AimThe National Patient Safety Agency (NPSA)1 identified heparin as a major cause of adverse events associated with adverse incidents, including some fatalities. By ensuring good communication, this should be associated with risk reduction.1 The aim of this study was to ensure there is clear anticoagulation communication on discharge, from the paediatric intensive care unit (PICU) electronic prescribing system (Philips), to the paediatric cardiac high dependency unit and paediatric cardiac ward. To investigate whether the heparin regimen complies with the hospital’s anticoagulant guidelines and if there is any deviation; that this is clearly documented. To find out if there is an indication documented for the heparin regimen chosen and if there is a clear long term plan documented for the patient, after heparin cessation.MethodsA report was generated for all patients who were prescribed a heparin infusion on PICU, between 1st January 2018 and 30th June 2018, from the Philips system. All discharge summaries from the PICU Philips system were reviewed. Only paediatric cardiac patients were included that had a heparin infusion prescribed on discharge, all other discharge summaries were excluded from the study. Each discharge summary was reviewed in the anticoagulant section; for the heparin regimen chosen, whether it complies with the hospital’s anticoagulant guidelines and if there was any deviation whether this was documented. The indication documented of which heparin regimen was chosen and whether a clear long term plan was documented after heparin cessation; for example if the patient is to be transferred onto aspirin, clopidogrel, warfarin or enoxaparin.Results82 discharge summaries were reviewed over the 6 month period between 1st January 2018 and 30th June 2018; 16 were excluded as were not paediatric cardiac, leaving 66 paediatric cardiac discharge summaries that were reviewed. 45 out of 66 (68%) complied with the hospital’s heparin anticoagulation guidelines. Of the 32% that deviated from the protocol; only 33% (7 out of 21) had a reason documented. Only 50% (33) of the summaries reviewed had an indication for anticoagulation noted on the discharge summary and 91% of discharge summaries had a long term anticoagulant plan documented.ConclusionThe electronic prescribing system can help to ensure a clear anticoagulation communication as shown by 91% of the anticoagulation long term plan being clearly documented; making it a more seamless patient transfer. On the Philips PICU electronic prescribing system there is an anticoagulant section on the discharge summary that has 3 boxes that need to be completed; heparin regimen, indication and anticoagulation long term plan. However, despite these boxes; deviations from the anticoagulant protocol were poorly documented as highlighted by only 33% having the reason highlighted in the discharge summary, only 50% of the indications were documented. Despite having prompts for this information on the discharge summary, the medical staffs needs to be aware to complete this i...
The humble drug Aspirin, derived from willow bark, is widely used in paediatric cardiology. It is used for a number of different indications mainly for its antiplatelet action; a few such examples include Blalock-Taussig shunts, Glenn shunts, post ablation stroke prevention and in Kawasaki Disease.The discharge summary is a means of communicating changes to GPs, other hospitals and paediatricians within the paediatric cardiac network. The aim of the review was to assess the situation currently; whether the indication and duration of aspirin were documented on the patient’s discharge summary. This issue has been raised through our paediatric cardiac network meeting.A retrospective study was carried out. A list of all patients discharged from the paediatric cardiac ward in January & February 2016 was obtained from Medway; our electronic patient information system for admissions and discharges. Using this list of patients, Heartsuite; our electronic cardiac database, was used to find 30 patients, who were discharged on aspirin.The following data was collected on each of these discharge summaries; whether aspirin was newly started or continued, whether the indication and duration of aspirin was documented.The data was collected and of the 30 discharge summaries viewed with aspirin on discharge; 18 (60%) were newly started on aspirin and 12 (40%) were continued on aspirin, 4 (13.3%) had the indication documented and 12 (40%) had the duration documented.The paediatric cardiac patients discharged on aspirin, as shown by the results in this review show that the majority of discharge summaries do not have the indication or duration of aspirin documented. So, there was found to be inadequate documentation and communication to users in our paediatric cardiac network. With this in mind a service improvement is necessary.The improvement suggestions are two-fold. Firstly, an additional note needs to be made to the surgical operation note that can be transferred to the discharge summary. Secondly, the addition of a mandatory field on the medication section of the discharge summary for the indication and the duration of aspirin.
AimPharmacists and dieticians are among the health care professionals who have identified a problem relating to the inconsistent recording of heights in paediatric patient notes. The Trust’s guideline ‘Growth – Standard for the measurement of weight and height/length in children identifies that ‘all children attending hospital must have their weight and height/length measured’.1 Height is required to calculate a number of parameters, including renal function and risk of malnutrition. It is necessary for the calculation of adjusted prescribing weights for overweight or obese patients.This project aimed to improve the percentage of heights being recorded in an appropriate place by introducing a poster to all wards within the hospital.MethodAll wards in the hospital were included in the audit. Baseline data was collected 8-9th February 2021. The poster was implemented from the 2nd March 2021 and a patient safety alert was circulated to staff during the week beginning 1st March 2021. Data was then recollected on 22nd March 2021.As outlined in the trust guideline, data was collected from: the front of the drug chart; the ‘Core Screening Tools for Children and Young People for inpatients’ document; and the World Health Organisation (WHO) Growth Chart recorded on our electronic record ‘Evolve’.ResultsThe percentage of patients with height recorded on the drug chart at baseline was 8.3%. This increased to 16% post-implementation. The percentage of patients with height recorded on the Core Screening Tool was 33.3%. This increased to 42.5% post-implementation. The percentage of patients with height recorded on Evolve at baseline was 22.2%. This decreased to 20.8% post-implementation.ConclusionThe post-implementation data collected would suggest that the poster has had a positive effect on improving the number of heights recorded for paediatric inpatients. There was a 93% increase in the number of patients with height recorded on their drug charts and a 28% increase in the number of patients with height recorded on the Core Screening Tool following implementation of the intervention.This shows an overall improvement in the recording of heights on drug charts and core screening tools, although there was a decrease in the percentage of patients with height recorded on Evolve. The use of Evolve was investigated during the data collection and it was identified that there is a lack of training on how to enter heights on the Evolve system and this may explain the low numbers of heights recorded using this system. Further Evolve training for staff would help to correct this issue and after consultation with the nurse education team, this has been added to the training programme for new nurses starting in the hospital.Improvement has been shown over this short period of time, with the increase in the percentage of heights documented for inpatients, although we are still a long way from the target of 100%. Further work is being carried out within the hospital with the aim that this information is consistently provided, thereby improving patient care.ReferenceTucker I, Elson R. Clinical guideline: growth - standard for the measurement of weight and height/length in children (version 1). Trust name. 2019 Available on request.
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