Guidelines on preventing pneumonia in mechanically ventilated patients and on improving pre-admission medication documentation have been published by UK agencies.
The draft safety solution guidance documents were issued by the National Institute for Health and Clinical Excellence (NICE) in collaboration with the National Patient Safety Agency (NPSA).
The recommendations, which are available for public consultation until 10 October 2007, form the first such guidance from NICE to make recommendations on cost-effective interventions to prevent or mitigate patient harm in the NHS.
For preventing ventilator-associated pneumonia, NICE provisionally recommends that:
ï¿½ Intubated mechanically ventilated patients are positioned with their upper body elevated (semi-recumbent or sitting) for as much of the time as possible, although this be inappropriate for some patients (such as those with spinal injuries).
ï¿½ Oral antiseptics (eg 2% chlorhexidine) should be included as part of the oral hygiene regimen for all intubated patients receiving mechanical ventilation.
To improve medicines reconciliation at admission, NICE provisionally recommends that all individuals who prescribe to patients be aware of what medications the patient is taking at admission, and that all hospital admitting units set up a medicines reconciliation improvement policy.
As well as specifying standardised systems for collecting and documenting data on current medications, the policy should ensure that:
ï¿½ A pharmacist is involved in reconciliation as soon as possible after admission.
ï¿½ Responsibilities of pharmacists and other staff in reconciliation are clearly defined.
ï¿½ Strategies are incorporated to help patients who have communication difficulties give details of their medications.
NICE chief executive Andrew Dillon said: “This is the first time NICE has developed guidance on safety issues within the NHS.
“Ventilator-associated pneumonia and ineffective medicines reconciliation at hospital admission are significant causes of patient morbidity and mortality and therefore present important safety concerns that need to be addressed.
“The core principles we apply to all guidance development and our extensive experience has enabled us to make strong recommendations that will help to improve patient safety in the NHS.
“We are keen to hear feedback on these draft recommendations and would urge people to send us their comments.”
NPSA deputy chief executive Dr Helen Glenister said: “Patient safety should be the top priority for everyone working in healthcare and we are delighted to be working with NICE on this new guidance.
“It’s an excellent opportunity for our two organisations to share our expertise and learn from each other for the benefit of frontline staff ï¿½ and ultimately patients. We are building on our existing work in developing safety solutions and sharing this knowledge with NICE to reduce risk to patients in these two diverse areas,” she added.
The draft guidance is available for public consultation on the NICE website until 10 October 2007. Comments received during this consultation will be reviewed at the next independent advisory committee meeting, and NICE expects to issue final guidance to the NHS in December 2007.
Press release 13/9/2007