Impact of a Mobile Meditation Application Among Hospital-Based Acute Care Nurses

Compassion fatigue has also resulted in increased absenteeism, errors, and other disruptive behaviors and can have negative effects on patient care. Examples may include medication errors and failure to rescue patients with unrecognized declining health status. [...]in a separate study of college students who were randomly assigned to use one of three apps, for ten minutes per day for ten days, Headspace users had positive outcomes. Methods The Professional Quality of Life 5 (ProQOL5) and Mindfulness Attentive Awareness Scale (MAAS) surveys were used to collect pre-and post-intervention data through Survey Monkey online.

Patient Safety Culture in the Emergency Center at the University Clinical Center of Kosovo and the COVID-19 Pandemic

BACKGROUND: Despite the developments in Kosovo's healthcare, there are still many challenges that hamper the delivery of proper health-care service. This was especially highlighted during the coronavirus disease 2019 (COVID-19) pandemic. AIM: This study aims to elucidate the factors that impede proper health service as well as reduce preventable medical errors by focusing on safety as a fundamental principle in patient care and a key component health services quality management. The main goal is to improve the overall approach to the patient by improving the workers performance and redesigning systems, with the goal of reducing patient risk not only in normal working environment but also in new and unusual situations such as COVID-19 pandemic. METHOD(S): In this cross-sectional study, data were collected and analyzed. Two questionnaires were compiled for this research: one was compiled to address patients who sought health services at the Emergency Center;the second questionnaire was designed for the Emergency Center personnel to identify the relationships between the workers, managerial staff, the problems of reporting errors, and similar. Moreover, relevant publications on the impact of the pandemic on the provision of health services were compared. Statistical analysis was done by IBM SPSS version 25. CONCLUSION(S): There is a need for improving Patient Safety Culture in The Emergency Center at the University Clinical Center of Kosovo. By reorganizing working hours for the workers of the Emergency Center, preventable medical errors would be reduced. Raising the capacities of the primary care level would reduce the load of the Emergency Center from interventions, which can be handled without a problem at the lower levels. Continuous professional trainings, as well as trainings focused on stress management, working under time pressure, and relationships between health service providers would significantly improve the level of patient safety in the Emergency Center.Copyright © 2023, Scientific Foundation SPIROSKI. All rights reserved.

AIM and Patient Safety

Patient safety has constituted a huge public health concern for a long period of time. The focus of safety in the healthcare context is around reducing preventable harms, such as medical errors and treatment-related injuries. COVID-19 pandemic, if anything, has act as a wake-up call for health experts to address latent safety problems. Advancements in the field of artificial intelligence have highlighted the use of intelligent systems as a proven means of improving patient safety and enhancing quality of care. This chapter explores trends in quality and safety research, the use of machine learning and natural language processing in the context of improving patient safety and outcomes, the use of patient safety databases as a source of data for machine learning, and the future of artificial intelligence in quality and safety. © Springer Nature Switzerland AG 2022.

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Burnout among physicians has been associated with a significantly higher risk of making errors (eg, medication errors, diagnostic errors, and decision-making errors,) leading to suboptimal patient care and reduced patient satisfaction. O The Nutrition feature is an interesting discussion of the latest food trends and food labels, as well as how to break down this information when discussing with parents. O The Dermatology section features a compelling case of an adolescent boy with scalp thickening and skin folding.

PHYSICIAN BURNOUT IN THE ICU: THE IMPORTANCE AND THE SOLUTION

Physician burnout has become a prevalent issue in intensive care units, and studies have shown it has become worse with the COVID-19 pandemic. Recognizing and reducing ICU physician burnout is important because of the potential effects on patient care, physician health, and the hospital. The most common symptoms of burnout include fatigue, callousness towards patients, inability to feel happy, anxiety, and depression. Causes of burnout can include work related factors, personal characteristics, and organizational factors. COVID has brought unprecedented work flow, increased number of critical and ethical decision making, and increase in death, all of which can lead to burnout. Strategies to combat burnout generally come in two different ways-organization based and individual based. This paper examines these current strategies and their efficacy in reducing burnout and proposes an implementation plan for the ICU to use based on current literature.

