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New Modules Alert: Introducing safeHANDS & safeGUARD

It may be of interest to you that we have now released our safeHANDS and safeGUARD modules to the safeMedicate suite.

What is safeHANDS?

safeHANDS is informed by over 30 years of research and extends the scope of our existing and widely used Foundation Numeracy Assessment (FNA) and Healthcare Numeracy Assessment (HNA) modules. It incorporates 20 core areas of mathematics and healthcare numeracy that underpin and inform the safe practice of a wide range of nursing proficiencies and clinical procedures.

safeHANDS makes it easy to assess your learners' capability to develop the mathematics and healthcare numeracy skills required to meet programme outcomes and provides a platform to support them in continuously developing their abilities in numeracy throughout their studies.

Healthcare Numeracy Performance Fingerprint Example

DEVELOP AND ASSESS UP TO 20 CORE AREAS OF MATHEMATICS & HEALTHCARE NUMERACY

Addition of Whole Numbers

Subtraction of Whole Numbers

Multiplication of Whole Numbers

Division of Whole Numbers

Negative Numbers

Fractions

Decimals

Percentage

Ratio

Equivalences between fractions, decimals, percentages

Conversion between SI and other measurement units

Conceptual problem solving

Formula & Equations

Rounding of Numbers

Estimation

Indices & Logarithms

Calculator Use

Measurement

Interpretation of tables, charts and graphs

Statistics

When scheduling a safeHANDS assessment for your learners, you can choose to include as many or as few of the skill domains providing the utmost flexibility in terms of learner or curriculum requirements.

We are currently offering this module at a 20% discount on any orders placed before December 31st.

You can find out more about safeHANDS here or you can join us on one of our free webinars and let our product specialists walk you through the key features and functionality.

What is safeGUARD? safeGUARD will provide your learners with a comprehensive understanding of the 6 rights of safe medicines management and their importance in maintaining patient safety throughout the medicines management processes.

Right documentation

Right patient

Right drug

Right dose

Right route of administration

Right time of administration

The safeGUARD Medicines Management Continuum Model considers three key phases of medicines management and the role of key members of the multi-disciplinary healthcare team in maintaining patient safety at each phase.

History Taking and Prescribing Phase

Pharmacy Dispensing Phase

Medication Administration Phase

safeGUARD adopts a clinical case study approach to undertake a stepwise review of important information in the clinical setting at each phase of the medicines management process. Each case study will require learners/practitioners to assess, verify and implement the patient-safety critical requirements of the medicines management process in order to demonstrate their competence.

PHARMACY DISPENSING PHASE

The role of the dispensing pharmacist.

Understand and consider the role of the dispensing pharmacist in checking and confirming the accuracy of the information documented on the medication order, advising on the safety and administration of the medication and performing any additional checks that must be made prior to dispensing the prescribed medication.

You can find out more information on safeGUARD here or you can join us on one of our free webinars and let our product specialists walk you through the key features and functionality.

Over the next upcoming months, we will be drip feeding a range of in depth videos that explain both modules so keep an eye out in your inbox for this!

New Modules Alert: Introducing safeHANDS & safeGUARD

It may be of interest to you that we have now released our safeHANDS and safeGUARD modules to the safeMedicate suite.

What is safeHANDS?

Healthcare Numeracy Performance Fingerprint Example

DEVELOP AND ASSESS UP TO 20 CORE AREAS OF MATHEMATICS & HEALTHCARE NUMERACY

Addition of Whole Numbers

Subtraction of Whole Numbers

Multiplication of Whole Numbers

Division of Whole Numbers

Negative Numbers

Fractions

Decimals

Percentage

Ratio

Equivalences between fractions, decimals, percentages

Conversion between SI and other measurement units

Conceptual problem solving

Formula & Equations

Rounding of Numbers

Estimation

Indices & Logarithms

Calculator Use

Measurement

Interpretation of tables, charts and graphs

Statistics

We are currently offering this module at a 20% discount on any orders placed before December 31st.

You can find out more about safeHANDS here or you can join us on one of our free webinars and let our product specialists walk you through the key features and functionality.

Right documentation

Right patient

Right drug

Right dose

Right route of administration

Right time of administration

History Taking and Prescribing Phase

Pharmacy Dispensing Phase

Medication Administration Phase

PHARMACY DISPENSING PHASE

The role of the dispensing pharmacist.

You can find out more information on safeGUARD here or you can join us on one of our free webinars and let our product specialists walk you through the key features and functionality.

Over the next upcoming months, we will be drip feeding a range of in depth videos that explain both modules so keep an eye out in your inbox for this!

#safemedicate #patientsafety #nursing #medicines management #6 rights #pharmacy #medicine #healthcare #medical care #pharmacist #hospital #medication #meds #health care #health

Reducing Medication Errors

Hello safeMedicate Users,

Welcome to the summer edition of the safeMedicate blog. Our mission is to provide valuable insights and practical tips to help healthcare professionals reduce medication errors and enhance patient safety. In this issue, we cover common causes of medication errors, best practices for prevention, and recent advancements in medication safety technology.

In This Issue:

1. Common Causes of Medication Errors

2. Best Practices for Reducing Medication Errors

3. Spotlight on Technology: SafeMedicate

4. Reader’s Question Corner

5. Upcoming Workshops and Webinars

1. Common Causes of Medication Errors

Medication errors can occur at various stages of the medication process, from prescribing to administration. Here are some common causes:

• Prescription Errors: Incorrect dosage, frequency, or drug choice.

• Dispensing Errors: Mistakes made by pharmacy staff when dispensing medications.

• Administration Errors: Incorrect administration of the drug to the patient.

• Documentation Errors: Inaccurate or incomplete recording of medication details.

By understanding these common causes, healthcare providers can take proactive steps to mitigate risks.

2. Best Practices for Reducing Medication Errors

Here are some best practices that can help reduce the likelihood of medication errors:

• Double-Check Prescriptions: Always verify the prescription details before dispensing or administering medications.

• Use Electronic Prescribing Systems: Electronic systems reduce the risk of handwritten prescription errors and provide alerts for potential drug interactions.

• Implement a Barcoding System: Barcoding medications can ensure that the correct drug is given to the right patient at the right dose.

