Programs Safer Systems Saving Lives

Toolkit: Interventions

Prevention of Adverse Drug Events

• Warfarin Management Guidelines
  A resource designed to address warfarin management in acute stroke patients. It includes guidelines for staff to ensure best practice prescribing and management, a discharge checklist and information for patients and carers - Liverpool Hospital*
• Pharmacy Warfarin Education Stickers
  This sticker lists key activities related to patient education It is inserted into patients medical records for sign off by pharmacist when activities attended - Liverpool Hospital
• Warfarin Alert card
  A wallet sized card including patient ID, Warfarin dose, INR and medical contacts - Liverpool Hospital
• Medication History and Reconciliation on Admission
  A modification of the Qld Health Medication Reconciliation Form - Liverpool Hospital
• Medication Risk Screening Tool
  This form builds on findings from the Medication History and Reconciliation Admission - Liverpool Hospital
• Medication Communication Fax Form
  This form facilitates communication with the GP in relation to medication reconciliation - Liverpool Hospital

* The team working on ADE at Liverpool Hospital acknowledges the Medication Safety Collaborative for providing the initial impetus for work undertaken during SSSL.

• Medication History & Reconciliation Form
  An adaptation of the form developed by the Queensland Health Safe Medication Practice Unit - Royal North Shore Hospital
• Medication Reconciliation Audit Tool
  A simple audit tool designed to raise awareness of the benefits of reconciliation and to identify opportunities to address the reconciliation process. This was part of a strategy involving ASET Nurses in the ED and a defined patient population - Coffs Harbour Base
• Medication History on Presentation
  A tool modified from the QLD Health Medication Reconciliation Form to address medication history and risk assessment - St. Vincent’s
  
• Improving Medication History
  A poster providing instructions on use of the Medication History on Admission Tool - St. Vincent’s
• Alert sticker for medical record
  Used by pharmacist to alert staff to findings of reconciliation process - St. Vincent’s
• Medication History,Confirmation and Reconciliation Process Flow Chart
  A tool to facilitate the process of medication reconciliation on admission - St. Vincent’s
• Medication Reconciliation Discrepancy Stickers
  Used in conjunction with above Flow Chart to alert medical staff to discrepancies in confirmation process - St. Vincent’s

Preventing Ventilator Associated Complications

• Protractor
  A tool for managing head of bed elevation - Liverpool Hospital
• Protractor Version A
  A tool for managing head of bed elevation - This is a paper based version that can be laminated and attached to each ICU bed - Gosford Hospital, Hornsby Hospital
• Protractor Version B
  A tool for managing head of bed elevation - A plastic ruler used in conjunction with spirit level and attached to ICU bed - Gosford Hospital, Hornsby
• FASTHUGS checklist
  Checklist identifying evidence based care components for management of ventilated patients. The checklist provides details of care activity and provides a trigger for performance and documentation - Liverpool Hospital
• FASTERHUG
  An adaptation of the FASTHUGS checklist - Hornsby Hospital
• VAC Checklist - The Tweed Hospital, Gosford, Lismore
  Several sites developed checklists either as stand alone for the purposes of the project or more commonly as an amended version of an existing ICU Care Plan. The purpose was twofold
  1. to ensure delivery of evidence based care and
  2. provide a process for continuous audit
• VAP Criteria
  A Flyer alerting staff to criteria for screening for VAP - Hornsby

Preventing Central Venous Catheter Related Blood Stream Infections

• FASTERHUG
  An adaptation of the FASTHUGS checklist - Hornsby Hospital
• CVC Checklist - St Vincent’s, The Tweed Hospital, Hornsby
  Several sites developed checklists either as stand alone for the purposes of the project or more commonly as an amended version of an existing ICU Care Plan. The purpose was twofold
  • to ensure delivery of evidence based care and
  • provide a process for continuous audit.
• CVC Trolley /Pack
  These were developed by several teams to ensure access to appropriate equipment and ensure adherence to evidence based guidelines. The packs contained and audit tool to reinforce adherence to guidelines and to facilitate audit - Gosford, POW, Hornsby
  
• Date/Time stickers for CVC Dressing
  Designed to facilitate monitoring of insitu days for CVC - POW private
• Exclusion Criteria for Subclavian Site
  This was a local response to the concern that some patients were not suitable for subclavian site insertion It was promoted through in-service for nursing and medical staff in ICU. Full Length Drape A full length drape is now available at this site and is included in CVC Insertion Packthat is assembled by volunteers - Gosford
  

Prevention of Surgical Site Infections

• Patient Education Resource
  This booklet is given to patients contemplating LSCS prior to delivery date advising the correct procedure for pre-operative skin hygiene and post operative wound management - Coffs Harbour
• Patient Wound Care Diary, Protocol for management of patients with wound infection post discharge
  Developed to enable follow up and timely intervention for patients following LSCS and for staff to monitor incidence of wound infection within 30 days post op. There is a privacy policy attached to the use of this diary. Complementary to the above this flow chart describes management of a patient who identifies a wound infection in the 30 day period post discharge - Hornsby
• Information Sheet for Patients (and families ) undergoing Caesarean section
  Designed to address pre- op skin preparation and post discharge wound management op - Hornsby
• Antibiotic Guidelines
  A laminated version of AB guidelines was prepared and displayed in each anaesthetic bay in OT - Lismore
  

Implementing a Rapid Response System

• ICU Liaison Nurse for ICU Transitional Program: Liaison Nurse Role, Transition Program Form
  This involved the deployment of an ICU nurse in a liaison role during change of shift between am & pm when there is a staff overlap. The role was designed to provide support and f/up for staff caring for patients recently discharged from ICU. The resource includes Role Description and Guidelines for implementing the transitional program - Lismore
  
• Code Blue
  Development of CODE Blue criteria designed to assist in the early identification of a patient in crisis - POW

Improving Care for patients with Acute Myocardial Infarction

• Fridge magnet
  This addresses key components of lifestyle management in Heart Disease and was designed to be a prominent reminder for the patient - Gosford
• Lifestyle education audit
  Addition of footer on patient list and handover sheets reminding staff to complete patent education. Risk prevention counseling information adapted to include alcohol and smoking management - Gosford
• AMI pathway
  A modification of the TASC pathway for addressing management of Acute Coronary Syndrome - Coffs Harbour