Case Story: MedicinesManagement

Summary	Scored Formative e-Assessments designed to improve Patient Safety
Group / workshop	Formative e-Assessment	Status	seed
Project details...

Situation

What was the setting in which this case study occurred?

In a ‘typical’ hospital approximately 7,000 individual doses of medicines are administered to patients each day and up to 40% of nurses time is spent on administering medicines. (The Audit Commission, 2001)In 2004 the Department of Health published ‘Building a Safer NHS for Patients – Improving Medication Safety’ which provided a review of the causes and frequency of medication errors, highlighted drugs and clinical setting that carried particular risks and identified models of good practice to reduce risks. The report’s authors recommend that to reduce the risks of drug administration NHS Trusts should ‘ensure that the staff administering drugs understand the indications, risks, precautions and contra-indications to each medicine and are competent to perform any calculations necessary’.In 2005 the NPSA published the first results of incidents reported via its National Reporting and Learning System (NRLS).  This information suggested that 10% of all untoward incidents reported across the NHS were medication related and the NPSA highlights a concern that ‘learning how to administer medicines is not well taught – particularly practical aspects’.There are two principal areas of concern regarding patient safety and medication:

• Safe Prescribing practice
  The remit of doctors and consultants
• Medicines Management and Administration
  Primarily the conern of nurses and other medical practitioners

Pharmacists have a remit that covers both these areas and provide guidelines and checks. Both competency testing and training are required to address the problem of potential drug prescription and administration errors.  However, staffing levels and irregular working hours mean that class contact would be expensive and/or logistically impractical. Thus a scored formative e-assessment solution providing detailed context-sensitive feedback has been adopted to cover both the competency testing and training elements. The e-assessments outlined in this example cover Medicines Management and Administration.  Other assessments have been prepared to address the issue of Safe Prescribing. References:
The Audit Commission, 2001 A Spoonful of Sugar: Medicines Management In NHS Hospitals.  Chief Pharmaceutical Officer, 2004 Building a Safer NHS for Patients: Improving Medicines Safety. Department of Health. The National Patient Safety Agency, 2005 Building a memory: preventing harm, reducing risks and improving patient safety. The first report of the National Reporting and Learning System and the Patient Safety Observatory.

Task

What was the problem to be solved, or the intended effect?

Objectives:

• To improve the management and administration of medicines by ensuring that the staff administering drugs understand the indications, risks, precautions and contra-indications to each medicine and are competent to perform any calculations essential for safe dosage.
• To demonstrate each individual’s fitness to practice.
• To identify key areas for individual personal development or training.
• For overall quality assurance in the management and administration of drugs

Intended audience:

Nurses, Midwives, Pharmacy staff, all other Healthcare Staff dealing with the care and administration of medicines in Acute Hospitals, Primary Care Hospitals, Community Health and Mental Health NHS Trusts.

Intended level:

In-practice, post-qualification, continuing  professional development.

Actions

What was done to fulfil the task?

• A suite of scored formative e-assessments with context-sensitive feedback covering: Medical Calculations, Use of the BNF, Administration & Documentation, Patient Safety, Medicines Code and Management of Controlled Drugs was prepared by experienced pharmacists and medical practitioners (design team) taking account of the range of skills found within the target audience and variations in practice across target groups.
• The e-assessments should be suitable for diagnostic testing, competency testing and training.
• All questions and whole assessments peer reviewed.
• Assessments trialled by representative target user-groups.
• Selected trials observed by members of the design team to refine useability and network compatibility.
• Assessments reviewed by the design team and final modifications made as a result of the feedback from trials, including some for enhanced accessibility.
• Assessments live on the networks of the Acute, Primary Care Hospitals, Community Health Care and Mental Health Trusts in the area.

Results

What happened? Was is a success? What contributed to the outcomes?

Assessments live from Nov 1^st.  Results to be reported.

Mentors and Line Managers will follow up individuals whose competency scores are low and may apply additional mentoring or training where appropriate

Lessons Learned

What did you learn from the experience?

From the design process:

• Design time can be protracted if number of experts is large, but once concensus is reached quality can be high.
• Pre-testing is essential to the refinement of the product and suitability for the target audience especially where users have of variable levels of computer literacy.

Update  

The case study was submitted to illustrate

       1.      the processes of design, pre-testing, refinement, deployment, efficacy evaluation and feedback from users into modification for subsequent runs. (e-assessment development cycle)
       2.      its use, not only for simple formative e-learning but also for competency monitoring and targeted continuing professional development.

       It is thus quite a formal formative e-assessment compared to some and might be classified as a 'scored formative e-assessment'.

       It is also illustrates quite a traditional view of formative assessment but one which can be quite effective.



       It could be developed to include peripheral blogs/forums/wikis that encourage reflective discussions of practical experiences relating to the topics and issues included in the assessments. This would be a useful addition that would allow individuals to gain the benefit of experiences and practices of others in the nursing environment.  Nurses are already well trained in reflective practice so this should come quite naturally to them.   Wikis relating to medical practice would need to be moderated by a qualified practitioner for patient safety reasons but the outcomes from these discussions might conceivably result in changes to medicines management practice within the Trusts concerned.

       Given the firewall issues that we have experienced in a number of Trusts, there may be practical issues (firewall restrictions, cache updating etc., reluctant IT services) associated with the relatively closed nature of NHS computer networks that might make Web 2.0 type environments difficult to establish.   I will report back on the practicalities of this in the NHS environment.

Licensing

This work is licenced under a Creative Commons Licence.