Safe medication practice in Palliative Care- First Do No Harm - Development of documentation to safely prescribe and administer continuous subcutaneous infusions in Palliative Care

Abstract

Introduction The most common medications used in Palliative Care are also recognised as those most associated with accidental harm in health care. Queensland Health's Safe Medication Practice Unit (now SMMU) has been associated over many years with the development of standardised communication tools to document the prescribing and administration of medications. The National Inpatient Medication Chart is one such tool now used in public hospitals across Australia. Among the projects undertaken by the unit was the development of a standardised form to document safely the Prescription and Administration of CSCI medications, in partnership with our clinical colleagues working in Palliative care.

Methodology 1.A steering committee of clinicians from medical, nursing and pharmacy professions working in Palliative Care was established and key principles of safe medication practice in Palliative Care established. 2. Development of a document to address the findings of the steering committee. 3. Audit use of the Document within a specified unit at the RBWH.

After much iteration a suitable document was prepared and tested on a ward at the Royal Brisbane and Women's Hospital. Educational materials were developed to provide effective training for nurses and junior medical staff on this unit.

5.Pre and post audits of documentation were carried out.

Audit Results There was: •Poor uptake of regular medication order review by medical staff •Standardisation to single type of subcutaneous infusion pump within hospital •Nursing calculation documentation in 92% of patients at post audit •Standardisation to single rate of administration throughout hospital •Regular 4 hourly observational check in 95% of patients at post audit

Conclusion Standardisation and the development of a form to document prescribing and administration processes for Continuous Subcutaneous Infusions (CSCI) led to clear improvements in most identified elements of safe medication practice in Palliative Care. Although there was poor documentation of a regular medication order review it was identified by our junior medical staff that they undertook this more often but did not document this process.