Why is Hospital@Home beneficial?
Frees up beds
Psycholigical benefits for patients, as they want to be at home!
IV therapy at home is 2-3x cheaper than in hospital
What are the potential benefits and risks of just letting patients self administer IV drugs?
Benefits --> Cheap, less nurse time spent
Risks --> Patient needs to clean lines and have a high level of responsibility. This can be lots of work for staff to get them to this level
What is the 'golden' guide for IV drugs as part of Hospital@Home?
What are the beneifts/negatives of Hospital@Home doing Bolus's or Infusions?
Bolus --> Quicker (so cheaper), Less volume (best if fluid restricted)
Infusion --> Lower risk of infusion rate reactions (eg, red man syndrome), other things can be done at the same time (like dressing changes), but they can damage fragile veins and they have a lower Cmax than boluses
When would a peripheral or a central line be used?
Peripheral --> Easy to insert/remove, for short term use
Higher risk of extravasation/infiltration and cant be used for all IV meds
Central --> Potential for indefinate use, low risk of extravasation/infiltration and all IV drugs can be given this way
What types of drugs can't be given peripherally?
Those with extremes of pH (eg, co-trimoxazole)
Those with a high risk of extravasation and infiltration
What is NHS 111?
A 24/7 telephone line that is manned by various HCPs, acting as a screening tool to ensure only those that need help get it
These are contracts that are given to private companies
It's a risk adverse system, meaning that if in doubt, get them seen!
What is the Community Pharmacy Consultation Service (CPCS)?
Where 111 directs patients to a community pharmacy to get an emergency supply of a medication for free
Still based on pharmacy legislation (so no CDs 1-3 except Phenobarbital)
Using the Human Error Theory, influencing which area would be the most effective in reducing errors?
Error Producing Conditions
Explain Safety 1 and Safety 2 Approaches
Safety 1 --> The aim to make as few things go wrong as possible
Belief that a chain of events cause errors
Learning from things that have gone wrong!
This is overally simplistic
Safety 2 --> Understanding that risks change on a day-by-day basis, and so we need staff to be able to recognise these and adapt things in order to prevent errors
Focussing on learning from what goes right!
What are the 5 current never events?
And what are the problems with never events in general?
Mis-selection of a strong potassium solution
Administraiton of a medication by the wrong route
Overdose of insulin due to abbreviations or incorrect device
Overdose of methotrexate for non-cancer treatment (eg, RA)
Mis-selection of high strength midazolam during consious sedation
Problems --> It's an unabtainable goal as they will happen!! Therefore this is following a safety 1 approach, instead of safety 2
May cause people to not report these events, as well as being demoralising if they do occur
What are the 4 most common drug administration errors?