A Lean Approach to Improve Medication Administration Safety by Reducing Distractions and Interruptions

Reducing Medication Errors in an Ambulatory Medical Center

BACKGROUND

Medication errors are a significant problem in ambulatory care, occurring at any stage, from prescribing to administration.

LOCAL PROBLEM

Medication error rates due to interruptions were high on an ambulatory medical unit.

METHODS

A quality improvement design was used for the project.

INTERVENTIONS

A Safe Zone protocol was developed by nurses, certified nursing assistants, and unit secretaries. Implementation included clear medication preparation areas, administration checklists, and staff and patient education.

RESULTS

The number of distractions decreased by 20% over a 90-day period. Medication errors decreased from a rate of 0.97 events per 1000 doses administered to a rate of 0.20 after implementing the Safe Zone protocol.

CONCLUSIONS

Due to its flexibility and adaptability, the Safe Zone protocol offers a template that can be replicated in environments needing to address similar issues.

'Development and Psychometric Testing of the Lean Management Scale for Nursing Services in Hospitals'

AIM

The aim of this study is to develop a new instrument (The Lean Management Scale for Nursing Services in Hospitals- LMS-N) to evaluate the lean levels of nursing services in hospitals and to evaluate its psychometric properties.

METHOD

A three-phase construct was used to develop this scale and to determine its psychometric properties: (1) creating the item pool, (2) preliminarily evaluating items and (3) evaluating psychometric properties. This methodological study evaluated the scale's face, content and construct validities, internal consistency, and temporal stability. The psychometric properties of the scale were tested with a total of 695 nurses in different sample groups. Data were collected between 18 November 2020 and 15 May 2021.

RESULTS

The scale's content validity index was 0.75. According to principal component analysis, the scale included 22 items and five subdimensions, and the total variance was 60.32%. In confirmatory factor analysis, the fit indices were good or acceptable for this construct. Its internal consistency was good or acceptable according to reliability analysis. Test-retest showed that the scale had temporal stability.

CONCLUSION

Lean Management Scale in Nursing Services in Hospitals is a valid and reliable tool that can evaluate the level of leanness of nursing services. It provides a comprehensive evaluation with five subdimensions: management support, visual stock management, work environment layout, preventive notification system and waste detection.

Effects of different types of interference on nurses' working memory: An ERP study

AIM

To explore the effects of different types of interference on nurses' working memory, and the role of attention control.

DESIGN

A repeated measures design.

METHODS

A single-factor, four-level within-subjects design was adopted. Thirty-one nurses completed a delay-recognition task with four blocks in September 2020: Interrupting Stimulus (stimuli requiring attention), Distracting Stimulus (stimuli to-be-ignored), No Interference and Passively View. Behavioural responses of the participants and EEG data were recorded. MATLAB 21b and EEGLAB 21b were used for electroencephalogram data preprocessing and data extraction.

RESULTS

Firstly, when nursing information system was used as task material, the accuracy rate and false alarm rate of primary tasks under interruption condition was statistically significantly different with that of distraction and no interference condition. There is a statistically significant difference in electroencephalogram measurement between correct and wrong response under interruption. Secondly, the role of attention control was different under interruption and distraction. There was a statistically significant positive correlation between the average amplitude distraction attention control index and task accuracy, and statistically significant negative correlation between the latency interruption attention control index and the accuracy of working memory task.

CONCLUSIONS

There were different effects of interruptions and distractions on nurses' working memory and the role of attention control were also different. Measures can be designed according to these results to reduce the negative impact of interference on nurses, so as to improve work efficiency and reduce patient risk.

IMPACT

This study has implications for clinical nursing during human-computer interaction. Resumption of the speed of the target information after an interruption affected task performance. Therefore, interventions should be designed to reduce the time needed for nurses to extract task information after an interruption, such as providing key clues in the information system interface.

PATIENT OR PUBLIC CONTRIBUTION

Registered nurses participated in the study as subjects.

Percepción de la administración segura de medicamentos en atención primaria

Objetivo

El propósito de este estudio fue conocer la percepción de enfermeras sobre la seguridad en la preparación y administración de medicamentos en un departamento de salud de atención primaria del Sistema Nacional de Salud de España.

Diseño

Estudio descriptivo transversal.

Sitio

Realizado en el Departamento de Salud 21 (Alicante-España) en los meses de septiembre hasta noviembre del 2021.

Participantes

Sesenta y seis enfermeras, con predominio de mujeres (88,9%).

Intervenciones

Se utilizó una entrevista semiestructurada con 10 preguntas. El criterio de inclusión tuvo en cuenta las enfermeras con más de dos años de experiencia trabajando en el centro de salud.

Medidas principales

Se evaluó la percepción de las enfermeras sobre el grado de seguridad en la preparación y administración de medicamentos.

Resultados

El 81,9% de la muestra no notifican los eventos adversos. Los pasos para la administración segura fueron variados. Se observó asociación significativa en la hora correcta de la medicación (p < 0,031) y la antisepsia (p < 0,026), según el número de enfermeras en las zonas básicas de salud.

