Improvement Plan Tool Kit for Medication Safety

Welcome to the medication safety improvement resource repository, a comprehensive guide aimed at providing healthcare professionals with evidence-based solutions and best practices for improving medication administration safety in hospitals. The repository was created with four main themes in mind that drive the medication safety improvement plan. The first theme is medication administration communication, which highlights the necessity of effective communication between physicians and pharmacists. We've selected research papers that offer evidence-based solutions for enhancing collaboration and lowering communication errors in medication administration. The second theme focuses on the need to design and execute medication reconciliation protocols and electronic health record systems to promote patient safety.

Best practices for enhancing patient safety through medication reconciliation procedures and electronic health records have been incorporated. The third theme is minimizing human error in medication administration, which highlights the need to develop a safety culture that encourages nurses to report medication administration errors and near-misses. We have included research articles that discuss the role of safety culture and barcode medication administration systems in reducing human errors. The fourth and final theme is medication safety improvement plan implementation strategies, which provide practical insights into successfully executing medication safety improvement plans.

Annotated Bibliography

Evidence-Based Strategies for Improving Physician-Pharmacist Collaboration and Communication

Dilles, T., Heczkova, J., Tziaferi, S., Helgesen, A. K., Vigdis Abrahamsen Grøndahl, Bart Van Rompaey, Sino, C. G., & Jordan, S. (2021). Nurses and pharmaceutical care: interprofessional, evidence-based working to improve patient care and outcomes. International Journal of Environmental Research and Public Health, 18(11), 5973–. https://doi.org/10.3390/ijerph18115973

This peer-reviewed journal article highlights the need for interprofessional collaboration in pharmaceutical care to improve care quality and patient outcomes. This resource can assist nurses in better understanding the value of teamwork and mutual respect among all stakeholders engaged in medication administration, such as patients, informal caregivers, the interprofessional team, and healthcare system administrators. According to the article, effective collaboration necessitates the sharing of objectives, responsibilities, and tasks, as well as a willingness to move beyond profession-specific abilities. This resource can help nurses learn how to collaborate with other healthcare providers, overcome socio-cultural obstacles and organizational hierarchies, and improve patient safety. This resource is appropriate for nurses working in hospital settings, particularly those who are involved in medication administration and patient safety initiatives, to help them understand the benefits of interprofessional collaboration and its potential impact on patient care and outcomes.

Martin, P., & Tannenbaum, C. (2018). A prototype for evidence-based pharmaceutical opinions to promote physician-pharmacist communication around deprescribing. Canadian Pharmacists Journal, 151(2), 133–141. https://doi.org/10.1177/1715163518755813

This article discusses a prototype for an evidence-based pharmacological opinion that encourages physician-pharmacist discussion about deprescribing. This resource can assist nurses in better understanding the need for effective communication between physicians and pharmacists in drug administration, particularly in the context of deprescribing in the geriatric department. The paper underlines the need for pharmacists to provide evidence-based pharmacological views suited to the patient's requirements, citing the source of the deprescribing advice, and offering alternative management choices. This resource can help nurses learn how to collaborate with physicians and pharmacists to create evidence-based medication management strategies that are tailored and beneficial for their patients. The material is useful for nurses working in geriatric or primary care settings where deprescribing is widespread to understand the importance of physician-pharmacist communication and how to establish successful medication management strategies that promote patient safety and improved outcomes.

Mercer, K., Burns, C., Guirguis, L., Chin, J., Maman, J. D., Dolovich, L., Guénette, L., Jenkins, L., Légaré, F., McKinnon, A., McMurray, J., Waked, K., & Grindrod, K. A. (2018). Physician and pharmacist medication decision-making in the time of electronic health records: Mixed-methods study. JMIR Human Factors, 5(3). https://doi.org/10.2196/humanfactors.9891

This study used a mixed-methods approach to investigate how physicians and pharmacists understand and communicate patient-focused medication information with one another, as well as how this knowledge can influence the design of electronic health records (EHRs) to support interprofessional shared decision-making for medication therapy management. This resource can assist nurses in better understanding the need for efficient communication and collaboration between physicians and pharmacists in medication administration, especially when managing drugs for patients with complex requirements. The essay underlines the need for EHRs to be structured to promote interprofessional medication management and cooperation, as well as provide pharmacists and physicians with accurate and full drug information. Nurses can use this resource to gain insights into how EHRs can be utilized to improve medication administration safety and enhance communication and collaboration between healthcare professionals. This resource may be appropriate for nurses working in the hospital or primary care settings, particularly those involved in medication administration and EHR system design and implementation, to help them understand the importance of interprofessional collaboration and how to develop effective medication management plans that promote patient safety and improved outcomes.