• Educate and Train Staff: Regular training sessions on medication safety and updates on new protocols are essential.

• Encourage a Culture of Safety: Create an environment where staff feel comfortable reporting errors or near misses without fear of punishment.

3. Spotlight on Technology: SafeMedicate

SafeMedicate is an innovative e-learning platform designed to improve healthcare professionals’ competence in drug dosage calculations. The platform offers a range of modules that cover fundamental to advanced skills in medication dosage calculations. By simulating real-world scenarios, SafeMedicate helps users bridge the gap between theoretical knowledge and practical application, ultimately reducing the risk of medication errors.

If your not already one of over 450,000 users of safeMedicate and want to be a part of reducing the risk of medication error, please visit SafeMedicate.

4. Reader’s Question Corner

Q: “What are some tips for ensuring accurate medication administration in a busy hospital setting?”

A: Here are a few tips:

• Follow the Five Rights: Ensure the right patient, right drug, right dose, right route, and right time.

• Use Checklists: Develop and use checklists for medication administration to avoid missing critical steps.

• Minimize Interruptions: Create a designated “no interruption” zone for medication preparation and administration.

• Verify Patient Identity: Always use two patient identifiers (e.g., name and date of birth) before administering medications.

5. Upcoming Workshops and Webinars

Join us for our upcoming webinar on the launch of our Module, safeHANDS Module. From September 2024, safeHANDS will assess your learners' capability to develop the mathematics and healthcare numeracy skills required to meet programme outcomes and support them in continuously developing their abilities in numeracy throughout their studies. You can register with the safeMedicate team.

Feedback and Subscription

We hope you found this newsletter informative and helpful. We welcome your feedback and suggestions for future topics. Subscribe to our newsletter here to stay updated on the latest in medication safety.

(ChatGPT, 2024)

#safemedicate #patientsafety #nursing #reducing medication errors

We’re having to increase our prices..

We’ve managed to hold our current prices since 2019 when we first launched our Future Nurse Suite (FNS) modules to meet the new standards and proficiency requirements of the NMC. Since then, we’ve made a number of significant enhancements to FNS along with adding new features to our platform based upon your requests or feedback. In line with all other businesses, annual inflation has continued to drive up costs to maintain our services year on year. As a consequence, we’ve had to make the difficult decision to increase the cost of our products and services by approximately 15% from August 1st 2024. This price increase will enable us to continue to invest in product developments and in the technological infrastructure that supports our service delivery and ability to provide you with essential and timely access to our Customer Success Team whenever needed. We’re proud to have maintained a consistent Trustpilot rating of ‘Excellent’ with a current Trust score of 4.8/5 based upon your feedback and that of your end users (students and practitioners). We’ll continue to work hard to maintain and better that score as we move forward.

#safemedicate #nursing #patientsafety

New research project aims to minimise pre-hospital medication errors for children

When emergencies occur in which children’s lives are at risk, it is of critical importance for paramedics to think – and move – quickly. However, the extremely urgent and fast-paced nature of such situations can pose considerable challenges to medical professionals’ efforts to achieve consistent dosage calculation competency.

With these challenges in mind, researchers from multiple disciplines have come together from such institutions as Western Michigan University, Western Michigan University Homer Stryker M.D. School of Medicine (WMed), and the University of Michigan, with a view to creating a head-mounted display application, using Microsoft HoloLens, to make paramedics’ lives easier in these situations.

Drawing upon the functionality of Microsoft HoloLens for the purposes of dosage calculation competency

At a time when there continues to be much talk about the potential benefits that mixed-reality headsets could bring across a wide range of fields, it is fascinating to read about this latest project that could be so instrumental in improving prehospital care for young patients.

The project bears the title, “Augmenting the On-scene Medic (ATOM): Development of a head-mounted display application to reduce prehospital pediatric medication errors”. It commenced in April 2023, and is expected to run until March 2026.

The team is putting in place the foundations for a new technology that could make an incalculable difference to young lives, supported by a $1.37 million grant from the United States Department of Health and Human Services Agency for Healthcare Research and Quality.

In the words of principal investigator for the project, Dr John Hoyle: “We’re going to use the functionality of the HoloLens to read drug vials and double-check doses pulled up in syringes, in addition to helping paramedics obtain a patient’s weight and calculating the correct drug dose for a patient. This has never been tried before.”

High error rates have been observed in cases of drugs administered to children

The statistics tell their own story about the potential importance of this project. Despite critical paediatric cases accounting for just 1% to 3% of paramedic emergency encounters, studies indicate a 31% error rate in all medication administered by EMS to children. In the case of midazolam and fentanyl, there are even higher rates of 61% and 35% respectively.

Dr Hoyle, who is also WMed’s assistant dean for simulation, and a professor in the departments of emergency medicine and paediatric and adolescent medicine, said that previous attempts to reduce errors with medication dosing had been unsuccessful. He added that already-available cognitive aids for paramedics had not entirely addressed the root causes of such mistakes.

He continued: “This is a difficult process for paramedics because they don’t get large amounts of paediatric training and the encounters in the field are rare so they have limited experience. This new technology has the chance to disrupt the high rates of paediatric dosage errors and finally bring those numbers down.”

A highly capable team has been put together for the project

With other members of the ATOM team including Western Drs Tycho Fredericks, Guan Yue Hong, and Autumn Edwards, and University of Michigan Drs Prashant Mahajan and Vitaliy Popov, there are high hopes for the pioneering study.

The team is set to spend the coming year gathering background information and developing the HoloLens application. In the second year of the grant, it is anticipated that pilot testing of the application will take place, followed in the third year by a randomised controlled trial across six cities in Michigan.

If everything goes well with the above processes, it is hoped that the application could be available for distribution by as soon as 2027.

With dosage calculation competency being such an ever-present priority for medical practitioners, it is crucial to consider every possible resource that could help make this a reality. To find out more about how the renowned safeMedicate suite of programs can contribute to competency in safe medication practice, please do not hesitate to contact us.

#safemedicate #safetynet #patientsafety #nursing #midwifery #midwife #healthcare

Overdosing of elderly patient given wrong medication by hospital nurses, led to his death days later

In another saddening reminder of the importance of addressing the problem of medication error, The New Zealand Herald recently reported on the case of an elderly man who was experiencing seizures, only for nurses to provide him the incorrect medication.

