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just find it. Hopefully that screen high shared on you can see it. So I just start to show and I wasn't sure he always going to be out to talk today. So, um, this is more oriented it towards nurse in. In many ways, that is medical. But, um, that's a good to have around three over anyway. So what? The objectives themes to just obviously one of our one of my objectives. Anyways, we just a number of Ms doses of time critical medications in that you feel our objectives to tie and limit that are, have no medical medications have been messed with in the department. And there's responsibility on nursing, medical and pharmacy staff to try and make sure that that doesn't happen. Obviously, doctors have to be there to prescribe it, or Strieber like me. I could describe it as well, also, then on the nurses to make sure it's given their responsibility to make sure it's also available and the department on. Then we'll have a quick look at the regional list of time critical medications on and focusing on the conditions that are most important for us any day. So why are we understand it. Um, well, there have been several report incidents in the last year. Pastes coming to harm as a result of messing medication. We're not getting up at the right time on consequences of mess medications include a deterioration in the condition of a patient. Distress for the patient had an increase in length of stay in hospital effects and nicely as well with the World Health Organization. Who's third? Google Challenge WAAS Medication Safety. Um, so they're three million things that have that have been, um, medications. It in high risk areas to 80 is kind of a high risk area. Transitions of care. So always leave. We're seeing people coming in. So that's the first point of contact and the hospital for Live on, then with dosing on D prescribing a swell. So that's terribly mean, thinks it's also then been brought down from wh your level into astrology document for Northern Ireland as well. So it is something that has been not bad. A whole faded, the medication safety off which miss doses and critical manage form a large part. In fact, I'm sure most of your baby aware, but there has been a nap. Fellow that has been appointed and under um on their adept project on Upton this year are within the trust will be to look at ways off, um, improving medication safety on obviously, one of the things that we looked at that that's hard to religious. The incidence is off critical medication. So firstly is important to say the old medications are correctly administered on prescribed at the right dose on the right time to patients. Um, we often forget the medication. As I said, the most common intervention. The patient will receive a hospital. And so there was a regional list off time critical mats that where was developed time critical manager lose That should be given a particular time of day or a delay may adversely side patient. So instead, mostly before we want to talk about today is instead of directly focusing on the medication because it's hard to remember what all the different time critical medications are. We focus on the conditions that the medication would be used to treat, so it be easier to remember that somebody's never lactic s, so therefore they're likely to be on time critical medication, then remember in every on the epileptic drug on what is somebody for Parkinson's as well. And so we like that there wasn't even more detail. Firstly, that is a copy off the regional list of stands is was displayed in department. It should still be there somewhere, so you can see it is quite extensive. List, um, on a very difficult to remember them all. So there are conditions, obviously any D that are more critical than others. And that's why we're going to focus and on those so and on that less than the ones that I picked out that we would see probably quite commonly, or steroids to, um, assim port to remember yes, with prescribe steroids for patients from the commend and for a good illness. But it's also worth remember that there's quite a little patients right there that are on steroids, long term as well. That's also worthwhile to remember, especially if it's an Addisonion patients. Well, they do. You need their steroids, and they probably need their daughters looked at as valuable come and get their own well. But it's important that those patients don't mess there. Does this warfarin and do X will. She will be fairly familiar with those. And I, um it's warfarin was always one because I needed an eye on our and you could tell, but I on our was somebody with a new X. Take pecks of on, for example, on duration of action of the picture bombs pretend to 12 ours and four, if you forget it, give a dose. And we're effectively not on the credit in that patient for on a period of time, which can be done for rhabdo and seeing with delays in the given of articulate, Let's aspirin better go tiger lower on the ones that we wouldn't more or we wouldn't see quite so commonly than under at referrals on. But so anybody is HIV positive and there isn't any irreparable, I'll do all come on a roll managed by the royal lot of Belfast. So if patients will have to bring in the room on medication very requiring undergrad provider ALS and then closet Penis rare so cause a Penis man, it's obviously been mental health on a delay, Mestre. One missed doses cause pain isn't really a major issue, and if you miss it for more than a little bit, 72 hours and the patient's going to have to go right back to start and take tree it way up from the start, which might mean that they're on weekly blood again on instead of monthly blood twice her bloods every two months. So it was cracking them piped on the patient, but the ones we only focus on more. So our epilepsy, asthma and diabetes on way already asked those three oz a swell. It's a bit warfarin and do X, and it's also to be aware of Parkinson's disease transplant patients. And then, as we mentioned, the Addison's So Parkinson's disease and and research is find a delay or admission, and Parkinson's patients receiving the medication contributes to 73% increase in the length off their hospital stay. It can cause the patient's symptoms to become were uncontrolled on the fact some functions is such a mobility and swallow s O, and actually say a patient come in middle of the night, you're due to get their dispersal amount of part first thing in the morning. We forget to give it to them on, and it comes to lunchtime on we her at is has happened that by at stage they may have deteriorated to such an extent that they're swallow has been affected. It makes it much more difficult to try and get them out apart and to the patient. Um, there have been occasions, and we've seen where has been possible to get anything and orderly to the patient on the streets over to patch. So obviously that has a detrimental