Course Access
Dear Fiona,
I have also been confronted with a similar issue recently about the use of medication rooms and extra inclusions in them. Our hospital is building a new building and there have been many discussions about the use of rooms and their functionality. One of the wards wanted to combine the medication room with the handover room and have the room as a dual purpose room to save on space. I objected to this on the grounds of medication safety in regards to distractions whilst drawing up medications and the risk of giving incorrect doses or incorrect medications. Considering that this ward gives post-operative medications and also any premeds as well I felt it was important for the staff to have an environment which would be conducive to the least amount of medication errors possible. I also argued that handover rooms often were rooms where people socialised with food and drink. My objections to having food and drink in a room where medications and equipment were present, and where things are stored and kept as clean as possible, so as not to induce infections to our patients was paramount.
I totally agree with Mattias, common sense and sound reasoning in this situation should be applied. If you need evidence, then the contributions of all who have replied to your email today should be contribution enough.
I did win the battle and the medication room is a sole room dedicated to medication activity only. The staff now also have a nice room to handover and meet in separate from the rest of the ward.
Good luck with your quest.
Terri Cripps | CNC Infection Control | Sydney Children’s Hospital
‘: (02) 9382 1876 | fax: (02) 9382 2084 |* : terri.cripps@sesiahs.health.nsw.gov.au| “:www.sch.edu.au| page: 47140
—–Original Message—–
Dear Fiona, dear Group,
This is yet another example where the call for “Where is the evidence?” is totally misguided and convenience-driven.
This is an issue of workplace safety and very basic hygiene in healthcare and in the workplace. This is a universal rule and applies to any patient treatment area, biomedical laboratory and pharmaceutical preparation area.
It also applies in any first-world healthcare setting that I am aware of.
It is supposed to keep apart items for human consumption (which can be subject to decay or spoilage) and for human medication, which require sterile or aseptic practices.
While it is necessary that our actions are underpinned by evidence, it is also necessary that any call for evidence needs to be underpinned by (a) application of common sense and sound reasoning, and (b) by applying the principles of biological plausibility (i.e. is what the evidence suggests consistent with what is known about the biological principles, e.g.
physiology or pathophysiology, of a situation?).
Let us bring up a totally hypothetical example. Please note that this is really totally hypothetical and I am not aware of a real incident. Suppose there is a medical director of an intensive care unit. This person wants to have goats and chickens running around the unit, to provide patients with a comfortable surrounding. Would you find real good published evidence (from original research work) that this is — what we are all convinced of — not a good idea? Would you find randomised double-blinded trials providing evidence in this example?
For the above (medication) example, I am not convinced you will find published evidence from original work. If anything, it will be in workplace standards, as was suggested.
This also shows that for well-established pro-safety measures with a long-standing track record, one really needs a reversal of this call for evidence. If a safety measure such as this is in place, and you remove it, it can have (a) either a negative effect, or (b) no effect, i.e. be neutral. If one applies logical reasoning, then the abandoning of such a safety measure cannot have a positive effect on patient and staff safety (think it through yourself). The logical consequence is that people who want to abandon this should come up with good evidence that it is really safe to do so. This is not only a logical requirement, but also one of medical ethics.
Best regards, Matthias.
—
Matthias Maiwald, MD, FRCPA
Consultant in Microbiology
Department of Pathology and Laboratory Medicine KK Women’s and Children’s Hospital 100 Bukit Timah Road Singapore 229899 Tel. +65 6394 1389 Fax +65 6394 1387
Glenys.Harrington
@HEALTH.VIC.GOV.A
U To
Sent by: AICA AICALIST@AICALIST.ORG.AU
Infexion cc
Connexion
Re: Medication Rooms
29/09/2010 07:27
AM
Please respond to
AICA Infexion
Connexion
Fiona,
A pharmacy area is primarily a designated area for the storage of sterile pharmacy stock. The rationale for not having anything “wet” in these areas is to protect the integrity of the stock from becoming wet and hence contaminated.
Facilities for tea and coffee making in a designated pharmacy storage area is likely to result in staff consuming fluids/drinks in the area increasing the risk of hand/ face/mouth contact and the possibility of hand contamination with oral organisms.
Urns should be confined to designated nutrition stations or staff tea room facilities to minimising the risk of contaminating sterile stock.
Regards
Glenys
Glenys Harrington, Infection Control Consultant |Communicable Disease Prevention and Control | Public Health Department of Health | Level 14 50 Lonsdale Street Melbourne Victoria 3000 Australia t. 1300 651 160 (03 909 65123) | f. 03 909 69174 | e.
glenys.harrington@dhs.vic.gov.au | http://www.health.vic.gov.au/ideas
From: Terry Grimmond
Date: 29/09/2010 08:23 AM
Subject: Re: Medication Rooms
Sent by: AICA Infexion Connexion
Hi Fiona,
I agree with Brenda. However, you are correct – I know of no studies and no citations of incidents or disease transmissions with tea-making. It would be a CDC “Category II – theoretical rationale”.
Terry Grimmond FASM, BAgrSc, GrDpAdEd
Consultant Microbiologist
Grimmond and Associates
Ph/Fx (NZ): +64 7 856 4042
Mob (NZ): +64 274 365 140
E: tg@gandassoc.com
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Hi Fiona,
I would be inclined to disagree with this option. Places where Tea and coffee are made traditionally are not kept in a pristine condition and the medication room should be maintained in a clean environment. I see OH&S issues as well. It would encourage more through put of staff and therefore more distractions whilst medications are drawn up. (therefore increased risk of error) Also hot drinks in an area where people are working is a risk for accidental burn injuries.
Brenda Anderson
Infection Control Coordinator
Goulburn Valley Health
Shepparton
—– Original Message —–
Hi All,
I have been asked to consider placing a zip urn for hot water access in a medication room. My initial response was it is not appropriate to make tea and coffee in the same room where staff are drawing up medications.
However when I have looked for the evidence to back this up I have had trouble finding any.
What do others think about this issue from an infection prevention and control point of view?
Kind Regards,
Fiona De Sousa
Infection Prevention & Control Coordinator Sydney Adventist Hospital
Fiona.Desousa@sah.org.au
185 Fox Valley Road, Wahroonga, NSW, 2076
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