WORKING PRINCIPLE AND INTELLIGENCE OF SMART INFUSION PUMP

There is a tremendous demand on the critical care resources due to the extensive spread of the ongoing coronavirus pandemic and the large number of patients requiring critical care. The efficacy of a device directly influences how long a patient lives since patients are often receiving critical care. Smart infusion pump is a medical device that can drip fluids into the patient's body. This device is considered as one of the most safety-critical medical devices due to the way it functions and the risks it presents. The main objective of this work is to develop an affordable infusion pump usin g embedded technology. The main tactic is to develop equipment that can identify air bubbles in infusion pump tubing since even a little one might obstruct blood flow and result in mortality. This method may provide consumers an accurate result, making it the greatest method for identifying bubbles and saving lives.

Strive to prescribe and do no harm

AimsPrescribing medication is a common intervention and hence prescribing errors are not uncommon events. From the literature 13% of paediatric prescriptions contain errors1 and recently it was estimated that 66 million of the 237 million prescription errors had potentially clinically significant outcomes.2 This has been highlighted following a recent critical incident and, as part of the learning recommendations;a multidisciplinary team (MDT) approach was formed to improve departmental prescribing education. The aim was to reduce the number of prescribing errors, therefore reducing harm to patients, and improving patient care. This was achieved through the joint efforts of trainees and ward pharmacist by developing robust evidence-based teaching not only at induction but as rolling sessions throughout the year which, due to COVID-19 restrictions, was delivered virtually. In conjunction there was also a revision of the induction paediatric prescribing test, regular review of the number of prescribing error incidents and drug chart audits with cycle completion and implementation of changes. The teaching programme and audits were started in December 2020 and are on-going.MethodsFrom December 2020 to May 2021, audits were undertaken initially using the RCPCH Paediatric Prescribing Error tool.3 We later revised the audit tool to also include the standards defined in our hospital inpatient prescribing policy. 30 random drug charts from across three paediatric inpatient wards were analysed every month with the aim to achieve greater than 90% in each standard (taking into account a baseline level of human error) and then to maintain this over time. To achieve this, learning from the audit was fed back to all members of the team via regular electronic and visual/verbal reminders and the teaching programme was amended to include troublesome topics. Adverse incidents were reviewed and teaching from this was also included in the teaching programme.ResultsSince December 2020, it took six months for the number of incidents due to prescribing errors to reduce from 14 in six months (December 2020-May 2021) to 10 in six months (June-November 2021). Audit results showed that since December 2020 we were scoring >90% in 3 out of the 10 domains. Three months into the teaching programme this improved to 4 out of 10 of the domains and at six months, 6 out of 10 domains. When re-audited with our revised audit tool, we achieved >90% initially in 10 out of 16 domains and then consistently maintained our standards across 11–12 out of 16 domains over a four-month period (October 2021-January 2022).ConclusionsThis project has shown that despite a global pandemic, a combination of innovation, education, technology, multidisciplinary skills and MDT working can implement and embed change to improve patient safety. When considering the bigger picture, we recognise this is a small part of the larger systemic processes that can influence medication errors and that with perseverance, we can aim to reduce the risk of adverse events due to medication errors and therefore provide the best care for our patients.ReferencesGhaleb MA, Barber N, Franklin BD, et al. The incidence and nature of prescribing and medication administration errors in paediatric inpatients. Arch Dis Child 2010;95;113–118.Elliot RA, Camacho E, Jankovic D, et al. Economic analysis of the prevalence and clinical and economic burden of medication error in England. BMJ Quality & Safety 2021;30:96–105.RCPCH Paediatric Prescribing Error Audit Tool. https://qicentral.rcpch.ac.uk/medsiq/safe-prescribing/paediatric-prescribing-error-an-audit-tool/

