Improving Medication Administration Safety in the Clinical Environment
Improving Medication Administration Safety in the Clinical Environment
after you find a scholarly nursing journal article, you will complete a one-two page summary and reflection on the article. the paper should be completed in APA format and include the following:
1. introduction, level 1, level 2, level 3 headings, and conclusion
2. one direct quotes from one of your references, appropriately cited in the body of your paper
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4. citations and references in APA format
Continuous Quality Improvement Improving Medication Administration Safety in the Clinical Environment Janet Tompkins McMahon ork interruptions create danger at the bedside, particularly during medication administration. A work interruption can be as simple as a telephone call, noise, or an invitation to conversation by a member of the healthcare team, patient, or family member while the nurse is preparing medications. Medication errors are a major concern for patients and can lead to unnecessary safety risks (Karavasiliadou & Athanasakis, 2014). Reduction of interruptions and associated errors with medication administration is essential. W Project Site and Reasons for Change The identified need for change was reduction of errors and distractions during medication administration. The current use of a no-interruption zone on a medical-surgical unit was identified by the project leader as an area for improvement based on repeated observations of nurses’ nonadherence to the zone during eight random visits. Nurses, other unit staff, and interprofessional team members appeared unaware of or ignored the purpose of the nointerruption zone. Some institutions have adopted use of medication safety vests for nurses to wear to alert colleagues and patients of their involvement in medication administration. According to Williams, King, Thompson, and Champagne (2014), safety vests, posted signs, highlighted decorative aprons, and sashes have been used to reduce work interruptions. The project leader decided to incorporate situation awareness (SA) with the use of a medication safety vest and 374 Work interruptions during medication administration are a serious problem negatively impacting patient safety. Using a medication safety vest and signage during medication administration improves situation awareness, reducing the potential for interruptions. signage on the nursing unit and within patient rooms (“Do Not Disturb the Nurse during Medication Administration”). SA refers to a practitioner’s conscious awareness of a circumstance or situation (Stubbings, Chaboyer, & McMurray, 2012). An educational in-service reinforced the purpose and rationale for the project. Program The project leader, a student in a Doctor of Nursing Practice (DNP) program, was interested in developing a capstone project for continuous quality improvement (CQI). She requested a meeting with the chief nursing officer (CNO) and unit nurse manager to address the observed clinical problem. The CNO encouraged pursuit of this CQI opportunity. Project planning began after the project leader received approval from the facility administrator. Clinical nurses on the unit were advised of the project 3 months before its initiation through communication during staff meetings. Improving Medication Administration Safety in the Clinical Environment
The project leader attended meetings the day before the launch to provide education regarding project implementation, including creation of SA, use of the medication safety vest and signage, and completion of surveys about adherence to the nointerruption zone. According to Sitterding, Ebright, Broome, Patterson, and Wuchner (2014), the need to understand interruptions with medication administration is necessary. Disposable medication safety vests (Riskologic, LLC) were donated to the project leader for use by the registered nurses (RNs) identified as responsible for medication administration after the educational session was completed. A vest labeled Do Not Disturb was used as a visual prompt to people who might approach nurses during medication administration. “Do Not Disturb the Nurse During Medication Administration” signage also was placed in medication preparation areas and all 28 patient rooms. Surveys regarding distractions, use of a medication safety vest and signage, and evaluation of the project leader’s educational program were included. MADOS Survey RNs completed a pretest/posttest survey on types of distractions. The Medication Administration Distraction Observation Sheet (MADOS) identified 10 sources of distractions and interruptions (Pape, 2003). Janet Tompkins McMahon, DNP, RN, ANEF, is Clinical Associate Professor of Nursing, Towson University, Towson, MD; and Nurse Educator-Integration Specialist, A&I Nursing Education. November-December 2017 • Vol. 26/No. 6 Improving Medication Administration Safety in the Clinical Environment Literature Summary • • • • • • Cooper, Tupper, and Holm (2016) found 63% of medication passes (n=30) were caused by interruptions during medication administration at a 271-bed Magnet® facility, resulting in decreased efficiency. Medication errors occur often within nursing practice compared to other types of errors (Tzeung, Yin, & Schneider, 2013). An integrative review by Hopkinson and Jennings (2013) found various interventions can be implemented to reduce work interruptions during medication administration, noting future research would be beneficial. Keers, Williams, Cooke, and Ashcroft (2013) found slips and lapses were common during medication administration.Improving Medication Administration Safety in the Clinical Environment