Medication Reconciliation Procedures and Electronic Health Records

Gionfriddo, M. R., Duboski, V., Middernacht, A., Kern, M. S., Jove Graham, & Wright, E. A. (2021). A mixed methods evaluation of medication reconciliation in the primary care setting. PloS One, 16(12), e0260882–. https://doi.org/10.1371/journal.pone.0260882

This article provides valuable insights into the barriers and challenges faced by healthcare providers in conducting medication reconciliation in primary care settings. Nurses can use this resource to gain a better understanding of the factors that contribute to incomplete or inaccurate medication reconciliation, such as lack of standardized workflows, insufficient training and knowledge, inadequate integration into clinical workflows, and lack of time. The paper makes recommendations for overcoming these obstacles, like education and training, standardized procedures, EHR redesign, and patient reminders. These tips can help nurses improve their medication reconciliation processes and guarantee improved patient outcomes. This resource may be especially beneficial for nurses working in primary care settings, where medication reconciliation is essential for maintaining safe and effective drug administration. Nurses can enhance their medication reconciliation procedures and, as a result, patient care by applying the recommendations made in this study.

Matta, G. Y., Khoong, E. C., Lyles, C. R., Schillinger, D., & Ratanawongsa, N. (2018). finding meaning in medication reconciliation using electronic health records: qualitative analysis in safety net primary and specialty care. JMIR Medical Informatics, 6(2). https://doi.org/10.2196/10167

This study investigates the impact of electronic health record (EHR) use on the quality of medication reconciliation in safety net health systems. The authors aim to develop a conceptual framework of how clinicians balance the demands and risks of EHR and communication tasks during medication reconciliation discussions in a safety net system. They examine 35 patient-clinician encounters and create a conceptual model that depicts the challenge of the multitasking clinician during medication reconciliation. The study finds that visits involve multitasking EHR use during almost half of medication reconciliation time, and clinicians balance the cognitive and emotional demands posed by incoming information from multiple sources, attempt to synthesize and act on this information through EHR and communication tasks, and adopt strategies of silent EHR use and focused patient-clinician talk that may help mitigate the risks of multitasking. Nurses can utilize this resource to better understand the problems doctors have while utilizing EHR during medication reconciliation, as well as to explore appropriate risk-mitigation and patient-safety methods.

Waldron, C., Cahill, J., Cromie, S., Delaney, T., Kennelly, S. P., Pevnick, J. M., & Grimes, T. (2021). Personal electronic records of medications (PERMs) for medication reconciliation at care transitions: a rapid realist review. BMC Medical Informatics and Decision Making, 21(1), 1–17. https://doi.org/10.1186/s12911-021-01659-8

This resource provides a rapid realist review (RRR) on the use of Personal Electronic PERMs are medication records that help with medication reconciliation (MedRec) at care transitions. The RRR provides eleven tentative hypotheses on how, why, when, where, and for whom PERMs are planned, implemented, or utilized in practice at care transitions that affect MedRec. The ideas encompass topics such as inclusive design, targeted training, stakeholder involvement, trust building, resource investment, patients as PERM users, and the beneficial influence of legislation or governance. This resource can help nurses understand the potential benefits and limitations of PERMs, as well as how they can be created, implemented, and utilized successfully to assist MedRec in care transitions. The resource can be used by nurses when designing, implementing, and evaluating PERMs in their practice to ensure that PERMs are used in a way that improves patient outcomes and reduces medication errors during care transitions.

