Reducing medication errors in children's hospices
A toolkit for helping to reduce medication errors in children's hospices has been developed by Bradford researchers and widely adopted across the UK.
The toolkit enables hospice managers to review processes and implement improvements that ensure that medicines safety is a priority.
Around 8,000 children receive care within the UK's hospice system and many of them have complex needs and medication regimes. The Bradford Medicines Management Team have many years’ of experience investigating medication error management: previous research, funded by the Department of Health, led to the design of a novel medication error reporting scheme. Other research within the team has focused on the adult hospice system, identifying the impact on staff and their managers of reporting errors.
The need for the toolkit was identified by Children’s Hospices UK, now called Together for Short Lives, and its development was funded by the Department of Health. It focuses on key areas of risk, enabling hospice staff to identify the weak points in systems and processes. Advice on medicines regulation is included, as well as on the competencies needed to administer medication regimes. There are also guidelines on medicines reconciliation and transcribing, non-medical prescribing and error reporting.
Since its publication in 2011, 49 hospices across the UK have adopted the toolkit. Staff within these organisations have participated in a cultural change in which they now feel encouraged and supported in reporting errors and near misses. In many organisations the number of reported incidents within hospices and dispensing errors from NHS Trusts has increased, but not the number of incidents in which harm has been caused.
Regular reviews of all reported mistakes and the circumstances in which they were made have led to significant reductions in medication errors from both hospice staff and from NHS Trusts. These improvements mean a reduced risk to the children in these organisations’ care.
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