1. Hospital Support Team Audit: Delays In Advice Being Implemented
Melanie Kilner
Clinical Nurse Specialist
ABMU HB Specialist Palliative Care Team
My name is Melanie Kilner
I work as a clinical nurse specialist in ABMU HB based at Ty Olwen.
Picture of Ty Olwen.

2. Problem?
The Hospital Support Team, had a hunch that not all advice given to the ward teams was always implemented in a timely fashion.
An audit was undertaken to assess the number of incidents of medication advice delays and to assess why assess delays were happening.

3. The Team Hospital Support Team across ABMU HB Nurses= 5 nurses
Doctors= 5 doctors

4. The Plan One ward Set a standard Pilot Pilot
We started the process by undertaking a pilot study on the oncology ward in Singleton hospital
To test the audit proforma
To Set a standard

5. The Pilot Time period of two weeks 12 audit forms completed
22 medication suggestions
3/22 delays
Face to face with doctor most chance of success
Change……
Audit proforma
Set number instead of time frame.
Audit proforma
It was tested and changes were made to make it more robust
included whether it was a dose alteration?
Did the hospital support team doctor prescribe?
Included dates seen by pharmacist and date it was dispensed?
Date of first administration
Methodology of main audit
Multi centre approach, involving the four main hospitals in the HB.
25 from each of the main hospitals.

6. Four Hospitals Singleton Morriston
Both covered by the Ty Olwen based hospital support team
Neath Port Talbot hospital team
POW covered by Y Bwythyn N hospital team

7. Plan Standard All medication advise recorded
Advice given before 2pm should be implemented the same day.
All medication advise recorded
Significance of timing of advice
How the advice was given
Any delays

9. Results

10. Results 92/100 forms fully completed (92%)
14/92 delays identified (15% of patients)
4 delays from NPT (4/24 17% of patients)
2 delays from Singleton (2/20 10% of patients)
7 delays from Morriston (7/23 30% of patients)
1 delay from POW (1/25 4% of patients)
Haven’t got the time to go into each of the delays, but have grouped them into:
Three main categories:
Prescribing- the doctors
Dispensing- pharmacy
Administration- nurses.

11. Administration
Four delays
Four Delays

12. Dispensing
Six delays
Six delays

13. Prescribing Five delays 5 delays:
2- conscious choice not to implement recommendations
3- not discussed with doctors, advice in health records/discussed with nursing staff.
Five delays

14. Discussion
Face to face discussion with the doctor had most success in terms of timely implementation of advice.
Too high a delay percentage in Morriston hospital.
Concept of severity introduced into discussion
Re-audit Morriston
Proforma adapted to incorporate, severity of symptom.
New standard set.
During the audit period
Severity- at this point the team discussed how knowing severity impacts on the delay. How much suffering did the delay potentially cause.
Hunch was that the delays occurred in the less severe symptoms.
Morriston- large very busy, tertiary centre compared to the other three hospital.

15. Standard No more than 10% of advice should result in a delay. But….
100% of recommendations should be acted upon where the symptom severity is 3-4/4
Based on the pilot and main audit, the team discussed across ABMU Hb and decided that 10% based on the results as far.

17. Morriston Re-audit
Prospective audit of 25 consecutive referrals as previously
1/25 delay
Administrative delay, medicine prescribed orally but unable to swallow.

18. Not the End.. Morriston re-audit was within standard set
Did the team change there approach?
Team believe it is important to re-audit this in 2012.