As a consequence of the overdose, the patient unfortunately passed away several days later.

Levomepromazine mistaken for levetiracetam

The newspaper serving the Auckland area of New Zealand reported that the man, in his 90s, was administered three times the recommended dose of levomepromazine, after the drug had been mistaken by two nurses for his prescribed medication, levetiracetam.

Following the patient’s death three days later, one of the nurses resigned, stating that she had found it difficult to acknowledge the mistakes she and her co-worker had made, and which had “caused the death” of the patient.

A Health and Disability Commissioner (HDC)’s decision, released in May 2023, referred to the patient as “Mr A”. Dr Vanessa Caldwell, Deputy Commissioner, found that the nurses had not noticed “red flags”, and showed a “lack of care and skill” when looking after Mr A.

The tragic event occurred in 2018, when Mr A was admitted to a hospital Emergency Department with stroke-like symptoms, including sudden onset right-sided weakness, a facial droop, and slurred speech.

It was discovered through a CT scan that the patient was experiencing a seizure, and a doctor prescribed him levetiracetam and diazepam.

The next morning, Mr A experienced multiple seizures, with some of these lasting 30 seconds. The two nurses responsible for his care, identified as Nurses B and C, agreed that he should be reviewed by the medical team.

Following this review, two doctors agreed that diazepam should continue to be given to Mr A, and that the levetiracetam dosage should be doubled to 500mg twice a day. Nurses B and C were informed of these changes.

However, when Nurse B sought to retrieve the levetiracetam from the shelf that morning, the medication was missing, and she asked for information on its location from Nurse C, who told her it had been moved to the opposite shelf.

Looking to the other shelf, Nurse B spotted, and took, a drug with a name beginning “lev”. But she did not realise this was in fact the anti-psychotic medication, levomepromazine.

Nurse B later stated that she was not familiar with this medication and wasn’t even aware of it being in the ward’s stock. Checking the name of the drug on the box, Nurse C also mistakenly read it as levetiracetam.

A mistake that had tragic consequences

The two nurses observed at the time that they lacked sufficient quantities of the medication to match the dosage required by Mr A. Nurse C therefore went to another ward in search of more of the drug.

After discussing the matter, the two nurses decided that 20 ampoules of the medication would be needed in order to make up the prescribed 500mg/5ml amount. However, the HDC’s decision said this was more than three times the recommended dose for a man of Mr A’s age.

The drug was subsequently administered to Mr A. However, when Nurse B then gave the patient a bath, she noticed that he had become unresponsive to the people surrounding him.

Less than an hour following this, the pharmacy technician voiced concerns to a colleague about Mr A receiving what she believed to be an unusual dose of levomepromazine.

When another pharmacist then discovered the missing levomepromazine, it was realised that this was the drug that had been given to Mr A, instead of levetiracetam.

The patient’s wife was informed, and he was transferred to the Intensive Care Unit (ICU). Sadly, just three days later, he died from pneumonia.

“Pain and sorrow” over the heartbreaking event

After Mr A’s death, Nurse C stopped working as a nurse. She said to the HDC that she regretted the “pain and sorrow” caused to Mr A’s family due to the tragic incident.

She was also quoted as saying that nursing had “become a lot more time-constrained and stressful over recent years”.

An apology letter was provided to Mr A’s relatives by Nurse B, who expressed her “sincerest and heartfelt apologies”, and said she took responsibility for her role in the patient’s passing. She had also undertaken a number of courses on medication errors.

The unnamed former district health board said, after a review of the care Mr A received, that the incident’s root cause was that “the process for [an] independent double check [was] not followed correctly”.

The decision said that a double check of medication entailed both members of staff checking the drug at the same time – often called out by one staff member, with the other acknowledging it – as opposed to both staff carrying out independent checks of the medication.

Dr Caldwell said that both nurses were in breach of the Code of Health and Disability Services Consumers’ Rights, having failed to spot the mistakes in preparation despite several “red flags”.

A number of recommendations were made by Dr Caldwell for the Te Whatu Ora (Health New Zealand) agency. These included updating the HDC on any changes made arising from the incident and carrying out an audit of all errors made in relation to medication over a three-month period.

Dr Caldwell further called for the “double-checking” process to be evaluated, alongside consideration of the medication storage setup, and the introduction of initiatives to optimise checking compliance, in order to reduce the scope for human error.

Learn more today about safeMedicate’s learning and assessment environments

If your organisation is seeking out the best way to enhance the safety of its practices and address the problem of medication error, please contact us about the role that safeMedicate can play by supporting the development and assessment of competence for safe medication practice.

New wearable patch developed that is capable of painlessly delivering drugs through the skin

Researchers at Massachusetts Institute of Technology (MIT) have developed a wearable patch that can be applied on the skin, painlessly delivering drugs using ultrasonic waves that create tiny channels for medication to be absorbed into the body.

According to the researchers, the patch could be adapted for the delivery of hormones, muscle relaxers, and other drugs through the skin.

Using ultrasound for transdermal drug delivery

It was already known that ultrasound exposure can enhance the skin’s permeability to small-molecule drugs. However, the development of the wearable patch meant there was no need for any bulky equipment, as is usually required for existing techniques.

The patch consists of disc-shaped piezoelectric transducers, with each disc embedded in a cavity filled with liquid solution of drug molecules. When an electric current is applied, the piezoelectric elements generate pressure waves in the liquid, creating bubbles with microjets that can penetrate through the skin.

When testing with pig skin, researchers found that delivering niacinamide with the ultrasound patch led to the drug penetrating the skin 26 times greater than the amount that would pass through without the waves and vibrations.

What does the wearable patch mean for drug treatments?

This patch system looks like a game-changer for the delivery of treatments, especially when it comes to delivering drugs for patients suffering from skin conditions and premature ageing. The current version of the patch sees drugs penetrating a few millimetres into the skin, making it useful for administering vitamin C or niacinamide, which are both beneficial for treating dark spots and blemishes.