Impact of pharmaceutical interventions in critical patients

Background and ImportanceThe high healthcare burden in the Intensive Care Unit (ICU) due to the SARS-CoV2 Coronavirus pandemic has created a work environment that increased medication errors. It is known that pharmaceutical interventions reduced medicantion errors.Aim and ObjectivesThe objective of this study is to know the impact of pharmaceutical intervention in critically ill patients.Material and MethodsRetrospective observational study carried out in a general hospital. All the pharmaceutical interventions performed in the Intensive Care Unit (ICU) between the months of October 2020 and April 2021 were analysed. It was registered in a database: Positive diagnosis of COVID-19 (SARS-CoV2 coronavirus disease), number of interventions, type of intervention and acceptance of the intervention.ResultsA total of 51 interventions were obtained in 169 patients admitted during the 7 months of the study (0.3 interventions / patient). 42.6% of the patients had a diagnosis of COVID-19. 17% of the patients admitted to the ICU had at least one intervention, of which 38% had more than 1 (mean 1.76 interventions per intervened patient). The most frequent reasons for intervention were dose modification due to inappropriate dose (35.3%) and inappropriate choice of presentation due to the route of administration (21.5%). 84% of the interventions were carried out in COVID-19 patients, with the mean number of interventions performed in these patients higher than in non-COVID-19 patients (1.87 vs 1.33). 92% of the interventions conducted by the pharmacist were accepted.Conclusion and RelevancePharmaceutical validation in the Intensive Care Unit (ICU) is essential to optimise the treatment of critical patients, increasing safety and efficacy of medications they receive and reducing medication errors. Patients diagnosed with COVID-19 are especially likely to benefit from pharmaceutical interventions, which are highly accepted by physicians.References and/or AcknowledgementsConflict of InterestNo conflict of interest

Errors detected in the telepharmacy procedure

Background and ImportanceAfter the rise of telemedicine with the COVID-19 pandemic, a telepharmacy consultation has been implemented in our hospital in the pharmacy outpatient area, sending medicines to community pharmacies within a population area of 600,000 inhabitants.Aim and ObjectivesThe purpose of this study is to analyse the medication errors (ME) that have occurred during a specific period of time, throughout the process of medication delivery. The aim is finding causes and possible improvements.Material and MethodsWe carried out a retrospective descriptive study. The errors that occurred between January 2021 and August 2022 (20 months) in the telepharmacy process were analysed, taking into account everything from the preparation in the hospital pharmacy to the collection of the medication by the patient in the community pharmacy. The MEs were collected in a local database. We described date, personal data of the patient, codes assigned to the single shipping route and destination community pharmacy, type of error and step in which the ME was detected.ResultsIn the period studied, a total of 69 MEs were recorded. We break them down into the following types: 20 cases with a quantitative lack of medication (28.99%), 19 cases in which a different medication was sent (27.54%), 15 with another patient‘s medication (21.74%), 10 with medicine with wrong dose (14.49%), 2 cases in which the medicine was not sent (2.90%) and another 2 in which the medicine was sent badly packaged (2.90%), 1 case in which the one in which the misidentified medicine was sent (1.45%) and 1 case in which a larger quantity was sent (1.45%). 48 MEs were detected by the patient (69.56%), 15 were detected in the community pharmacy (21.74%), 4 were detected in the hospital pharmacy (5.80%) and 2 cases were detected during the transportation of the medication (2.90%). None of the errors detected had consequences for the patient to our knowledge.Conclusion and RelevanceAmong the MEs detected, the most common were those related to a quantity defect or lack of a medication and those in which a different medication was sent. In general, they are errors that could be avoided by automating processes that are currently carried out manually.References and/or AcknowledgementsConflict of InterestNo conflict of interest

