Yes / Medication errors involving insulin in hospital are common, and may be particularly problematic at the point of transfer of care. Our aim was to improve the safety of insulin prescribing on discharge from hospital using a continuous improvement methodology involving cycles of iterative change. A multidisciplinary project team formulated locally tailored insulin discharge prescribing guidance. After baseline data collection, three ‘plan-do-study-act’ cycles were undertaken over a 3-week period (September/ October 2018) to introduce the guidelines and improve the quality of discharge prescriptions from one diabetes ward at the hospital. Discharge prescriptions involving insulin from the ward during Monday to Friday of each week were examined, and their adherence to the guidance measured. After the introduction of the guidelines in the form of a poster, and later a checklist, the adherence to guidelines rose from an average of 50% to 99%. Qualitative data suggested that although it took pharmacists slightly longer to clinically verify discharge prescriptions, the interventions resulted in a clear and helpful reminder to help improve discharge quality for the benefit of patient safety. This project highlights that small iterative changes made by a multidisciplinary project team can result in improvement of insulin discharge prescription quality. The sustainability and scale of the intervention may be improved by its integration into the electronic prescribing system so that all users may access and refer to the guidance when prescribing insulin for patients at the point of discharge.

Call number: LD2668 .T4 1960 H84

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Rationale: Interprofessional collaboration (IPC) occurs when “multiple health workers from different professional backgrounds work together with patients, families, careers and communities to deliver the highest quality of care” (WHO, 2010, p. 13). Successful discharge planning for patients from hospitals is dependent upon IPC (Shepperd et al., 2004). The purpose of this study is to identify and examine barriers or facilitators to IPC as they pertain to discharge planning on a neonatal intensive care unit (NICU). Methods: Case study design using an online survey, participant observation and semi-structured interviews for data collection. Healthcare workers on a NICU at a large Canadian teaching hospital were surveyed to determine their views on the discharge planning process, leadership and IPC. Participant observations took place during the weekly IPC rounds to observe the healthcare workers when discussing discharge plans and to identify key informants for interviews. Based on these observations, 10 health care workers were selected to interview to gain a more in depth understanding of IPC in the discharge planning. Data collection occurred from December 2010 to February 2011. Results: Survey results (n=66) indicate that the majority of healthcare workers on the NICU support IPC. However, the interview data demonstrated that problems arose during an emergency discharge. An emergency discharge occurs when an existing patient on the NICU needs to be discharged to another unit in order to provide a bed for a new admission. The lack of effective communication, role clarity issues, and a need for mutual respect act as barriers to the full participation of all members of the interprofessional team in an emergency discharge. Conclusions: Defining the context is important; IPC works well in a non-emergency situation on the NICU. The level of involvement of the healthcare workers in IPC varies due to previous experience working on interprofessional teams (IPT). The medical lead is responsible for making the decision about a discharge. However, what has been identified as important is an IPC leader who is responsible for ensuring that all information from the IPT members is accessible to inform the medical lead. / UOIT