfect person to take it on as I had done a lot of work on the ‘Classic’, which gave me a good understanding of how the Safety Thermometer works.
On the ‘Classic’ we did a lot of work adapting it and educating our nurses so they understood why we were doing it. For the Medication Safety Thermometer the challenges were similar – educating people so they understand why they’re doing it, getting buy-in from the staff and making sure it is all done on time.
How have you implemented the Medication Safety Thermometer?
We started testing on a 27 bed medical ward with me, a pharmacist and a couple of colleagues. This trial run allowed us to get a feel for the paperwork and the process; I then adapted this slightly so that when we next tested it was much smoother. In the next test, we did it with the ward manager and a pharmacist, so that we got buy-in from them and they understood why we were doing it. The response we had was really positive and they helped massively with feedback for the form.
In December we then expanded to 4 wards overall, 2 medical and 2 surgical. We adapted the sheet so that all of the patients fitted onto one – which the teams really liked – but they still had the 3-page form as a guide. Now we are on to 6 wards including all of our surgical wards.
How have you used the data?
Originally I was inputting it into the online Survey Monkey and also into my own Excel copy, so I could produce some graphs. I would then produce a two page report to show them simple things such as how many people had been surveyed and what had been good and bad.
I have now developed this into a dashboard which matches the one from the ‘Classic’ – this will help people to understand it easier as they are more familiar with the layout and style.
We are now working on what exactly we need to measure, so we can decide what we want to try and improve on. With the ‘Classic’ it is simpler as you have got the four harms but with Medication Safety there are a lot more measures. We are currently looking at things like allergies, reconciliation and mis-dosages. Also we need to find out who we are targeting the data at, it could be doctors, nurses or pharmacists.
What tips would you give to other organisations using the Medication Safety Thermometer?
Feedback is absolutely crucial to the staff who are carrying out the Medication Safety Thermometer. It could be a newsletter, it doesn’t have to be pretty graphs or dashboards, just telling people the basic facts and figures gets much more buy-in than if you don’t feedback anything. The teams will then feedback to you, which is also essential. One of my nurses came back and said you know we have got omitted doses but do you know we are a surgical ward and have patients who are nil by mouth? I then told her that it is categorised differently and she was happy. But that communication between teams is key.
What advantages have come out of using the Medication Safety Thermometer?
One of the major positives has been the joint working between my team, the pharmacy team and the wards. This has brought those teams much closer and the buy-in and feedback has definitely improved because of it. The pharmacy and nursing teams have been very accommodating in moving shifts around to make sure the work gets done.
I am pleased to have the opportunity to influence the Medication Safety Thermometer process and I am particularly proud that the single audit I developed at the George Eliot has been adapted to use nationally.
Another plus point has been the fact that I now get sent my raw data from the Safety Thermometer team – which has allowed me to put together dashboards and use the data in different ways.
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