Improving management of medicine - Bromley NHS Trust
Challenge
A common problem that patients in Bromley encounter, identified
by anecdotal and audit evidence, is the difficulty with medications
they have if they are admitted to hospital especially as an
emergency.
The most common area of complications is the availability and
administration of Parkinson's drugs and also the inadvertent
prescribing by junior doctors of contra-indicatory drugs.
Action
Several adjustments to the service have been put in place to try
and avoid these difficulties:
- The 'Green Bag System' is a particularly useful innovation for
Parkinson's patients who are often on medication which is not
immediately available on the wards. People with Parkinson's are
commonly on tablets that require frequent administration and
significant delay can lead to potential complications such as poor
swallowing leading to aspiration pneumonia. By taking their own
medication into hospital with them in a green bag problems can be
avoided.
- All known Parkinson's patients now have an icon by their name
on the computer system alerting staff to the fact that they have
Parkinson's disease. This enables medical teams especially in
A&E and the Medical Assessment Unit (MAU) to be aware of the
patient's condition and call on the resources of the Parkinson's
team early.
- All patients with Parkinson's that present to A&E and MAU
are alerted to the Parkinson's Disease Nurse Specialist (PDNS) and
if possible are assessed to prevent unnecessary admissions. If
admission is deemed necessary, priority is given for the patient to
be admitted to the Lead Consultant's ward.
- Patients admitted to other wards and specialities also get
assessed and their medications are reviewed as early as possible by
the PDNS and/or Consultant.
- Emergency Parkinson's disease guidelines have been drawn up
which are available for all staff on the computer system. They are
also incorporated into the patient's notes.
- Parkinson's medication is easily available – this ensures that
the medication needs of people with Parkinson's who are admitted
out of hours can be met.
- Patients with Parkinson's use a medication record, developed by
the hospital. They can use it to keep track of the Parkinson's
medication they take and the times they take them. This provides
useful information to hospital staff about their medication regimen
to staff if they are admitted into hospital.
Achievements
The service uses a multidisciplinary team approach. It is
recognised as a service of excellence for its work on early alert
and assessment of in-patients and their medications.
The team was recognised for its achievements and was a runner up
in the Hospital Doctor Awards in 2006.
The PDNS has been recognised by the patients and the rest of the
team as a key driver behind the innovations and she has been
nominated for the Bromley Nurse of the Year Awards.
Contact details
Belinda Kessel
Belinda.Kessel@bromleyhospitals.nhs.uk
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