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Continuous Quality Improvement

Druggles: A Quality Improvement Initiative on Medication Safety

Project Lead: Dr Sanjay Gupta

SMART Aim

To reduce medication related incidents in paediatric medicine in-patient wards by 25% by 31st December 2022.

Why is this important to service users, carers, and/or staff?

More than 237 million medication incidents per year in England with estimated cost £98 million and 1700 lives per year.

Medication related incidents remain high in paediatric medicine department at HUTH, despite regular induction and training for the trainees and nurses.

The dose calculation in paediatrics is based on weights, body surface area and age. Hence there are greater chances of making errors.

Tests of change

  • We gathered information about medication related incidents for paediatric medicine prior to our intervention.
  • Brainstorming the MDT led to implementation of pharmacist led MDT huddle called ‘Druggle’ in July 2020.
  • The data on incidents was obtained through F&W Division’s QI facilitator
  • A feedback was collected by paediatric trainees after each Druggle
  • The pharmacist shared the learning points with the wider team after each Druggle

Tools and how we used them

  • Following a stakeholder analysis, we held several sessions of Brain-Storming’ and active listening from wider MDT team, including pharmacists, nurses, trainees and consultants.
  • A Fishbone diagram (simplified version below) helped identify some of the causes leading to drug errors
  • The first PDSA cycle started by introducing Druggles in July 2020 and continued till December 2021 (led primarily by the pharmacist)
  • The SPC chart did not show any special cause variation (reduction in incidents)
  • The second PDSA cycle started in June 2022 with change in time of Druggles and involvement of paediatric trainees and senior nurse to support the pharmacist

Results: What did the data say and what were the outcomes?

  • For the second cycle of Druggles having protected 15 minutes at the end of morning handover once a week increased the participation by wider team members.
  • 100% of attendees found the Druggles helpful and a ‘safe space’ to discuss medication related queries and incidents
  • The SPC chart shows Special Cause effect with reduction in number of medication incidents since June 2022

Learning and next steps

  • This QI project will be presented at the International Forum on Quality & Safety in Healthcare in May 2023
  • We are trying to spread Druggles in other clinical areas, including paediatric surgery, neonatal unit and ward 16 at CHH.
  • Involvement and ‘buy-in’ by the wider team is essential for Druggles to continue and be impactful.
  • Druggles should be short (no more than 15 minutes), focused and well-led in order to be effective and not to interfere with busy clinical duties.
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Essentials

CQC Rating

Hull University Teaching Hospitals NHS Trust was rated as Requires Improvement by the Care Quality Commission on 23 March 2023.