The clinical pharmacist: an essential actor in times of crisis

Background and ImportanceDuring the health emergency period related to the emergence of the COVID-19 pandemic, clinical pharmacists have played a vital role in mitigating medication errors, especially prescription errors in hospitals.Aim and ObjectivesThe aim of this study was to carry out a descriptive analysis of the pharmaceutical interventions (PI) on the prescriptions of the patients of the COVID units of our establishment.Material and MethodsA prospective study was conducted on patients with positive COVID-19 status admitted to a hospital COVID unit over a period of four months. The pharmaceutical analysis prompted interventions to rectify medication-related errors.ResultsThe study included 108 patients. Prescription analysis led to 63 PIs. The sex ratio (M/F) was 0.5 in a favour of female predominance. Hypertension was the most common cardiovascular disease, affecting 34% of patients. Most drug-related problems were overdose accounting for 38% (16/63). The most common PI in 40% of cases was dosage adjustment (18/63). The main drug classes concerned were general anti-infective agents for systemic use 25% (16/63), followed by corticosteroids 23% (15/63) and hydroxychloroquine 19% (12/63) especially in the event of interaction with drugs that lengthen the QT interval.Conclusion and RelevanceThe commitment of clinical pharmacy in such a pandemic is therefore important. Its presence has led to a reduction in the problems of drug prescriptions.References and/or Acknowledgements1. No conflict of interest.Conflict of InterestNo conflict of interest

Dynamic Candidate Solution Boosted Beluga Whale Optimization Algorithm for Biomedical Classification

In many fields, complicated issues can now be solved with the help of Artificial Intelligence (AI) and Machine Learning (ML). One of the more modern Metaheuristic (MH) algorithms used to tackle numerous issues in various fields is the Beluga Whale Optimization (BWO) method. However, BWO has a lack of diversity, which could lead to being trapped in local optimaand premature convergence. This study presents two stages for enhancing the fundamental BWO algorithm. The initial stage of BWO's Opposition-Based Learning (OBL), also known as OBWO, helps to expedite the search process and enhance the learning methodology to choose a better generation of candidate solutions for the fundamental BWO. The second step, referred to as OBWOD, combines the Dynamic Candidate Solution (DCS) and OBWO based on the k-Nearest Neighbor (kNN) classifier to boost variety and improve the consistency of the selected solution by giving potential candidates a chance to solve the given problem with a high fitness value. A comparison study with present optimization algorithms for single-objective bound-constraint optimization problems was conducted to evaluate the performance of the OBWOD algorithm on issues from the 2022 IEEE Congress on Evolutionary Computation (CEC'22) benchmark test suite with a range of dimension sizes. The results of the statistical significance test confirmed that the proposed algorithm is competitive with the optimization algorithms. In addition, the OBWOD algorithm surpassed the performance of seven other algorithms with an overall classification accuracy of 85.17% for classifying 10 medical datasets with different dimension sizes according to the performance evaluation matrix.

Assessment of antibiotic appropriateness in hospitalized veterans with COVID-19 in the VA MidSouth Healthcare Network (VISN9)

Background: Bacterial coinfections with COVID-19 appear to be rare, yet antibiotic use in this population is high. Limited guidance is available regarding the use of antibiotics in these patients. In response, a multidisciplinary group of physicians and pharmacists from 5 VISN9 facilities developed a guideline for the use of antibiotics with COVID-19 in July 2021. This guideline created a network-wide standard for antibiotic use and facilitates the assessment of antibiotic appropriateness in hospitalized veterans with COVID-19. Methods: In this observational, cross-sectional study, we reviewed veterans diagnosed with COVID-19 from August 1 through September 30, 2021, who were admitted to VISN9 facilities. Use of antibiotics was assessed during the first 4 days of admission. If antibiotics were prescribed, their use was determined to be appropriate or inappropriate based on the presence or absence of a finding concerning for bacterial coinfection as outlined in the guideline (Table 1). Additional data including procalcitonin results as well as positive sputum cultures were collected. Results: In total, 377 veterans were admitted for COVID-19 during the study period. Among them, 42 veterans (11%) received antibiotics for nonrespiratory infections and were removed from this analysis. Of the remaining 335 veterans, 229 (68%) received antibiotics and 116 (51%) of those met guideline criteria that were concerning for bacterial coinfection. Additionally, 32 (14%) of the 229 veterans who received antibiotics had >1 finding concerning for bacterial coinfection. Procalcitonin levels were obtained in 97 (42%) of 229. Only 33 veterans (14%) who received antibiotics had an elevated procalcitonin, and only 19 (8%) had a positive sputum culture. Conclusions: Antibiotic use was common in hospitalized veterans with COVID-19 in VISN9 facilities. This results are comparable to findings in the published literature. Among those receiving antibiotics early in their hospitalization, half were considered appropriate based on our guideline. Quality improvement initiatives are needed to improve implementation of the network guideline to reduce the overuse of antibiotics for management of COVID-19. Additionally, procalcitonin may be a helpful tool for hospitalized veterans with COVID-19.Funding: NoneDisclosures: None