Other influences included written communication errors, perceived workload, and distractions and interruptions. Williams, King, Thompson, and Champagne (2014) found safety vests, posted signs, and use of highlighted decorative aprons and sashes reduced work interruptions during medication administration. According to Sitterding, Ebright, Broome, Patterson, and Wuchner (2014), a gap in knowledge and understanding of situation awareness exists during medication administration. Adherence Survey CQI Model Plan, Do, Check, and Act (PDCA) model (Russell, 2010) Quality Indicator with Operational Definitions & Data Collection Methods • The number of medication errors on the unit was examined with data • • • pleted and placed in a designated locked box on the nursing unit for the project leader’s collection. To ensure communication for the project, the anticipated time frame and overall project information were documented in minutes from the nursing unit meetings each time the project leader shared additional information. After completion of the 4-week project, the MADOS survey was administered by the project leader to RNs on both 12-hour shifts. Those not present for the final meeting again were given the survey in their mailboxes with instructions to place completed surveys in the designated locked box located on the nursing unit. extrapolated from the hospital medication variance reporting system. The number of distractions was evaluated by the Medication Administration Distraction Observation Sheet (MADOS). The MADOS identified 10 sources of distractions and interruptions (Pape, 2003). The MADOS was used pre- and post-project. Adherence to use of the medication safety vest was documented on the Medication Safety Vest Report each day during the 4-week project period. Effectiveness of the medication safety vest use, signage, educational sessions, and reference binder was evaluated after the project. A survey tool (Nurses Perceptions of the Medication Safety Vest, Signage, and Education Survey) also was used. Clinical Setting 28-bed medical-surgical unit (average daily census 25-28 patients) in a 251bed regional medical center Program Objectives • Decrease number of medication errors on the designated nursing unit. • Improving Medication Administration Safety in the Clinical Environment
Create situation awareness to reduce distractions and medication errors during medication administration with use of the medication safety vest and unit signage. Examples included telephone calls, interactions with patients and visitors, wrong dose, missing medications, physicians, and external noises. The modified survey tool (used with permission from the publisher) identified nurses’ perceptions of the reasons and frequency of distractions during the medication administration. Nurses also were asked to identify the 10 most frequent distractions (1=most frequent, 10=least frequent). This was explained to RNs during the in-service by the project leader, and was reinforced on the MADOS form for RNs to see when following the directions. Descriptive statistics were used to examine these categorical data. The MADOS survey (Pape, 2003) was provided to all RNs attending the educational meeting the day before the project began, and distributed in RNs’ mailboxes for those not present at the meeting. These additional surveys were to be com- November-December 2017 • Vol. 26/No. 6 During the initial meeting about the project, an adherence survey tool was introduced to RNs. The survey was a new tool developed by the project leader to evaluate previous adherence to use of the medication safety vest. The project leader’s DNP committee provided feedback regarding content of the new tool before its initial use. The nurse unit had designated nursing leaders in place with resource nurses staffed on every 12-hour shift. Resource nurses (baccalaureate-prepared nurses) were invited and encouraged to be champions for the project. Champions evaluated medication safety vest use on 12-hour shifts daily by completing The Medication Safety Vest Compliance Report. Designated champions collected data every 12hour shift each day for the project as requested by the project leader during orientation to the pilot study. The report listed percentage ratings (100%-90%, 89%-80%, 79%70%, 69%-60%, 59% and below) corresponding to a grade of A, B, C, D, or E, respectively. Champions assigned a letter grade to RNs administering medications to patients every 12 hours for the 4-week period.