Not only is this method more controllable, but it also offers “less systemic toxicity”, said Canan Dagdeviren, the senior author of the study and an associate professor in MIT’s Media Lab.

The patch provides an alternative way for doctors to administer medication on patients, capable of targeting a local area, which is not possible with medication that is taken orally or intravenously.

In fact, use of the patch means that drugs bypass the gastrointestinal tract completely, unlike the situation with oral delivery, which requires “a much larger dose in order to account for the loss that you would have in the gastric system”, stated Aastha Shah, MIT research assistant. “This is a much more targeted, focused modality of drug delivery.”

This technique also has the potential to be used to deliver drugs that need to reach the bloodstream like caffeine, lidocaine, or fentanyl. The patch is still being further enhanced, with researchers currently working on optimising it for testing on human volunteers.

In the meantime, doctors and nurses still have to rely on achieving and measuring accurate drug calculations. safeMedicate’s medication assessment for nurses can help medical professionals assess and improve the vital skills necessary for ensuring they are able to calculate drug dosage without error.

The tailoring of medication doses to DNA ‘lowers side effects by 30%

A development that will interest many professionals seeking to optimise safe drug dosage calculations is the discovery by an international group of researchers that patients who have their medication doses matched to their DNA, experience a 30% reduction in side effects.

Led by Leiden University Medical Center (LUMC) in the Netherlands, the U-PGx consortium also includes such institutions as Uppsala Universitet in Sweden, the University of Liverpool in the UK, and Institut für Klinische Pharmakologie in Stuttgart, Germany. Henk-Jan Guchelaar, Professor of Clinical Pharmacy at LUMC, coordinated the study.

What did the study find out about the matching of medication doses to DNA?

There are clearly issues with current “one-size-fits-all” approaches to prescribing medication; patients naturally vary in their genetic information, which means one patient’s response to a specific drug can often be quite different to someone else’s.

Some individuals, for example, process medication in a shorter space of time than others, which means that in order to achieve the necessary effect, they require a higher dose. Other patients, however, process medication more slowly, with an associated risk of side effects.

The researchers sought to devise an answer to this problem by developing a ‘DNA medication pass’, which links the genetic profile of a patient to drugs for which DNA influences processing. When this pass is scanned, doctors and pharmacists can learn what medication, and dose of that medication, would be optimal for the given patient.

It was discovered through this study – which was published in The Lancet – that patients who actively made use of the medication pass, and whose medication and doses were determined on the basis of their DNA, experienced 30% fewer serious side effects than individuals who were prescribed a standard medication dose.

The research involved the assessment of around 7,000 patients from seven European countries, encompassing a variety of medical specialities, including oncology, psychiatry, cardiology, and general medicine.

Some participants in the study were randomised to the genotyping arm, and had their DNA mapped. Up to 12 weeks following the start of treatment, patients were put in touch with a nurse specialist, who asked about any side effects they may have experienced, such as anaemia, diarrhoea, muscle pain, or nerve pain.

Patients who held the DNA medication pass didn’t merely experience fewer side effects; they also indicated a high level of satisfaction with the pass itself. The researchers said that the pass helped the patients to feel like they were in greater control, as they became actively involved in their personalised treatment.

Could the DNA medication pass now be incorporated into standard care?

With the group’s study being the first to demonstrate the practical application of using a panel of genes to customise medication prescriptions to the individual, the answer to this question would seem to be “yes”.

Prof Guchelaar said that “for the first time, we have proven that a ‘tailored’ strategy works at a large scale within clinical practice. There is now enough evidence for us to proceed with implementation.”

It is also important to acknowledge, however, that as steps are taken to figure out the implementation process, questions will arise that will be different in each country. “By adapting implementation to suit each country’s healthcare system,” Prof Guchelaar noted, “we can make treatment more effective and safer for millions of patients.”

Certainly, for stakeholders operating across every part of the medical research and healthcare sectors that have an interest in ensuring accurate and safe medication dosage calculations, the findings of this study are extremely important ones.

To date over 4.6 million safeMedicate drug dosage calculation assessments have been employed in the education of healthcare professionals across the globe. To learn more about the role that the safeMedicate team play in actively supporting students in the crafting and diagnostic assessment of competence, please feel free to contact us.

#safemedicate #nursing #calculations

High rate of mistakes at New Zealand pharmacy further underlines importance of accurate prescribing calculations

According to a recent report by the New Zealand-based Stuff website, a woman was left suffering from “heart attack-like symptoms” as a consequence of being given the incorrect medication strength by a busy pharmacy in the Bay of Plenty area.

22 mistakes in all were found to have been made by the pharmacy when giving out medication between August 2019 and August 2020.

The woman who experienced “heart attack-like symptoms” – including chest pain and dizziness – was forced to seek immediate medical care. The error by the in-store pharmacy at Countdown supermarket in the Bayfair shopping mall, Mount Maunganui on 29th August 2019 had led to her spending a month taking the wrong dose of the medication, Accuretic, for her high blood pressure.

What did the subsequent investigation discover about the pharmacy’s errors?

Complaints arising in relation to this incident – and other dispensing mistakes the pharmacist made in late 2019 – led to the Health and Disability Commissioner in New Zealand launching an investigation. As a result of this process, it was discovered that further errors had been made until as late as August the following year.

Health and Disability Commissioner Morag McDowell ultimately found the pharmacy to have breached the code of the Health and Disability Services Consumers’ Rights. She stated in a report published on 20th February 2023 that “there was a lack of adequate monitoring to identify the high number of dispensing errors that were occurring at the pharmacy”.

The report found that of the total of 22 dispensing errors, one pharmacist was responsible for 16 of the incidents, with the other six mistakes being the responsibility of the pharmacy manager.

The errors included instances of similarly named medications being mixed up, the wrong number of repeats being given on the medication label, the incorrect medication strength being dispensed, unclear instructions being provided on the medication label, and calculation errors.

Five of the 22 incidents meant that the patient either took the wrong medication, or did not take the prescribed medication at all.

Ms McDowell said in her report: “This number of errors, made by more than one staff member, is very concerning and is indicative of a systemic failure.”

Mitigating factors noted, including inadequate levels of staffing

Also discovered to have breached the code was the pharmacist employed during the period from which the complaints arose. However, the report flagged up mitigating factors that appeared to impact on the pharmacist’s practice.

