3D printers suffer from the inverse relationship between throughput and minimum feature size; with smaller features inducing a cubic increase in print time. Here we introduce Nano-3DP, a hybrid process that combines digital light projection 3D printing with nanoscalerelief patterning. The tool enables large volume (cm 3 ) prints with nanoscale details at a truly rapid rate (~120 mm/hour). 40 nm features, half the size of the finest printed details to date, are produced across a scalable print volume. We address the intrinsic issues of throughput and pixel induced surface inhomogeneity. To demonstrate the unique potential realized by this printing method across different areas of science optical lenses, injection molding tools and bio-implants originally acquired by x-ray CT are produced with functional nanoscale surface details. Notably, in vitro bone cell analysis delivered a profound 4.5-fold increase in osteogenesis purely through the inclusion of nanoscale features on the printed surfaces.
IntroductionThe Medication Prescription and Administration Record (Kardex) must always be legible and complete. It is this initial point of prescription writing that opens the way for errors and delays to delivery of treatment to occur due to omitted or misinterpretation of the prescription.1 A Regional Safety Forum introduced a Paediatric Safety, Quality and Improvement Collaborative in November 2013, where the local Trusts could come together to learn about new initiatives and discuss ongoing projects. One area our Trust felt was important and decided to explore was medication safety, starting with medication prescribing.Overall aimThe aim of this project is to examine how well the kardex is being completed and how it can be improved.MethodsData collection was commenced in September 2014 by the paediatric pharmacist.A weekly kardex review audit was carried out looking at two areas:The correct completion of the front of the kardex (against 7 criteria – patient name, hospital number, date of birth, allergy status, ward, weight, date of weight).The overall prescription writing error per drug (against 17 criteria).Five kardexes each week were audited and were selected randomly from the current in-patients.An education intervention was a poster for the ward to highlight best practice prescribing guidelines.The initial 4 week results were presented at the next Paediatric Learning Session. Any particular areas of concern were fed back to the medical staff on the ward. Data collection continued to determine if there was any improvement with medical staff being aware of the audit and also with the poster being prominently displayed on the ward.ResultsIn September 2014 the accurate completion of the front of the kardex was 94.3% (week 1); 94.3% (week 2); 93.9% (week 3) and 94.3% (week 4). This improved in October to 94.3% (week 5); 100% (week 6); 94.3% (week 7) and 100% (week 8).The mean prescription writing error per drug in September was 1.375 error per drug with the weekly results documented as 1.8 (week 1); 0.8 (week 2); 1.7 (week 3); 1.2 (week 4), compared to October which showed the overall mean prescription writing error per drug to be 0.3275. The weekly results were 0.62 (week 5); 0.2 (week 6); 0.36 (week 7) and 0.13 (week 8).ConclusionThe completion of the front page of the kardex has shown improvement from September to October. It is now being completed 100% accurately, compared to initially only 94.3%.There has been a reduction in the prescription writing error rate, as is shown in the results, but there is room for further improvement.At the most recent Paediatric Safety Forum meeting it was discussed how the different Trusts were auditing prescribing and that we could consider the possibility of both a regional audit tool and also look at a Regional Paediatric Pharmacy Training on Prescription Writing for the paediatric doctors rotating.ReferenceMaxwell SRJ, Wilkinson K. Writing safe and effective prescriptions in a hospital kardex. J R Coll Physicians Edinb2007;37:348–351.
AimTo determine the efficiency of dispensing paediatric discharges at dispensary vs ward level.MethodA data collection form was designed for use during a two-phase audit. During the first week of data collection, the turnaround time of dispensing discharges in the dispensary was collected. In the second week, the turnaround time of dispensing discharges at ward level on the paediatric ward was recorded.The dispensary standard of a 60 min turnaround for medium priority discharges1 was used for both weeks. Medical, surgical and ENT prescriptions were all included in the audit.ResultsInformation relating to 23 discharges was collected during week one at dispensary level. In week 2, 21 discharges were assessed.When assessing the minimum and maximum time taken from when a patient was informed of their discharge to medications being given, there was a reduction of 98 min when completed at ward level for minimum time and 75 min for the maximum time.The average turnaround time for dispensing prescriptions was 94 min at dispensary level and 26 min at ward level. Only 57% of discharges completed in the dispensary met the standard turnaround time of 60 min compared to 100% completed at ward level. Discharge prescription turnaround time was decreased by 72% when completed at ward level.In total sixteen discharge steps were identified using the traditional dispensary based method for discharges. These ranged from the patient being told they can go home on the ward round to the prescription being written and sent to pharmacy, and finally returned to the ward for transfer to the patient.The process of dispensing discharges at ward level enabled a reduction of 50% of the sixteen steps, subsequently expediting the discharge process.ConclusionWhen discharges were completed at ward level standards were met 100% of the time and a reduction in eight discharge steps was accomplished. Thus highlighting that a ward level dispensing service is necessary on the paediatric ward in this District General Hospital.ReferenceWallace K. Prescription Tracker System (PTS). Patient services District General Hospital2014.
AimThe paediatric wards in two hospital sites within one Trust deal with the supply of newly diagnosed diabetic prescriptions differently and the aim of this project was to have uniformity throughout the Trust with regards the supply of these discharge items, with both hospital pharmacy sites supplying the discharge items. Having completed the Pharmacy Management Clinical Leadership in Pharmacy (CLIP) program I wanted to use new skills learned throughout CLIP to be able to lead on influencing a change of practice on one hospital site and have uniformity across the Trust. I wanted to be able to persuade one site to change their practice of over 20 years and start getting the items dispensed through the hospital pharmacy.MethodsUsing the GROW model I ensured I was clear on what my plan was and that my goals were SMARTER. I had to deal with a number of different professionals and was prepared for some conflict as was expecting resistance to change. I met with the key stakeholders with regards the change. I communicated with medical staff, nursing staff and dispensary manager in the relevant hospital, and used the Colours Model1 to help me with this. The Colours Model is a simple and effective way to analyse our own communication preference and also to understand the preference of others. Knowing this I was then able to flex my communication style accordingly to engage with all parties more effectively. I identified what ‘colour’ I classed each group as and used different styles of communication for each. I also reviewed the records of newly diagnosed diabetic patients discharged from the paediatric ward over a period of one year to determine what discharge letter was given to the patient, and what detail was on it.ResultsOf the patients discharged in 2017, only 44% had a discharge on the relevant electronic system with pharmacy items on it, with just one having all required items. I communicated the following way with the different staff, once I had identified their ‘colour’. Medical staff (GREEN - Amiables, who are task focused and have indirect style). I focused on whole team and explained the benefit for change across interface. Nursing staff (RED - Drivers, who are task focused and have a direct style). I got straight to the point, explained reasons and results. Dispensary manager (BLUE - Analyticals, who are task focused and have an indirect style). I emailed in advance. Got to the point and gave exact details.ConclusionAll Staff agreed to the change in process in the paediatric ward. All discharges for newly diagnosed diabetic children on both sites will be electronically written and dispensed within the hospital pharmacy. The outcome for patient care is a more seamless transition of care between interface. By undertaking the CLIP programme I acquired a number of important skills to enable me to successfully lead this change. I made my voice heard and led with impactful communication.ReferenceCLIP workbook Leading with Impactful Communication Chapter 5 The Colours ModelJanuary 2018.
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