PRACTICUM SUMMARY REPORT

Name: Iona Campbell

Team Members: Iona Campbell, Suaad Al-Salti, Rachel Fane
Project Title: To explore the relationship between medicine reconciliation compliance and accuracy of insulin
prescription on the rate of hypoglycaemia in patients who are insulin dependent admitted to the Acute Surgical
Receiving Unit
University/Organization Name: University of Dundee, Robert Gordon University

Health System Sponsor Name: Shady Botros, NHS TAYSIDE

Aim of project (1-2 sentences)

To decrease the rate of hypoglycaemia in insulin dependent patients on the Acute Surgical Receiving Unit (ASRU)
during the first 72 hours of admission by 50% within four weeks. However, this is part of an extended piece of work
which will work towards the same goal, span over six months and include all surgical wards within Ninewells
Hospital.

Planned changes tested (2-3 sentences

A sticker placed in the medicine reconciliation form was formatted in conjunction with feedback from the front line
staff who would be using the sticker day to day. The sticker aimed to improve the compliance with insulin medicine
reconciliation and the accuracy of insulin prescriptions.
A second test of change was to engage the clinicians with the implementation of the sticker into the surgical
clerking document and to then receive feedback as insulin dependents patient were admitted, unplanned, to the
acute surgical receiving unit.

Predictions (2-3 sentences)

By implementing the sticker to support the compliance of insulin medicine reconciliation an increase in the
accuracy of insulin prescription is expected to decrease the rate of hypoglycaemia in insulin dependent patients
during the first 72 hours of admission.

Rate of hypoglycaemia will be reduced but will be dependent on factors outwith the scope of this project, including
clinical factors such as duration of nil by mouth, timing and duration of surgery and organisational factors including
time limitations on this project and number of insulin dependent patients admitted over the four week period.

Results
Present your results with a graph(s).

Summary of results (3-4 sentences):

Baseline data demonstrated a 60% compliance with detailed insulin medicine reconciliation. The sticker
intervention (PDSA 2) developed in (PDSA 1) increased the compliance of insulin medicine reconciliation to 80%
during the 2 weeks of implementation, this fell short of the 95% target but work will continue beyond the scope of
this project. The outcome measure could not be charted due to time limitations of the project. Unlike initial
predictions only 18% of insulin dependent patients experienced an episode of hypoglycaemia during hospital stay,
compared to 70% experiencing hyperglycaemia (out of a total of 17 patients).

Learning (4-5 sentences)

Comparison of questions, predictions, and analysis of data:
DSA 1 chart wasn’t able to be undertaken on real patients due to few number of insulin dependent patients
admitted. Mock simulations were required to gain feedback in a timely manner about sticker layout and design.
Overall feedback was positive and after a couple of iterative changes a final design was reached as no further
changes were suggested by front line staff. A pink background was suggested and feedback agreed that this would
fall in line with standard insulin paperwork already in place.

PSDA 2 predictions were met with clinicians engaging in the insulin sticker however the rate of completion was
variable due to night-shift using paperwork from a different location, a rotation of foundation year staff and low
numbers of patients admitted on insulin.
Impact on systems (3-4 sentences)
Discuss the project’s significance on the local system and any findings that may be generalizable to other systems:
By undertaking background data around insulin prescription it was clear that the paperwork currently used was not
adequate to provide standardised care to all patients as insulin medicine reconciliation did not sit easily within the
current format. By improving the format using the sticker and linking the coloured background of the sticker to the
pink colour used in other insulin paperwork a standard approach was implemented that allowed for more accurate
medicine reconciliation and transcription to insulin prescription.
Analysis of the current system by way of a process diagram allowed for weakness to be identified and areas for
improved standard of care to be recognised such as no self administration policy being in place and variable and
indeterminate length of patients being made nil by mouth due to no clear policy.

Conclusions (3-5 sentences)

Summarize the outcome of the project. Is this project sustainable? What are the requirements for sustainability?
The significant outcome for this project was to successfully implement an insulin medicine reconciliation sticker for
use as a step towards improving insulin dependent patient care on the surgical wards. Compliance with completion
of the medicine reconciliation sticker was improved from 60 to 80% over the course of the project. Sustainability of
the project is possible through handing ownership over to the front line team and achieving reliable buy in from
staff in a high turnover clinical area

Reflections/Discussions (5-7 sentences)

Discuss the factors that promoted the success of the project and that were barriers to success. What did you learn from
doing this project? What are your reflections on the role of the team?
Successes of the project include working within an inter-professional team of medical and pharmacy student,
allowing for a pooling of knowledge and expertise from different clinical backgrounds and to see things from
different perspectives, comparing courses and experiences. In addition, working in a clinical area gave us the
opportunity to engage with different members of the multidisciplinary team, build a sense of resilience and
improve our confidence. We were good at planning for contingency, adjusting our intervention according to
feedback and have a back up plan if an unforeseen circumstance arose, the use of technology was very effective for
planning work and communicating as a team. Barriers throughout the project include a high staff turnover in a busy
ward environment, it was difficult to engage some clinicians fully with the intervention. It was also challenging for
some members of the team entering an unfamiliar ward environment as an outsider to try and implement the
intervention, finding sticker paper and a suitable facility to print them was also time consuming, as was the
availability of free rooms in the medical school to analyse data. Overall this has been a very rewarding opportunity,
we have learned how quality improvement projects do not always go to plan but the valuable thing about the
Model for Improvement is that it allows for adjustments throughout the project. Bridging differences between
professions and working collaboratively proved challenging at times requiring compromise, something that will be
reflected in future careers.

By signing this document (electronic signature is acceptable), I attest that the information provided by the learners in this
project is accurate.
LEARNER(S):

Signature: iona Campbell Signature:

Printed Name: IONA CAMPBELL Printed Name:
Area of Study: Medicine Area of Study:

Signature: Rachel Fane Signature:

Printed Name: Rachel Fane Printed Name:
Area of Study: Pharmacy Area of Study:

Signature: Suaad Al-Salti Signature:

Printed Name: Suaad Al-Salti Printed Name:
Area of Study: Pharmacy Area of Study:
FACULTY SPONSOR: HEALTH SYSTEM SPONSOR (if different from faculty
sponsor):
Signature: Vicki Tully
Signature: Shady Botros
Printed Name: Vicki Tully
Printed Name: Shady Botros
Institution: Unviersity of Dundee
Institution: NHS Tayside

AUTHORIZATION
Do the learners, faculty sponsor, and health system sponsor authorize this project for publication at www.ihi.org?

X Yes