One such factor was inadequate staffing levels, which resulted in more than one employee at the site “failing to provide services in line with professional standards”.

Independent advisor, pharmacist Sharynne Fordyce, said that not checking the medication accurately against the original prescriptions would be regarded as “a severe departure from accepted practice.”

The pharmacist resigned from the pharmacy in 2021 and said to investigators that she had been dealing with a number of personal issues, which she said had likely impacted on her concentration. She said that her confidence had been “severely impacted” with each mistake and added that her pharmacy manager had been “hard to approach”.

Meanwhile, the company behind the pharmacy – trading as Countdown Pharmacy Bayfair – said it was unaware of the number of mistakes that occurred at the site at the time, and that it only became aware of this when responding to the investigation by the commission.

The commission’s report stated that the company had taken a serious approach to the matter and had implemented changes to help improve the working environment. The commissioner put forward additional recommendations with regard to safety and accountability.

Stories like the above unfortunately draw attention to the importance of having the right practices in place to ensure safe medication practice. To learn more about the key role safeMedicate plays, please do not hesitate to get in contact with a member of the team.

DECODING THE DNA OF HEALTHCARE NUMERACY

Establishing a mathematics and healthcare numeracy benchmark for nursing

Research & Development Briefing Paper: January 2023

AUTHORS: Keith W. Weeks PhD, RN; David Pontin PhD, RN; Diana Coben PhD; Alex Weeks BSc; John M. Clochesy PhD, MA, RN; David Rowe PhD. ARTWORK: Matt Brown BA; Kirsty Weeks BA

Whats the issue?

There is wide agreement that nurses need to be skilled in healthcare numeracy but no consensus on what skills they should have. As a result, teaching and assessment vary from place to place, creating entry barriers to nursing, increasing attrition, restricting Registered Nurse global mobility, and increasing the risk to patients.

Whats our solution?

Our world-leading research identifies the healthcare numeracy competence needed for safe and effective nursing practice and regulation [see Fig 1&2].

We have developed a comprehensive taxonomy of healthcare numeracy for nursing and translated it into an authentic virtual clinical environment. This supports in-context learning, competence assessment, and application.

We call this process ‘decoding the DNA of healthcare numeracy’ because, while some healthcare numeracy is self-evident, much of it is deeply embedded in nursing practice. What has become second nature to Registered Nurses appears opaque to new students.

Who is it for?

Our work has implications for nursing regulators, policy makers and educators. It is also relevant to other safety-critical vocations and disciplines.

What is it?

Our Healthcare Numeracy Taxonomy provides a benchmark for safe practice. Our programme includes:

- Healthcare Numeracy Assessment

- Healthcare Numeracy Performance Fingerprint and

- Mathematics and Healthcare Numeracy Learning Support Environment

This provides a standard reference point to measure and support the development and maintenance of competence of students and Registered Nurses:

Students are supported as they move from point of programme entry to point of registration and beyond, while reducing attrition caused by inappropriate forms of assessment

Registered Nurses are supported as they refresh their skills for revalidation, while reducing practice error and increasing patient safety.

Figure 1: Nursing competence model (adapted from Weeks et al 2019).

Figure 2: Advance organiser illustrating a constructivist-based authentic virtual-to-situated clinical practice environment transition model, designed to support nursing mathematics and healthcare numeracy competence development, integration, transfer and application to professional nursing practice

Figure 3: 20 healthcare numeracy skills forming the building blocks of safe nursing

How did we create our Healthcare Numeracy Programme?

Identification

We identified the 20 healthcare numeracy skills that form the fundamental mathematical building blocks of safe nursing (see Fig 3). These skills combine in specific sequences to inform 60 common clinical nursing procedures and processes. Click the link for an animated video [7 minute view].

https://drive.google.com/file/d/1tASjLA9XvQKl8A4MENb_2T0lyJNfXbqf/view

Analysis, Transcription and Mapping

We analysed the step-by-step processes of each clinical procedure or process. As each step unfolded, we ‘transcribed’ (identified, externalised, classified and copied) the combination of mathematics skills into a ‘transcription grid’. Each relevant skill is represented by ☑️ in the relevant skill box (see Fig 4):

Figure 4: ‘Transcription’, i.e., identification, externalisation, classification and copying of the combination of mathematics skills underpinning and informing the nursing science and safe practice of the procedure/process into a ‘transcription grid’ (e.g., the eight healthcare numeracy skills underpinning and informing the measurement, calculation and recording of a radial artery pulse rate)

We confirmed the combinations and sequencing of 20 core cross-cutting healthcare numeracy knowledge and skills in each of the 60 core clinical nursing procedures and processes.

These were mapped and classified into a framework of individual and combinatory Healthcare Numeracy Taxonomies (HNT; cHNT). The outcomes were translated into the:

Healthcare Numeracy Assessment (HNA)

combinatory Healthcare Numeracy Assessment (cHNA)

Healthcare Numeracy Performance Fingerprint (HNPF) and

Mathematics & Healthcare Numeracy Learning Support Environment (M&HNLSE) models.

Relative distribution of mathematics and healthcare numeracy skills

After mapping the HNT, we analysed the distribution and incidence of the 20 skills across nursing practice (see Fig 5). Our analysis revealed that about 40% relate to pharmacology, prescribing, drug dosage calculation and measurement, and medicines management. The remaining 60% relate to wider nursing practice.

Figure 5: Distribution and incidence of use and application of 20 core mathematics and healthcare numeracy skills across nursing science and 60 nursing procedures and processes analysed

This work has implications for nursing regulators, policy makers and educators. It is also relevant to other safety-critical vocations and disciplines. The full paper can be accessed here.

Breast cancer drug Enhertu recommended for a wider range of patients

Hundreds more people with breast cancer in England and Wales are set to become eligible for the breast cancer drug Enhertu, following the decision of the National Institute for Health and Care Excellence (NICE) to recommend it for earlier stage disease.

The decision, set out in final draft guidance, will mean access to the drug being granted to such patients through the Cancer Drugs Fund (CDF). It also means that NICE has now recommended all 18 of the breast cancer treatments it has considered since 2018.