"Second victims" in Covid-19 pandemic: A crosssectional study among medical doctors of the Catanzaro Hospital

Introduction: Medical errors are a serious public health problem. The COVID-19 pandemic has caused further stress to doctors with the increase in patient mortality, the lack of definite guideline and growing work demands. In this scenario, the patient is not the only victim of the medical error. The "second victim" (SV) is defined as a health worker who was involved in an unforeseen and negative event for the patient, who suffers physically and psychologically, because he was traumatized by his own mistake and/or by the injuries caused to the patient. The SV phenomenon prevalence varies from 10.4% up to 43.3%. Objective(s): The aim of this study is to evaluate the second victim phenomenon during the COVID-19 pandemic among medical doctors of the Catanzaro University Hospital (Italy). Method(s): A cross-sectional study will be conducted by administering an anonymous questionnaire to the Catanzaro University Hospital medical doctors using SurveyMonkey software. Descriptive analysis will be performed. Result(s): The data collection is ongoing. Currently, 300 subjects are included in the sample. Conclusion(s): The second victim phenomenon has a negative impact on doctors, colleagues and patients. It is important to aid health workers involved in an adverse event by activating support networks and adopting appropriate strategies in order that the event is a source of learning and not of demotivation.

Determinants, predictors and negative impacts of burnout among health care workers during COVID-19 pandemic.

The first defense line of the battle, healthcare workers (HCWs), faces a significant challenge in managing the current COVID-19 pandemic. An online electronic survey was sent to HCWs via email and social media networks. Socio-demographic data and work environment-related variables were assessed. Consequences of burnout (BO) were reported, e.g., elicited medical errors. Maslach burnout inventory was used to diagnose BO. Two hundred and eighty-four participants were included with a mean age of 39.83 ± 7.34 years, 70.8% worked in the COVID-19 frontline, 91.9% were followed daily updates about COVID-19, 63.7% were not satisfied with the coordination between triage and isolation, 64.4% got COVID-19 infection, 91.9% had a colleague or family member developed COVID-19 infection, and 21.5% experienced a colleague /a family member died due to COVID-19. Multivariate analysis by linear regression revealed that; working as a frontline HCW (OR 1.28, CI = 0.14-2.55) and sleep deprivation (OR 3.93, CI = 1.88-8.22) were the predictors of burnout.

Call to Action: Creating Resources for Radiology Technologists to Capture Higher Quality Portable Chest X-rays.

