Bois de Cery – CH 1008 Prilly
Tél. 021 643 73 53 – Fax: 021 643 73 54
E-mail: [email protected]
www.fhv.ch
Fédération des hôpitaux vaudois
Acting on noise and light, as part of a
program to reduce adverse drug events
Anthony Staines, PhD,
Patient Safety Program, FHV
Professeur associé, Université Lyon 3, France
More patient safety by design: Systemic approaches for hospitals
April 5, 2017
Careum Auditorium, Zürich
1
1 goal
3 topics
Reduce
adverse drug
events by 20%
in 18 months
within 10
participating
hospitals.
Sustain.
1.
2.
3.
Patient
identification
High-Alert
Medication
Medication
preparation
within the ward
13 interventions
1.
2.
3.
4.
5.
6.
7.
In each hospital
1 steering committee
1 project team
1 measurement team
8.
9.
10.
11.
12.
13.
Patient Identification Policy
Patient Identification Wristbands
Bedside check of wristbands
Labels and labelling procedures
List of High-Alert Medications
Selecting and purchasing at central
pharmacy
Managing High-Alert Medications
within the care units
Prescribing High-Alert Medications
Preparing and dispensing High-Alert
Medications
Structured Medication Storage
Equipment
Appropriate preparation room
Medication preparation
Patient involvement and
2
empowerment
Method: Breakthrough Collaborative (IHI).
SP :
learning session
PA :
action period
PDSA : Plan – Do – Study - Act
P
Invite
teams
Preparatory
work
P
A
A
A
D
D
C
Identify and
invite experts
Develop
models
C
SP1
SP2
April 7, 2017
D
C
Presentations
knowldedge
spread
SPn
PA1
6 months
P
PA2
PAn
18 months
Anthony Staines, Ph.D.
3
Guidelines for the design of ward pharmacies
4
5
Recommendations with regards to light
• Our body needs light to be stimulated. It is a key source
of motivation.
• The Swiss State Secretariat for Economic Affairs
recommends between 500 and 1000 lux for activities
requiring high concentration.3
• The United States Pharmacopeia (USP) recommends
1000 lux for complex tasks. It also recommends regular
measurements of brightness at key locations. 2
• The French Association for Lighting recommends
brightness above 500 lux for precision tasks, for example
500 lux for consultation rooms, 625 lux for laboratories
and 500 lux for pharmacies. 4
2. Institute for Safe Medication Practices, Safe Practice Environment Chapter Proposed by USP. 2009.
3. SECO, Commentaire de l'ordonnance 3 relative à la loi sur le travail. 2009. Chapitre 2, article 15.
4. Association française de l'éclairage, Recommandations relatives à l'éclairage des établissements de
santé. 2000.
6
Brightness measurement protocol
Work surface is devided into elementary
rectangles. Brightness is measured at the center of
each Bmean = (B1 +B2 +… + Bn ) / n
Ideal brightness is
Bmean minus 25%
Ideal brightness is
300 lux
7
n depends on the K coefficient. K=(a x b)/h (a + b) with a and b being length and width in meters and h being height.
n=4 for K<1, n=9 for 1<K<2, n=16 for 2<K<3, n=25 for K>3
Brightness
measurement form
Light meter
8
Brightness of light - improvement
Photo Hôpital de Lavaux
Photo Fondation de Nant
9
10
Brightness measurement
Lux mean
day time
Tolerance zone
night time
11
Recommendations with regards to noise
• Too high levels of noise can negatively impact the
professional’s health (nervousness, stress).
• The Swiss State Secretariat for Economic Affairs
recommends 40 dB to 50 dB for activities requiring
concentration. 1
• The United States Pharmacopeia (USP) recommends 35
to 40 dB for activities requiring high concentration. 2
• Total absence of noise (no stimuli at all) is not favourable
for concentration. 2
• When desinging a ward pharmacy, it is wise to define a
location, a layout, construction materials and access
control allowing reduced sound nuisance.
1.
2.
SECO, Commentaire de l'ordonnance 3 relative à la loi sur le travail. 2006. Chapitre 2, article 22.
12
Institute for Safe Medication Practices, Safe Practice Environment Chapter Proposed by USP. 2009.
Noise measurement
• Switch on the sound level meter
• Leave it on during the whole medication
preparation process.
• It measures mean sound level, as well
as minumum and maximum.
13
Sound level in ward pharmacies
dB mean
day time
Tolerance zone
night time
14
http://www.bionicearshow.org/content/hearing-screening/
15
Audit of pill boxes - % of discrepancies
(missing dose – excess dose, missing medication, excess
medication, wrong dosage, wrong dosage form, wrong moment,
substitution after prescription)
Before/during
After
16
Trigger Tool - Methodology
– 20 charts per month, selected at
random within the planned roll-out
perimeter
– 2 reviewers (pharmacist-nurse or
nurse-nurse) and a physician for final
validation
– All patient in roll-out perimeter (except
pediatrics and psychiatry)
– 20 minutes per chart
Results for all hospitals having taken
part in the project for 30 months :
– 2’447 charts reviewed until march 2013
– 319’864 doses
– 286 ADEs
– 245 patients affected by at least 1 ADE
17
All hospitals involved for 30 months in the project
% of patients harmed by at least 1 ADE
18
All hospitals involved for 30 months in the project
Until March 2013
Number of ADEs/1000 doses
% of patients harmed by at least
1 ADE
19