Authors (including presenting author) :
Li OME (1)(2), Chan ONW(1)(2), Cheung YP(1)(2), Ho YP(1)(2), Ho TL(1)(2), Wong WKK (1)(2)
Affiliation :
(1)Operating Theatre and Theatre Service Center (2)Princess Margaret Hospital
Introduction :
Medication error was emphasized and became departmental and organizational top risk register 2018. In response to medication incident on a trauma patient, theme of medication safety was selected. A series of improvement works on medication handover throughout trauma patient journey in operating theatre were established, including establishment of standard statement on medication handover; clinical lectures, poster promulgation; visual cue cards and in-house checklist of medication handover for trauma patient.
Objectives :
To enhance the standard of medication handover throughout trauma patient journey among operating theatre nurses that patient receives correct medication according to the Five Rights principle.
Methodology :
1. Retrospective review and literature review on medication incident related to trauma logistics to identify the contributing factors and improvement suggestions. 2. A comparative study to compare nurses’ concept of medication handover during trauma care in operating theatre before and after improvement works. 3. Based on standard statement of medication handover established, an audit on medication handover for trauma patient was conducted to ensure the performance and compliance of theatre nurses. Evaluation tools for measuring the effectiveness of project included: 1. Comparative study on theatre nurses’ concepts of medication handover during trauma care in OT. 2. Medication handover audit for Trauma Patient Journey. 3. Medication incident report of trauma.
Result & Outcome :
There were 76.5% theatre nurses attended three identical clinical lectures. The results of comparative study positively shown increased staff confidence; reduced time used in trauma admission; higher medication ranking among the 10 critical items; reinforce staffs’ practice on medication handover; more clear understanding on nurses’ roles and responsibilities. The compliance rate of the audit on Medication handover for Trauma Patient Journey was 99.98%. There was NO report of the medication incidents on trauma patient in OT in 2019. Medication error is preventable. It is challenging for nurses to maintain high level of standard care and caution of work under circumstances of stress, urgency and multi-dimensional care. Trauma care is teamwork. Each member works on his or her own responsibilities to ensure trauma patient receiving quality care. Therefore, focus should not only be put on the administration of medicine but also the medication handover during trauma patient journey.