The Role of Safety Culture and Bar Code Medication Administration Systems in Reducing Human Error in Medication Administration

Ho, J., & Burger, D. (2020). Improving medication safety practice at a community hospital: a focus on bar code medication administration scanning and pain reassessment. BMJ Open Quality, 9(3). https://doi.org/10.1136/bmjoq-2020-000987

This peer-reviewed journal article discusses the implementation of two quality improvement initiatives, bar code medication administration (BCMA) scanning, and pain reassessments, in a community hospital to improve medication safety practices. The article discusses the baseline rates of medication scanning and pain reassessments, as well as the strategies utilized to launch and sustain the programs, such as data openness, weekly dashboards, education, and plan-do-study-act (PDSA) cycles. The study found substantial increases in both BCMA scanning rates and pain reassessment compliance, with outcomes that lasted 17 months after adoption. The article also mentions a decrease in adverse medication events caused by administration mistakes and opioid-related adverse events. Nurses should utilize this resource to learn more about the necessity of adopting BCMA scans and pain reassessments to enhance drug safety, as well as techniques for successfully implementing and maintaining these programs in a healthcare context.

Mulac, A., Mathiesen, L., Taxis, K., & Gerd Granås, A. (2021). Barcode medication administration technology used in hospital practice: a mixed-methods observational study of policy deviations. BMJ Quality & Safety, 30(12), 1021–1030. https://doi.org/10.1136/bmjqs-2021-013223

This article discusses a study on the use of barcode medication administration (BCMA) technology in hospital practice and the deviations from the policy that can occur. The researchers employed a mixed-methods technique to monitor medication administration rounds on two hospital wards, and they discovered BCMA policy deviations in more than half of the observations. The data was analyzed using the SEIPS model, which revealed that variances occurred owing to factors such as task level, organization, technology, environment, and nurses. The study emphasizes the necessity for work system modifications, notably in terms of regulations and technology, to maximize the use of BCMA by nurses during medicine dispensing and administration. This resource can help nurses understand the possible causes of BCMA policy deviations and suggest opportunities for improvement in their practice. It is intended for nurses who work in hospitals where BCMA technology is utilized to improve medication safety.

Westbrook, J. I., Sunderland, N. S., Woods, A., Raban, M. Z., Gates, P., & Li, L. (2020). Changes in medication administration error rates associated with the introduction of electronic medication systems in hospitals: a multisite controlled before and after study. BMJ Health & Care Informatics, 27(3). https://doi.org/10.1136/bmjhci-2020-100170

This peer-reviewed journal article investigates the impact of electronic medication systems (EMS) on medication administration errors (MAEs) in hospitals. The study was conducted using a controlled before and after design in three intervention and three control wards in two adult teaching hospitals. The deployment of EMS was related to a moderate but considerable reduction in overall MAE rates and a 56% drop in the proportion of potentially dangerous MAEs, according to the research. The most common forms of MAEs, according to the study, are incorrect IV rate, timing, volume, and dosage. This resource can help nurses understand the impact of EMS on MAEs and the need to follow safety measures. The findings can help nurses to implement EMS and improve medication safety practices in hospitals.

Implementation Strategies for Medication Safety Improvement Plans

Stolldorf, D. P., Ridner, S. H., Vogus, T. J., Roumie, C. L., Schnipper, J. L., Dietrich, M. S., Schlundt, D. G., & Kripalani, S. (2021). Implementation strategies in the context of medication reconciliation: a qualitative study. Implementation Science Communications, 2(1), 1–14. https://doi.org/10.1186/s43058-021-00162-5

This qualitative study reports the strategies that hospital implementation teams used to implement an evidence-based medication reconciliation (MedRec) Toolkit. The Expert Recommendations for Implementing Change (ERIC) taxonomy was utilized to guide the evaluation of the various strategies adopted by the hospital teams. According to the research, hospitals mostly employed the ERIC strategies of "Plan," "Educate," "Restructure," and "Quality Management," while infrequently using the ERIC strategies of finance and policy context. In addition, two new non-ERIC strategy categories emerged: "Integration" and "Professional responsibilities and duties." The study demonstrates that complex interventions, such as the MARQUIS MedRec Toolkit, can benefit from the ERIC taxonomy, and that changes and new approaches are required to adequately capture the spectrum of implementation options. Nurses should use this resource to better understand the strategies for implementing MedRec interventions, which can be useful in developing and implementing effective MedRec programs in their organizations.

