The impact of a multi-component medication safety bundle on medication safety in the adult resuscitation rooms of an Emergency Department

We will determine if a ‘multi-component medication safety bundle’ in adult resuscitations can reduce moderate and major medication errors in ED resuscitations. To first identify the extent of the problem, baseline data is required from our study setting. In Phase I of the study, the observation of 169 medication administrations which meet our inclusion criteria will be undertaken, and data collected. The research nurse will be informed of a patient’s impending arrival to a resuscitation room by either pager (if an emergency “code call” is sent out), or by telephone call from the resuscitation room coordinator. We will include any patient that presents to a resuscitation room, provided they meet the following inclusion criteria: 1. Patients aged over 18 years old 2. Present directly to an adult resuscitation room (R1-5), or are moved to a resuscitation room from elsewhere within the emergency department 3. a) Are likely to be administered at least four intravenous/ intramuscular/ intraosseous/ subcutaneous medications – OR – b) Are likely to be administered at least one “high risk” medications (vasopressor or paralytic medication) Exclusion criteria: 1. Resuscitations where the primary investigators of this study are involved in a clinical capacity will be excluded Upon the arrival of the patient to the resuscitation room, the research nurse will assess the patient’s suitability for this study by confirming they meet all 3 of the inclusion criteria (either criterion 3a or 3b listed above) and none of the exclusion criteria. If the patient is to be included, the research nurse will make themselves known to the resuscitation Team Leader, and will clarify that they are present in a “hands-off” capacity only. The research nurse will utilise the data collection package and document the occurrence of errors for each medication ordered, prepared, and administered. They will also observe and record any non-drug errors, pertaining to documentation and communication. As well as the drug and non-drug errors, a number of patient demographic data points and supplementary data points will be collected to aid in answering our secondary objectives. The research nurse will also distribute a brief anonymous survey at the end of the resuscitation, to one doctor and one nurse involved in the prescription, preparation and/or administration of medication. Following the successful data collection of 169 medication administrations, the multi-component medication safety bundle will then be introduced. The multi-component medication safety bundle details: The study looks primarily at the impact of having a dedicated ED resuscitation trained pharmacist that is both present in the resuscitation room and also providing impact through quality improvement, guideline implementation and education initiatives. The multi-component safety bundle will include a number of clinically relevant education interventions. These interventions will be led by expert clinical pharmacist with assistance from emergency medicine consultants, resuscitation nurses, nursing clinical coaches, and nurse educators. These may involve teaching in face-to-face resuscitation simulations, at handover sessions, group or individual training and email communication. The frequency and duration of the training will be dependent on what focus areas for improvement are identified from phase I of the study and what normal day-to-day workflow allows. There is no specified frequency or duration at this stage. Due to the large workforce within our department the adherence to the intervention (e.g training sessions and attendance) is not mandatory and monitoring of adherence will not be applicable. The interventions will include some of the below: - Improving utilisation of the “Resus Drug Flipbook” - Communication of medication related verbal orders - Sharing of common drug-drug, drug-patient and drug-herbal interactions to be aware of - Resus antibiotic sepsis guideline changes - Postpartum haemorrhage kit medication guidance updates - The review of medication trolleys in the resuscitation room - Correct labelling of resuscitation medications Phase II of the study will be observing resuscitations following the implementation of the multicomponent medication safety bundle. Again, 169 medication administrations in resuscitations that meet the inclusion criteria will be observed by a research nurse, and the same number and type of errors will be watched for. At the end of the resuscitation, the same survey will be distributed to one doctor and one nurse involved in the prescription and administration of medication. For each patient in phase I and phase II there can be multiple medication administrations that occur.