What is the significance of this decision for patients?

With there being no cure for advanced breast cancer, treatment for this stage of the disease aims to prevent deterioration of the patient’s condition, extending, maintaining, and improving their quality of life for the longest possible time.

It is therefore heartening news that the clinical trial evidence indicates Enhertu is more effective than standard care with Trastuzumab emtansine at giving patients more time before their cancer gets worse.

However, in a statement outlining its recommendation decision, NICE said that as the clinical trial was still ongoing, there was not yet sufficient evidence to show how much longer people live when treated with Enhertu rather than Trastuzumab emtansine. This meant the cost-effectiveness estimates for the new drug were “highly uncertain”.

It is this factor that means Enhertu will initially be made available via the CDF, instead of through routine NHS funding channels. The CDF provides temporary funding for the use of cancer drugs with unproven payments, allowing time for further evidence to be collected.

The independent appraisal committee concluded it was possible for Enhertu to be cost-effective if additional evidence from the ongoing trial, as well as from NHS practice, can show how much longer people receiving the treatment live.

In the meantime, Enhertu has not been recommended for routine use in the NHS, but instead for use within a managed access arrangement. This allows people to receive the treatment while evidence continues to be gathered about the drug’s effectiveness. The in-depth data will then be used by NICE to recommend whether the medicine should become routinely available on the NHS.

Enabling patients with incurable disease to “live normal, healthy lives for longer”

Professor Peter Clark, NHS England CDF Clinical Lead, said about the news of NICE’s recommendation: “This cutting-edge drug will give hundreds of patients with secondary incurable breast cancer hope, increasing the amount of time people have before their cancer gets worse, and allowing them to live normal, healthy lives for longer.”

Meanwhile, patient organisation Breast Cancer Now, described the move as highlighting the CDF’s “continued importance… in enabling promising treatments to reach patients on the NHS quickly and it shows what is possible when NHS England, NICE, and the pharmaceutical industry work together.”

While new drug recommendations and approvals will always be crucial in the ongoing battle to improve patient care, something else of immense importance is ensuring competent, accurate, and safe medication dosage calculations, time after time. The learning and assessment modules that constitute safeMedicate help to ensure medical professionals are equipped with these vital skills.

World Antimicrobial Awareness Week observed around the globe

Did you know that 18th to 24th November is World Antimicrobial Awareness Week (WAAW)? This global campaign is celebrated annually, with the aim of enhancing awareness and understanding of antimicrobial resistance (AMR) and encouraging best practice for the responsible use of antimicrobials among the general public, health professionals, and lawmakers.

It is hoped that these best practices will, in turn, help prevent drug-resistant infections becoming even more widespread.

The peril of antimicrobial resistance, and what is being done to help

The term ‘antimicrobial resistance’ refers to the phenomenon of bacteria, viruses, fungi, and parasites evolving over time and ceasing to respond to medicines. This situation makes it more difficult to treat infections, and heightens the risk of the spread of disease, severe illness, and death.

Antimicrobial resistance, then, is an issue that needs to be taken extremely seriously by healthcare workers and the wider world, and by those who use the safeMedicate learning and assessment environments to ensure competent and safe drug calculations.

As it became more and more evident just how serious the problem of antimicrobial resistance was, the decision-making body of the World Health Organisation (WHO) – the World Health Assembly – endorsed a global action plan in May 2015.

As part of that plan, it was resolved that steps would be taken to put in place effective communication, education and training, as a means of improving awareness and understanding of antimicrobial resistance.

What is the UK Government doing to support the global effort against AMR?

With researchers having estimated that some 1.27 million deaths in 2019 were attributable to antimicrobial resistance in bacteria, it is clear that the world can no longer merely look on; action must be taken to minimise and control the risk AMR poses to current and future generations.

The UK Government, for example, has played its own part by setting out a five-year national action plan covering the years from 2019 to 2024, as well as a 20-year vision for how the UK will contribute to the containment and control of AMR from now until 2040.

That vision encompasses such ambitions as a lower burden of infection, the optimal use of microbials, and new diagnostics, therapies, vaccines, and interventions.

In prescribing and administering medications, it is also crucial for medical professionals to know that they are responsibly and safely calculating dosage. The safeMedicate assessment and learning environment can play their own major role in ensuring this is the case.

Research suggests manuka honey could be instrumental in clearing potentially fatal lung infection

In news that will be of interest to many of those anxious to ensure the highest levels of drug calculation competency within their practice, scientists at Aston University have developed a possible new treatment combining widely used medication with natural manuka honey.

The nebulisation treatment has been conceived as a means of helping to clear a drug-resistant lung infection that can present the risk of death in cystic fibrosis patients.

The bacterial lung infection in question is Mycobacterium abscessus, and according to findings published in the Microbiology journal, the scientists created a novel treatment for the condition by combining manuka honey with the antibiotic amikacin.

Of particular relevance from a drug calculation competency perspective, the use of the manuka honey combination brought about an eight-fold lowering of the antibiotic dosage.

What is Mycobacterium abscessus?

Mycobacterium abscessus is the name given to a bacterial pathogen from the same family responsible for causing tuberculosis. However, the difference with this particular bug is that it causes serious lung infections in individuals – including children – who have pre-existing lung conditions, such as bronchiectasis and cystic fibrosis. It is also associated with skin and soft tissue infections.

Up to this point, it has been virtually impossible to eradicate Mycobacterium abscessus in cystic fibrosis patients. It can also be life-threatening in the event of the patient needing a lung transplant not being eligible for surgery due to the presence of the infection.

What did the research involve?

The study entailed the use of samples of the Mycobacterium abscessus bacteria taken from 16 cystic fibrosis patients who were suffering from the infection. The researchers followed this by testing the combination of manuka honey and the antibiotic amikacin, to determine the dosage that was necessary in order to kill the bacteria.

The team turned to a lab-based lung model and a nebuliser – a device that produces a fine spray of liquid frequently used for the inhalation of a medicinal drug.

The nebulisation of manuka honey and amikacin together led to the discovery that bacterial clearance could be enhanced, even when reduced doses of amikacin were used. This, in turn, stood to minimise life-altering side-effects for the patient.

