Currently an Advanced Trainee in General Medicine and Nephrology, I have a keen interest palliative care and the implementation of clinical quality initiatives to improve patient outcomes.
A Quality Initiative - From Hand Calculations To Clinical ‘App’ - SCIMA: Transforming The Way Nurses Prepare Subcutaneous Infusions
Current Problem Subcutaneous infusions deliver medications continuously, usually at the patients end of life; in the hospital, hospice or community. Performing the required calculations manually is a daunting task, often due to poor confidence completing calculations and making decisions about the appropriate syringe volume, diluent and correctly identifying medication compatibility issues. Anecdotally, high numbers of errors occur in the preparation process, often in patients with limited physical reserve. There is no DHB policy mandating the recording of hand calculations, making adverse event reviews difficult. A Solution A web-based application called SCIMA (Subcutaneous Infusion Medication Application) was developed to mitigate patient harm events through the automation of the preparation process. After entering the required medications and dosage, SCIMA calculates the medication volumes, diluent volume/type, syringe size and highlights medication incompatibilities. Linked with the patients NHI, SCIMA records all information in the form of a printable and recallable ‘Preparation Order’ or ‘How to prepare guide’. An administrator portal allows information underpinning the application to be updated. SCIMA aims to enhance a patient’s health journey, through the mitigation of errors, whilst saving nurse’s time in resource pressured environments. The Review Following clinical committee approval, a single ward pilot in Wellington Hospital is currently being undertaken (Jun/July). Results of a review of this quality initiative will be presented. Pre/post audits aim to assess SCIMA’s ‘real life’ use by reviewing the effect on nurse confidence, impact on medication harm events, whilst documenting feedback for further development. Using SCIMA’s reporting tools, each ‘use’ will be reviewed against clinical notes, ensuring the applications clinical accuracy. Using captured data, comment will be drawn about prescribing habits and use of specific medications e.g. opiates vs. renal function. Both the 'Pitfalls and Pearls' of implementing a quality improvement initiative in the DHB will be highlighted to inform future trainees in their endeavours.