1. Information poster for the administration of commonly used medication in dysphagia Emma Lowe, Hilary Oldham, Joan Karasu, Sharon Platt Clinical service technicians, Pharmacy Department, Christie NHS Foundation Trust Introduction Method A short questionnaire was distributed to a complete nursing shift on each of our main in-patient wards (a total of 18 nurses), in order to gain an insight as to whether the ward staff would find such information regarding administering medication in dysphagia helpful The clinical technicians discussed, analysed and identified the most commonly prescribed medicines on the wards within our Trust A laminated A3 information poster of commonly prescribed medication in the Trust was produced, following infection control protocol and using current and accurate information from the NEWT guide This poster was displayed in the treatment areas on the main in-patient wards A month later, a second short questionnaire was then distributed to a complete nursing shift on each of our main in-patient wards (a total of 18 nurses), to obtain feedback from the nursing staff Due to the specialist nature of the Trust we see a high number of patients with dysphagia. This can be caused by a number of issues including; mucositis, radiotherapy, oesophageal occlusion and high volume of tablets/capsules. Most of the medication required by our patients is available in liquid form but some are not, or are not stocked on the ward. This can lead to a delay in administration while nurses are waiting for pharmacy for an alternative or for information on whether or not the tablet can be crushed (or capsules opened). Although information is available to ward staff using the internet or the NEWT guide 1, obtaining this can be time consuming and not easily accessible. Pharmacy staff are not always immediately available to offer information and a quick reference guide on the ward could improve efficiency of the administration process. In 2010, the NPSA released a rapid response report on ‘Reducing harm from omitted and delayed medicines in hospital’ 2 which highlights the importance of avoiding delay in the administration of medicines. As a team, we thought that it would be useful to have some information regarding tablets-crushing/capsule-opening available on the wards. We therefore decided to carry out a service evaluation to see if the ward staff thought this information would be helpful. Our aim is to collate information from trusted sources (see references) to produce a poster which will be displayed on all the in-patient wards, identifying the mode of administration where liquid preparations are not immediately available. Thus, when staff require the information they will be able to use the poster as a quick reference guide to see if the prescribed medication can be crushed/opened, to avoid unnecessary delays in administration. Results/Discussion For the initial questionnaire; 72% of nurses asked said they knew where to obtain information previously about whether a tablet can be crushed or a capsule opened before administering; 89% of nurses asked said they would find the poster useful; 83% said they think such a poster would improve patient waiting time for medication administration; and 100% said they require such information on a regular basis. For the second questionnaire; 94% said that they had found the poster useful; 88% said they thought the content of Before the poster was displayed on the wards, as an example, if a patient was prescribed fluconazole but was unable to swallow the capsule (which is kept as stock on the wards), the nurse would have to contact pharmacy who would then order the liquid formulation. This could cause a delay in the patient receiving their treatment due to the dispensing process. The capsule can be opened and the contents dispersed in water. The patient would receive their medication this way until the liquid was available on the ward. In the past the dose may have even been omitted if the medication was required out of hours. Now with the poster these potential delays are minimised (if the medicine is included on the poster) until the liquid form is available. The poster allows nursing staff to quickly access the information when it is required, so that there is no delay in the patient receiving their medication. Staff found that the poster was an informative, useful, quick reference guide to aid adherence in the administration of medication for patients with dysphagia. The poster will require annual review to update. Conclusion References 1. Smythe J. The NEWT Guidelines: for administration of medication to patients with enteral feeding tubes or swallowing difficulties. 2 nd ed. Betsi Cadwaladr University Local Health Board (East);2010 2. National Patient safety Agency. Reducing harm from omitted and delayed medicines in hospital. NPSA, 2010. Available at:http://www.nrls.npsa.nhs.uk/resources/patient-http://www.nrls.npsa.nhs.uk/resources/patient- safety-topics/medication-safety/?entryid45=66720&p=2 3. Joint Formulary Committee. British National Formulary online) London: BMJ Group and Pharmaceutical Press [Accessed on 7/04/13] Date of preparation: 23/09/13 the poster was appropriate; 69% said they had used it on a regular basis (31% had not had the opportunity to use it). Comments from the nursing staff on the wards included; “the poster made it easier and quicker to find the information”, “I didn’t have to wait for pharmacy”, “improves familiarisation with medications”, “improves care for the patient as they don’t have to wait for their dose!” Requirement of information on crushing/opening medication