Conclusión

Nuestros resultados indican las percepciones de enfermeras sobre mejoras en el grado de implementación de estándares o herramientas para la administración segura de medicamentos, con especial atención en la falta de conocimientos, la sobrecarga asistencial (elevada ratio paciente/enfermera) y los dilemas asociados con la notificación.

Reducing Near Miss Medication Events Using an Evidence-Based Approach

BACKGROUND

Near miss medication events are pervasive without patient harm, mostly because of coincidence. Dynamic clinical environments challenge nurse compliance with medication administration rights and proper use of electronic technology.

PROBLEM

All nurses are educated in appropriate medication management, but our unit's barcoded medication administration scanning and electronic patient identification practices fell below the 97% benchmarks, representing hundreds of near miss medication events each month.

APPROACH

Transformative leadership guided frontline staff to identify gaps in care processes and determined root causes for unsanctioned medication administration practices using a FOCUS (Find-Organize-Clarify-Understand-Select)-PDSA (Plan-Do-Study-Act) methodology.

OUTCOMES

An interdisciplinary team committed to zero events of preventable harm overcame challenges to improve care delivery. Medication management scores exceeded organizational benchmarks, with sustainable gains over 2 years.

CONCLUSIONS

A rapid-cycle, evidence-based approach engaged staff to reduce near miss medication events. Workable solutions driven by transparent communication and interpersonal collaboration influenced positive safety behaviors.

Exploring Nurses' Perceptions of Medication Error Risk Factors: Findings From a Sequential Qualitative Study

A focus group study was conducted to explore nurses' perceptions of medication administration error associated factors in two medical wards of a tertiary hospital. Nurses were invited to participate in focus group discussions. Thematic analysis was employed and identified four themes: professional practice environment related factors, person-related factors, drug-related factors, and processes and procedures. Staffing, interruptions, system failures, insufficient leadership, and patient acuity were perceived as risk factors for medication errors. The findings of this study complement the findings of an observational study which investigated medication administration errors in the same setting. Although some findings were similar, important risk factors were identified only through focus group discussions with nurses. Nurses' perceptions of factors influencing medication administration errors provide important considerations in addressing factors that contribute to errors and for improving patient safety.

Developing an immersive virtual reality medication administration scenario using the nominal group technique

AIM

This paper aims to describe how the Nominal Group Technique was applied to obtain focused content to develop medication administration error scenarios for future use to educate practicing RNs with immersive virtual reality simulation.

BACKGROUND

In the United States, medication errors account for up to $46 million in daily loss to hospital operational budgets. Each phase of prescribing, dispensing, administration, monitoring, and reconciliation is crucial in reducing potentially life-threatening outcomes associated with medication errors. Registered Nurses are responsible for safely administering diverse classifications of medications to patients in various healthcare settings. However, human and system factors can contribute to the exposure of hospitalized patients to a medication error. Virtual reality simulation-based education can be a methodology to educate practicing Registered Nurses on safe medication practices.

DESIGN

A Nominal Group Technique process was used to generate consensus from participating Registered Nurses on human and system factors that can contribute to medication administration errors.

METHODS

The process consisted of (a) preparation, (b) running the group with an introduction of the subject, (c) generation of ideas, (d) listing of ideas, (e) discussion of ideas, (f) ranking of top ideas, (g) voting on top ideas, (h) discussion of the vote outcome, and (i) re-ranking and rating the top items. Human and system factor idea items encompassed medication errors during ordering, prescribing, or administering medications. Both novice and experienced Registered Nurses rank-ordered these factors as those most likely to encounter or which would most likely occur during one working shift.

RESULTS

Descriptive statistics of frequencies and percentages were used to analyze the findings when grouped by human and system factor categories. Non-parametric testing with a Kruskal-Wallis test was conducted to compare the human and system factors by categories and years of Registered Nurse experience. Findings revealed that the factors of Time Management: getting behind, hurried, urgent (KW-H 11.2, df 4, p = .025) and Right Medication: medications have similar look and sound-alike names (KW-H 11.1, df 4, p = .025) impacted safe medication administration for both the novice and experienced nurse.

CONCLUSION

The NGT process identified human and system factors contributing to errors and impacting safe medication administration practices. Findings will support the creation of medication administration scenarios for use with immersive virtual reality simulation.

Nurses' Perceptions on the Implementation of a Safe Drug Administration Protocol and Its Effect on Error Notification

Patient safety and quality of care are fundamental pillars in the health policies of various governments and international organizations. The purpose of this study is to evaluate nurses’ perceptions on the degree of implementation of a protocol for the standardization of care and to measure its influence on notification of adverse events related to the administration of medications. This comparative study used data obtained from questionnaires completed by 180 nurses from medical and surgical units. Our analyses included analysis of variance and regression models. We observe that the responses changed unevenly over time in each group, finding significant differences in all comparisons. The mean response rating was increased at 6 months in the intervention group, and this level was maintained at 12 months. With the new protocol, a total of 246 adverse events and 481 incidents without harm was reported. Thus, actions such as the use of protocols and event notification systems should be implemented to improve quality of care and patient safety.