Background Patient rotation, foreign body overlying anatomy, and anatomy out of field of view can have detrimental impacts on the diagnostic quality of portable chest x-rays (PCXRs), especially as the number of PCXR imaging increases due to the coronavirus disease 2019 (COVID-19) pandemic. Although preventable, these "quality failures" are common and may lead to interpretative and diagnostic errors for the radiologist. Aims In this study, we present a baseline quality failure rate of PCXR imaging as observed at our institution. We also conduct a focus group highlighting the key issues that lead to the problematic images and discuss potential interventions targeting technologists that can be implemented to address imaging quality failure rate. Materials and methods A total of 500 PCXRs for adult patients admitted to a large university hospital between July 12, 2021, and July 25, 2021, were obtained for evaluation of quality. The PCXRs were evaluated by radiology residents for failures in technical image quality. The images were categorized into various metrics including the degree of rotation and obstruction of anatomical structures. After collecting the data, a focus group involving six managers of the technologist department at our university hospital was conducted to further illuminate the key barriers to quality PCXRs faced at our institution.. Results  Out of the 500 PCXRs evaluated, 231 were problematic (46.2%). 43.5% of the problematic films with a repeat PCXR within one week showed that there was a technical problem impacting the ability to detect pathology. Most problematic films also occurred during the night shift (48%). Key issues that lead to poor image quality included improper patient positioning, foreign objects covering anatomy, and variances in technologists' training. Three interventions were proposed to optimize technologist performance that can lower quality failure rates of PCXRs. These include a longitudinal educational curriculum involving didactic sessions, adding nursing support to assist technologists, and adding an extra layer of verification by internal medicine residents before sending the films to the radiologist. The rationale for these interventions is discussed in detail so that a modified version can be implemented in other hospital systems.  Conclusion This study illustrates the high baseline error rate in image quality of PCXRs at our institution and demonstrates the need to improve on image quality. Poor image quality negatively impacts the interpretive accuracy of radiologists and therefore leads to wrong diagnoses. Increasing educational resources and support for technologists can lead to higher image quality and radiologist accuracy.

Assessment of the Quality of MedDRA Coding in a Sample of COVID-19 Vaccine Medication Error Data: An International Journal of Medical Toxicology and Drug Experience

Introduction: High interest in the last two years was globally put by Health Authorities on the recording, coding, and reporting of medication errors to ensure the safety and effectiveness of the use of medicines and to provide reliable information to healthcare professionals and patients. Medical coding is a prerequisite for efficient, effective, and reproducible data outputs. Objective: Not applicable. Methods: A sample of medication error coding results was assessed for accuracy and consistency of MedDRA coding and identification of main types of coding errors. It included 1500 coded reported terms for COVID-19 vaccines medication errors, assigned to MedDRA codes by national regulatory authorities or pharmacovigilance centers and drawn from the Uppsala Monitoring Centre (UMC) VigiBase through August 25, 2021. Results: One-third of the records could not be assessed due to incomplete or unclear verbatims. In one-third, code assignments were correct, but another third of the sample was not adequately coded. Most frequent coding errors corresponded to vague PT assignments, while more detailed information was available for a more precise coding. This observation is similar to the EudraVigilance database, where some of the most assigned MedDRA terms for medication errors also represent vague concepts. Conclusion: These findings indicate that understanding of medication error documentation and assessment and of MedDRA content and coding guidelines need to be reinforced. The MedDRA Maintenance and Support Services Organization (MSSO) offers several MedDRA coding trainings, including coding of medication errors. The authors provide valuable references to the latter, to the applicable ICHEndorsed Guides for MedDRA Users, and to relevant EMA guidance.

Environmental Sustainability in the Healthcare Sector: An Overview of Research

In the Spring of 2020, the world was dealt a difficult blow with the pandemic of the novel Coronavirus. One of the most striking issues facing healthcare providers and hospitals was the lack of medical supplies and Personal Protective Equipment (PPE). The increased use of PPE during the pandemic highlights the problem with the volume of medical waste and its impact on the environment. Approximately 5 million tons of total waste is produced by hospitals around the world per year (Practice Greenhealth, 2020). A study conducted by Health Care Without Harm, found that "healthcare's climate footprint is equivalent to 4.4% of global net emissions (Karliner, Slotterback, Ashby, and Steele, 2019, p. 60)." Research regarding environmental sustainability of the healthcare sector is broad, complex, and disjointed. Therefore, the research is less helpful to hospital administrators. The purpose of this paper is to provide an overview of the research, demonstrate the significance of the issue, and to provide a context for discussing more helpful information.