effect to the patient on turns off, losing their swallow with their ability to eat and drink. And then it takes time for that, obviously, to recover UK. Parkinson's audit reported a negative for significantly negative factors experienced before the 3.7% of patients who didn't receive your medication on time. There are partners is timers that are available in the hospital. I think there were some in 80 at one state's having checked, don't know their study there or not. But if they're not, we can get a another couple of well and that just allies to be programmed. Put the nurses pocket and then a little buzz from the medication is. Do your five minutes before the medications do to try and cut down on the number of MS doses on to make sure, Parkinson's elbow is probably the one that needs to be, given that the exact times. So it's not good enough to be on our on giving Parkinson's tablets. We should try and give it another precise times, which is why you will see Parkinson's patients actually written up for medication at times that do much. The times on our card X is, um, especially if there are trolling it. Um, so that's just important thing to write for it have elapsed, then serious harm can occur of the patients mess doses for, however, on the epileptic, uh, Mr on the electric medications, the patient was going to have a seizure. It has potentially serious implications in everyday life, for example, not been able to drive. They want example that sticks in my mind was from under um, where there was a patient that was admitted on a Friday evening to surgery. They were little bit month. Um, I didn't even it under the epileptic sound on Friday night, Saturday morning, Saturday night on the patient on to have a seizure, and they're they are off the Sunday morning and ended up job in a See you, Um, just because they haven't been doing attention given well, and I was an essay, I and then when that comes with that was that the best medication had had a significant and fight all, not diabetes, And we won't do it right. But DKA is important to remember that DKA can occur if diabetic medication is missed, especially insulin. And it doesn't take a whole lot of doses. There was a patient up in one of the medical wards You something, mister 10 o'clock insulin at nighttime by two o'clock in the morning, UH, was in DKA. So it doesn't actually take very much steps on patients over the age of transplants, missing doses or transplant medications. Such a tight, really Mr Micro family. It can also increase the risk of rejection of the graft. So what can we do on its first? Let's important to identify that patients have a condition that means they have a time correct medication. So it's important to realize that there are Parkinson's who have around the know very patients. Nurse to nurse are between shifts of F. It's always a worthwhile thing to note and inquired what medications they're on for their condition, what they would normally take highly, would normally take it at home and when they would normally take it at home. If there are medications, Juice inspector doctor prescribed her and get the medication up that could be done on the inside of the phlegm. See after starting needy patient. Obviously, if they are over the medical of surgeons, then ensure that is written out in the car next time. Fashion, um, in regards to source of the medication has the patient brought end? So it's really sad, for example, off on the retrovirals. Um, we won't have those in the hospital. They aren't stopped anywhere in North, none other than in the royal patients. They'll have to bring in the room medication if they want that. And seven today is it in the message story about the department? Oh, aren't any There were start covers. I I started out that's asking it to the pharmacy. Or if I abolished contact the bad monitor, you could try and shorts the medication. Sure, your chart that bad managers have, which tells them were a lot of the critical man so actually stored within the hospital on that means them that they should be able to look at that on new. Where would have a routine laser? What Ward would routinely have model part. Is it in the emergency room? Um, you know, where is it? Actually start. Right. So we have looked at the start for medications kept in the medicine Cialis rather than the covers. A swell. So what does he do? You try to keep the most commonly prescribed on the other lab X, Parkinson's and diabetic. Oh, our medicines in it. Um, always. It's not realistic to start every tablet for these conditions any D, but the vast majority are available in the hospital on. And as I said, that is a chart to chewing her a critical Mansare cap with in the hospital in the in the trust. So that is the chart that you probably will be able to see it very clearly. But bad managers have a copy of that. I think we're talking about maybe about a copy over and 80 and dying here. And then there's a similar chart. Three D and afternoons mail. Just try a dying from a number of mess Medici medications. It's also hard as well for ours on to see If you're in the rain multiple boards, you leave the lookout and see you. Where should keep it, Um, on their regular warts. Talk to hopefully all those things. We'll help anybody getting questions. Thanks very much. True. Think. And my question started asking for the last half. It was in the trust Internet, but you don't have that question with your 12. I think so. And actually help, I think. Well, the thing is, we're just, um we were, like, even take Amitiza it. Waas. You know, when we're seeing a patient who your own from these medications, then we need to take more. Except for that also, you know, even if you're if we're not in a patient and the medicine or surgery If we knew that was gonna be three hours before the medics, our card from the patient and then we need to capture that we're prescribing those temper your medications and ideally, only got I don't want a card X, but you could put them on the forms. If you wish and they play is one of the reasons why it's so important that we have a few issues with patients who have been seen overnight, and I thought certainly to be seen by D a year in the morning and then just laughter that I'm missing the DEA You in the morning, and we've been quite clear, and hopefully you'll know that that's not what we do. You, uh, patient should be better than the medicine overnight. Really? So that the medical team can come on. Next visit cardiacs. They're 10. Put any temperature medications. Not enough to show for you in the morning, but they will pick him up, but and your amount in the patient, their you're a patient. So, um, it's your responsibility to make sure that patient has their medicate, the time kind of medications prescribed. And so no other questions come up there. In the meantime, while I've been No, no. So I think you're gonna know gyms. Thank you. Problem. Okay. Chairs