“Great promise as an improved therapy”

Lead author and PhD researcher Victoria Nolan said of the researchers’ findings: “So far, treatment of Mycobacterium abscesses pulmonary infections can be problematic due to its drug-resistant nature. The variety of antibiotics required to combat infection result in severe side effects.

“However, the use of this potential treatment combining amikacin and manuka honey shows great promise as an improved therapy for these terrible pulmonary infections.”

The findings of studies like these will certainly greatly inform the practice of drug calculation competency, with it being a great boon for us to discover that new treatments may be possible enabling undesirable side effects from medication to be reduced.

safeMedicate is an e-learning solution that can further help ensure competent and safe medication practice, with various learning and assessment modules available to assist medical professionals in their training.

Please do not hesitate to contact us to ask any further questions you might have about our virtual drug dosage calculation learning and assessment environments.

How invaluable could AI be for boosting productivity and drug discovery in the pharma industry?

If it seems at times as if artificial intelligence (AI) is gradually permeating any and every aspect of our lives, there are probably very good reasons for that. And there are certainly signs of this technology proving its worth in the pharmaceutical and biopharma industries, which have been beset by sluggish productivity down the years.

By that, exactly how sluggish has productivity been? Well, a University College London (UCL) report in 2018 stated that there had been an approximate halving in the number of new drugs given United States Food and Drug Administration approval per billion dollars of R&D expenditure, every nine years since 1950.

As a recent article from Labiotech.eu has noted, the COVID-19 pandemic did seem to serve as a catalyst for an uptick in productivity. That is not exactly a massive shock, given that back in 2020, governments, regulators, and big players in the life sciences sector were all throwing their weight behind the development of vaccines and treatments.

And yet, in some ways, the drug development process in the 2020s hasn’t altered all that greatly from its earliest days. There remains a strong degree of ‘trial and error’ inherent in drug discovery, which all adds up to an often slow and frustrating process.

There is evidence that AI could be a saviour for drug development

On this backdrop, there is an increasing urgency to instigate change that would help overcome such obstacles. In the words of Michael Nally, CEO at the American drug discovery firm Generate Biomedicines, “the artisanal nature of drug discovery is inherently difficult to scale. While the unmet needs continue to be extraordinarily profound, it just costs more to develop every new drug.”

Mr Nally’s CV includes an almost two-decade tenure at Merck – the pharmaceutical multinational that trades as MSD outside of the United States and Canada – prior to joining the venture capital (VC) company Flagship Pioneering in 2021.

Although Flagship is particularly known for having founded Moderna – the pharmaceutical and biotechnology company strongly associated with mRNA vaccines – another one of its portfolio companies in recent times has been Generate Biomedicines, where Mr Nally took the helm.

Mr Nally was particularly drawn to Generate due to its work on protein engineering as a source for novel protein and antibody medications.

Again, as Mr Nally himself has put it: “The great hope for the industry is that we will understand biology in a fundamentally more profound way than ever before.” He described Generate as “a truly computationally native company that sits at this intersection of science and technology. If you can harness that power, every part of the drug discovery and development process could be improved.”

The organisation’s use of machine learning (ML) and other computational tools is enabling it to design protein drugs that bind to their target much more effectively than current drugs. This, in turn, could lower the dose required in order to benefit patients.

Another aspect of Generate’s work is the development of protein drugs and antibodies that are capable of escaping recognition by the patient’s immune system, thereby ensuring that such therapies’ effect is not negated.

Promising signs of an exciting era for AI-powered drug discovery

While Generate is far from the only company that is doing remarkable things with AI to help accelerate the drug discovery process, it is certainly one of the names that ought to be watched, not least on account of its efforts to develop entirely new proteins and other large molecule drugs.

It all suggests that the pharma industry’s longstanding productivity woes could well be solvable, if drug discovery can be made more scalable through the work of firms like Generate.

Much remains to be seen about the progress that will be made on this goal, but we will certainly continue to watch developments on this front with interest.

Our own learning and assessment modules that constitute the safeMedicate suite of programs draw upon unique interactive technology to help make possible the most effective drug calculations and medication assessment for nurses and other healthcare practitioners. As a result, you can have the utmost faith in our solutions. Please do not hesitate to contact us if you have any further questions about the services we can provide.

Danish pharmaceutical giant commits $200 million to the creation of the first quantum computer for life sciences

The pharmaceutical sector has long taken an interest in artificial intelligence (AI) and machine learning, and the potential applicability of these technologies to drug development.

However, the Danish multinational Novo Nordisk has signalled how serious it is in pursuing this avenue, by pledging $200 million towards the creation of a world-beating quantum computer.

What do we know so far about the project?

Launched in conjunction with the University of Copenhagen, the Novo Nordisk Foundation Quantum Computing Programme is set to make use of the knowhow of internationally renowned researchers from Denmark, the United States, Canada, and the Netherlands. The aim is to build a quantum computer capable of accomplishing tasks that no other computer currently in existence can do.

The company wants to construct a machine that will perform calculations at a speed that even the most sophisticated computers presently available are unable to match.

As far as Novo Nordisk is concerned, such calculations would process immense quantities of data in relation to the human genome and disease, to enable personalised medicines to be developed faster.

When might we see Novo Nordisk’s supercomputer ‘in the flesh’?

The short answer to that question is: we’ve got at least years to wait. The company has admitted that “challenges persist in developing a fully scaled, fault-tolerant, generally applicable quantum computer.”

The collaboration is set to last for 12 years, and its first priority – accounting for the first seven years – is expected to be the development of the required hardware and materials. The remaining time will then see the chosen platform scaled up to a size that university and industry researchers can use.

As the company commented in a release on 21st September: “Quantum technologies will be key in the advent of personalised medicine by allowing the analysis of immense genomic data sets, as well as adding clarity to the complex interactions of the human microbiome or by accelerating drug discovery and development of new medicines.”

Technology that works towards safe medication practice

We are no stranger to calculations ourselves, of course – albeit of a different kind – with the safeMedicate suite of programs helping hundreds of thousands of nursing and healthcare practitioners in calculating drugs dosages in a variety of contexts.

