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. 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 nurse 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 Parkinson's nurse and/or consultant.
  
• Emergency Parkinson's 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 Parkinson's nurse has been recognised by the patients and the rest of the team as a key driver behind the innovations. She has been nominated for the Bromley Nurse of the Year Awards.

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