A study of the prescribing and administration of immuno-suppressant medication in patients receiving liver, kidney and pancreas transplantation

Abstract

Introduction There is little data on immuno-suppressant administration and prescribing to transplant patients. It was considered a high risk area because errors in prescribing and administration of immuno-suppressants can potentially have serious consequences like graft loss, side effects and even death. The reality was however that the lack of data meant that no one knew whether this was an area for improvement or not. The need for data collection was recognised and the aim of this study was to develop and validate a tool to inform the analysis of the patient journey (Failure Mode Effect Analysis) and identify opportunities for quality improvement of immunosuppressant medication use. (Time did not allow for the FMEA to be conducted). Methods One-to-one semi structured interviews were conducted with clinical staff (2 pharmacists, 2 nurses and 6 doctors) to explore their perceptions of high risk areas. A case study was done to define the patient journey and identify potential areas where the patient might be at risk of harm. Analysis of database of incident reports (from 2010) was conducted. Lastly, analysis of pharmaceutical care issues identified by clinical pharmacists (2 pharmacists) was done. Results Some of the areas identified by staff from interviews were; need for consistent education to patient by all healthcare professions, need for education of staff, communication with primary healthcare professions with regard to risk associated with immuno-suppressants, teamwork amongst the staff on the ward and documentation of interventions. A patient journey detailed where and when high risk processes could occur. The patient journey identified the following areas as high risk: nurses being busy, interrupted or not giving appropriate education. Patients being non-compliant in medications and follow-up meetings, doctors not having clear handwriting, doctors not writing the formulation of immuno-suppressant etc. Database analysis confirmed that Datix® was not a well used reporting system and incidents were mainly in the immuno-suppressant administration category. The incidents reported emphasised the need to follow safe use of medicines policy. Pharmaceutical care issues were not well documented and there were no consistent interventions to confirm particular high risk areas. Discussion The richest data came from interviews and highlighted actions that could be used to reduce risk of harm from immuno-suppressive drug therapy. The data collected can be used to generate an FMEA for agreement and use by a multidisciplinary team.