Safe medication practice will always be of imperative importance in healthcare environments, and that is no less the case for drug calculations. Please feel free to contact our own team today for answers to any questions you may have about the relevance and applicability of safeMedicate to you.

Study sheds light on bodies with ‘Neanderthal’ genes processing medicines differently

There are many complexities to consider when it comes to medication dosage calculations, and the findings of new research provide further ‘food for thought’ with regard to the potential impact of genetic differences.

The anticoagulant warfarin is certainly one medication for which careful dosage calculation is needed. An overly small dose might not have the impact required; too big a dose, however, heightens the risk of the body bleeding uncontrollably. It is an undeniable balancing act – one that could be even more challenging to strike for people who have certain genes in common with Neanderthals.

“The admixture with Neanderthals has a direct impact in the clinic”

The researchers carrying out the study – as published in The Pharmacogenomics Journal – found that variants in enzymes with the purpose of breaking down pharmaceuticals such warfarin, statins and ibuprofen have ancient roots with potential lessons for how humans process medicines differently.

Leading the study was Hugo Zeberg, of the Department of Neuroscience at the Karolinska Institute in Sweden. The assistant professor commented: “This is one case where the admixture with Neanderthals has a direct impact in the clinic. Otherwise, therapeutic doses can be toxic for carriers of the Neanderthal gene variant.”

Migration helped bring about notable genetic differences

The ever-greater sophistication of genome sequencing has helped shed light on how Neanderthals – our direct ancestors who were still walking the Earth just tens of thousands of years ago – gradually spread across the world and intermingled with other migrants, raising families along the way.

There is still much to be known about how these migratory lifestyles manifested in genetic variations in today’s humans. Nor will all these variations be very significant; however, the impact that an ancestral form of enzyme or protein channel has on human health could be crucial to understand.

Of specific interest is the CYP2C9 gene, which encodes the cytochrome P450 – a superfamily of enzymes in the liver with responsibility for breaking down various medications frequently used for the treatment of conditions such as epilepsy and inflammation.

There are also, however, many variations in CYP2C9’s coding, with these structural variations differing in how effectively they metabolise pharmaceuticals. This means the version of CYP2C9 a given person inherits could have major implications for the period a specific dose of medicine lingers in their body.

To give an example of how drastic those differences can be, the type known as CYP2C9*2 is 70% less active than the more frequently seen CYP2C9*1 gene variant. This might lead to carriers of CYP2C9*2 being slower to metabolise certain pharmaceuticals.

As for the specific Neanderthal connection, this was discovered by Zeberg and his fellow researchers, when they observed sequences taken from 146 families. They found that the stretch of DNA in which the two cytochrome gene variants responsible for encoding the P450 cytochrome were present, was similar enough to the Neanderthal version to indicate the two genes are almost guaranteed to have been passed on due to a mixing of family lines tens of thousands of years ago.

As the researchers acknowledged, it’s not necessarily a discovery that will greatly impact on how people are treated with such medications as statins and warfarin. Considerable care is already taken over medication dosage calculations for relevant conditions, with frequent blood tests helping to keep dosages within reasonable confines. Nonetheless, the findings of the study certainly provide important context that help us understand to an even greater extent the diversity of health we see today. And we’re sure that’s something both healthcare practitioners and students who have long benefitted from the safeMedicate suite of programs will appreciate.

ADHD medication shows promise for treatment of apathy in Alzheimer’s patients

A review of a series of existing studies has concluded that a group of drugs used in the treatment of attention deficit hyperactivity disorder (ADHD), depression, and high blood pressure could also be useful for lowering apathy levels in those suffering from Alzheimer’s.

The medications covered in the research target noradrenaline which is a neurotransmitter in the peripheral as well as central nervous systems.

As Alzheimer’s disease first develops, the part of the brain responsible for controlling the release of noradrenaline can sustain damage. This, in turn, impacts on what is referred to as the noradrenergic system.

There is thought to be an association between the loss of cells in this area and the emergence of well-known dementia symptoms such as apathy, which is seen in about half or more of all dementia sufferers.

An Alzheimer’s patient suffering from heightened levels of apathy can be prone to ceasing activities that they once enjoyed, and they might struggle to perform even the simplest day-to-day tasks, such as making food and showering. This can then bring about a risk of other health issues.

“A dynamic two-way relationship between apathy and cognitive impairment”

Scientists from Imperial College London, University College London and the University of Cambridge sought to determine whether dementia symptoms such as apathy were treatable with drugs that target noradrenaline. In order to do this, they reviewed 19 previous studies in which 1,811 patients participated.

They found that the drugs were not only beneficial for the patients’ overall cognition, but also had an encouraging impact on efforts to reduce apathy and agitation.

Such findings raise the prospect of an effective Alzheimer’s treatment being developed relatively quickly, drawing upon already-available medication that targets the neurotransmitter.

One of the scientists behind the latest study, Imperial College London researcher Dr Michael David, commented: “Apathy is one of the most common symptoms in Alzheimer’s, and it is not fully understood.

“There is a dynamic, likely two-way, relationship between apathy and cognitive impairment, where dysfunction in the noradrenergic system could prevent patients from recognising things that require them to act – in essence creating an apathetic state.”

However, the researchers also underlined the importance of additional clinical trials being carried out, particularly to answer queries in relation to the dosage and how the drug interacts with other dementia medications.

Another Imperial College London academic who was involved in the new study, neurologist Dr Paresh Malhotra, stated: “At present there is no approved, specific medication for apathy in Alzheimer’s disease. The data for methylphenidate, a drug included in the current meta-analysis (a medication assessed within the safeMedicate platform), are promising, but there is no approved drug for this very common and disabling symptom.”

It is expected that further clinical trials will now be conducted by the group of scientists. Dr Malhotra is currently running a trial at Imperial of guanfacine, which is a noradrenergic medication.

Enquire to us about our e-learning solution that helps ensure safe medication practice

Would you like to learn more about how safeMedicate can develop and assess your skills with the world’s leading resource for healthcare students and practitioners? With over 43,000 Authentic Dosage Problems to assess your competence, visit our website for more information or you can contact our dedicated team here with any questions.

Source: https://www.sciencefocus.com/news/adhd-drugs-could-help-alzheimers-patients-who-suffer-from-apathy/

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