A Synergy Value Analysis of Sustainable Management Projects: Illustrated by the Example of the Aesthetic Medicine Industry

This study aims to construct a mathematical model to determine the dimensions of an economic, social, and environmental project with the goal of sustainable management. By identifying the optimal weights, the synergy values for sustainable management can be maximized. Taking aesthetic medicine companies as examples, this study attempts to construct the index projects of the economic, social, and environmental dimensions of sustainable management in an uncertain environment. Linear relationships (a combination of fixed synergistic values and varying synergistic values) are used to calculate the import optimal weight under optimistic, normal, and pessimistic circumstances. This study helped companies to introduce triple bottom line (TBL) indices to plan their issues under sustainable management and development, thus, enabling the parent company to achieve the optimal weight for the project costs to put in its subsidiaries. Additionally, this study prioritizes the weight of the influence on the management of the aesthetic medicine industry according to the risk probabilities, to minimize the uncertainties of risk management in corporate management and reduce the possibility of direct and indirect cost losses caused by financial distress, functional fluctuations, and negative impact on the medical equipment market, thereby maximizing the estimated total project value under sustainable management. This study constructs an aesthetic medicine-specific mathematical model concept using the triple bottom line model as the basis for sustainable corporate management and proposes an approach to obtain sustainable weight in uncertain conditions. By doing so, companies can add various managerial methods for the same industry, and new ideas are provided to the academic community to discuss the development of decision-making assessment criteria for risk assessments in sustainable management.

Strive to prescribe and do no harm

AimsPrescribing medication is a common intervention and hence prescribing errors are not uncommon events. Ghaleb et al 2010 showed that 13% of paediatric prescriptions contain errors and recently Elliot et al 2020 estimated that 66 million of the 237 million prescription errors had potentially clinically significant outcomes. This has been highlighted following a recent critical incident and, as part of the learning recommendations, a multidisciplinary team approach was formed to improve departmental prescribing education. The aim was to reduce the number of prescribing errors, therefore reducing harm to patients and improving care. This was achieved through the joint efforts of trainees and ward pharmacist by developing a robust evidence based teaching programme not only at induction but as rolling sessions throughout the year which, due to COVID 19 restrictions, was delivered virtually on TeaIn conjunction there was also a revision of the induction prescribing test, regular review of the number of prescribing error incidents and drug chart audits with cycle completion and implementation of changes. The teaching programme and audits were started in December 2020 and are on-going.MethodsFrom December 2020 to May 2021, audits were undertaken initially using the GMC prescribing standards. We later revised the audit tool to reflect the standards defined in our hospital inpatient prescribing policy which incorporated the GMC standards. 30 random drug charts from across 3 paediatric inpatient wards were analysed every month with the aim to achieve greater than 90% in each standard (taking into account a baseline level of human error) and then to maintain this over time. To achieve this, learning from the audit was fed back to all members of the team via regular electronic and visual/verbal reminders and the teaching programme was amended to include troublesome topics. Adverse incidents were reviewed and teaching from this was also included in the teaching programme.ResultsSince December 2020, it took 6 months for the number of incidents due to prescribing errors to reduce from 14 in 6 months (December 2020-May 2021) to 10 in 6 months (June-November 2021). Audit results showed that since December 2020 we were scoring >90% in 3 out of the 10 domains. 3 months into the teaching programme this improved to 4 out of 10 of the domains and at 6 months, 6 out of 10 domains. When we re-audited with our revised audit tool, we achieved >90% initially in 10 out of 16 domains and then consistently maintained our standards across 11-12 out of 16 domains over a 4 month period (October 2021-January 2022).ConclusionThis project has shown that despite a global pandemic, a combination of innovation, education, technology, multidisciplinary skills and team-working can implement and embed change to improve patient safety. When considering the bigger picture, we are reminded that this is a small part of the larger systemic processes that can influence medication errors and that with perseverance, we can aim to reduce the risk of adverse events due to medication errors and therefore provide the best care for our patients.