Time Critical Medicines; Embedding a robust triage identification process within EDs to support self administration of patients preadmission TCMs

Emergency Department Craigavon Area Hospital, Southern Health and Social Care Trust

Project summary

A Time critical medication (TCM) is a medication already prescribed for a patient prior to attendance at an Emergency Department (ED). These drugs need to be taken at a specific times during the day. Examples include drugs to treat epilepsy, diabetes and Parkinsons. Disease. A delayed or omitted dose of any of these medications may result in harm to the patient. Evidence from Parkinsons UK shows that a missed doses of Parkinson’s medication can increase the length of stay in hospital by an average of four days. It can result in swallowing issues, increasing the likelihood of pneumonia, confusion and agitation and mobility issues, which in severe cases has resulted in the permanent loss in the ability to walk. The GRIFT report details that in patients with a diagnosis of Diabetes, missed doses of Insulin can result in erratic bloods sugars, resulting in increased length of stay by up to 3 days, and in severe cases Diabetic Ketoacidosis that in severe cases may result in death. When a patient attends ED it is a period of uncertainty, stress and anxiety. For patients presenting with acute conditions, their long-term disease states may not seem like the area of focus. However, in these acute periods of illness it is critical that continuation of preadmission TCM dosing schedules is adhered to, to support recovery, reduce impact on functional decline and ensure preadmission disease states are managed well allowing no long-term negative effect. As the number of ED attendees increases across EDs in Northern Ireland so does the waiting times associated with seeing a clinician. Withing SHSCT, although a robust time for triage of the patient was observed, waiting periods to be assessed during times of extreme pressure can exceed 24 hours. Whilst waiting, patients do not routinely have medications prescribed and most do not bring them to ED. The project was developed In line with Transforming Medication Safety Northern Ireland (TMSNI) strategy, aligned with the WHO’s third Global Patient Safety Challenge: Medication Without Harm. The HSCNI ‘Know, Check, Ask’ campaign also encourages patient involvement in safe medication use. A poster detailing TCMs using the RCHEM MISSED acronym was developed for triage of patients to highlight the importance of informing the triage nurse and to continue to take their prescribed medicine whilst waiting full assessment unless indicated otherwise. This poster was also used across GP OOH, Urgent care facilities and with Primary Care clinicians to ensure when advising on an ED attendance it was highlighted to bring their TCM. A communication video was developed for sharing across Trust intranets, external social media platforms and for use within local newspapers/reporters. For all communication the following tag line was created ;Remember, every minute counts. We want you to get it on time, every time!