By Sarah Klein and Douglas McCarthy
OSF St. Joseph Medical Center-a 155-bed facility in Bloomington, Ill.-used a failure mode and effects analysis (FMEA) to identify variation in the process that nurses used for administering medications. (Learn more about FMEA on the Institute for Healthcare Improvement's website.)
In response to the findings, the hospital assembled a team of frontline nurses to develop a standardized approach for administering medication to ensure that the "five rights" are met: right patient, right drug, right dose, right route, and right time for drug administration.
The team developed an 11-step process that all nurses should follow when adminstering medication.
Step 1. A patient chart check is completed by a registered nurse.Step 2. The patient's electronic health record (EHR) or paper chart is compared with the order in the automatic medication dispensing cabinet.Step 3. The EHR/paper chart and the automatic medication dispensing cabinet are opened to the correct patient.Step 4. If the medication is highlighted in blue on the automatic medication dispensing cabinet, the nurse must verify the order on the EHR/paper chart.Step 5. The medication is pulled from the dispensing cabinet and checked to see that it matches the EHR/paper chart order (right medication, right dose, right route, right time, right patient).Step 6. The automatic dispensing cabinet receipt is printed after all medications have been removed.Step 7. The medication is taken to the patient room in a prepared container along with the printed receipt.Step 8. Patient identification is verbally confirmed or the patient's armband is checked (right patient).Step 9. Medication packets are opened one at a time.Step 10. The patient is educated about the new medications.Step 11. The dose/route is verified with the automatic medication dispensing cabinet receipt (right medication, right dose, right route).
By January 2009, as the nurses were about to complete their education on the new process, eight staff members from the quality department began conducting audits by watching the nurses administer medication. The auditors found that nurses followed every step in the process 39 percent of the time. After 14 months of auditing, the process was completed correctly nearly 100 percent of the time.
While acknowledging that the results may partly reflect the Hawthorne effect-the phenomenon in which subjects improve or alter their behavior in response to being observed-Debra Dalton, OSF St. Joseph's director of quality resource management, says the magnitude of the increase, as well as the decrease in variation, suggests the improvement is also linked to the newly developed medication process.
Sarah Klein is the editor of Quality Matters, a newsletter published by The Commonwealth Fund, New York.
Douglas McCarthy is president, Issues Research Inc., Durango, Colo., and is senior research adviser to The Commonwealth Fund.
This article is excerpted with permission from the following resource: Klein, S., and McCarthy, D., OSF HealthCare: Promoting Patient Safety Through Education and Staff Engagement, The Commonwealth Fund, New York, March 2011.
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