Trakulsunti, Y., Jiju Antony, & Douglas, J. A. (2021). Lean Six Sigma implementation and sustainability roadmap for reducing medication errors in hospitals. TQM Magazine, 33(1), 33–55. https://doi.org/10.1108/TQM-03-2020-0063

This peer-reviewed journal article provides a road map for adopting and maintaining Lean Six Sigma (LSS) in hospitals to decrease medication errors. The paper divides the process into three stages: readiness considerations, preparation, initiation, and implementation, and sustainability. The article includes a complete list of preparedness aspects that must be addressed before beginning an LSS effort, such as good communication, patient focus, and staff engagement. For successful implementation, the article suggests adopting the DMAIC approach as well as LSS tools and methodologies. This resource can help nurses understand the important aspects and methods for implementing LSS in their institutions to prevent medication errors. This resource is appropriate for use during the planning phase of an LSS project or when preparing for a quality improvement initiative related to medication administration in the hospital.

Whitfield, K., Coombes, I., Denaro, C., & Donovan, P. (2021). Medication utilization program, quality improvement and research pharmacist—implementation strategies and preliminary findings. Pharmacy, 9(4), 182–. https://doi.org/10.3390/pharmacy9040182

This article describes the implementation of a Medication Utilisation Program (MUP) to lead drug-use assessments, medication quality improvement, and research activities at a tertiary medical center. The article emphasizes the need to have a strategic plan that matches the organization's strategy and main objectives. The MUP pharmacist works with medical, nursing, and allied health professionals to conduct quality improvement and research projects, guaranteeing a multidisciplinary strategy for medication optimization. The article emphasizes the challenges of determining the impact on cost and quality outcomes, as well as the significance of integrating pharmacists into care teams, access to clinical data, and physician buy-in to achieve success. Nurses should use this resource to better understand the role of the MUP pharmacist in leading medication-use evaluations, medication quality improvement, and research activities. Nurses can collaborate with MUP pharmacists to optimize medication through a multidisciplinary approach.

References

Dilles, T., Heczkova, J., Tziaferi, S., Helgesen, A. K., Vigdis Abrahamsen Grøndahl, Bart Van Rompaey, Sino, C. G., & Jordan, S. (2021). Nurses and pharmaceutical care: interprofessional, evidence-based working to improve patient care and outcomes. International Journal of Environmental Research and Public Health, 18(11), 5973–. https://doi.org/10.3390/ijerph18115973

Gionfriddo, M. R., Duboski, V., Middernacht, A., Kern, M. S., Jove Graham, & Wright, E. A. (2021). A mixed methods evaluation of medication reconciliation in the primary care setting. PloS One, 16(12), e0260882–. https://doi.org/10.1371/journal.pone.0260882

Ho, J., & Burger, D. (2020). Improving medication safety practice at a community hospital: a focus on bar code medication administration scanning and pain reassessment. BMJ Open Quality, 9(3). https://doi.org/10.1136/bmjoq-2020-000987

Martin, P., & Tannenbaum, C. (2018). A prototype for evidence-based pharmaceutical opinions to promote physician-pharmacist communication around deprescribing. Canadian Pharmacists Journal, 151(2), 133–141. https://doi.org/10.1177/1715163518755813

Matta, G. Y., Khoong, E. C., Lyles, C. R., Schillinger, D., & Ratanawongsa, N. (2018). finding meaning in medication reconciliation using electronic health records: qualitative analysis in safety net primary and specialty care. JMIR Medical Informatics, 6(2). https://doi.org/10.2196/10167

Mercer, K., Burns, C., Guirguis, L., Chin, J., Maman, J. D., Dolovich, L., Guénette, L., Jenkins, L., Légaré, F., McKinnon, A., McMurray, J., Waked, K., & Grindrod, K. A. (2018). Physician and pharmacist medication decision-making in the time of electronic health records: Mixed-methods study. JMIR Human Factors, 5(3). https://doi.org/10.2196/humanfactors.9891

Mulac, A., Mathiesen, L., Taxis, K., & Gerd Granås, A. (2021). Barcode medication administration technology used in hospital practice: a mixed-methods observational study of policy deviations. BMJ Quality & Safety, 30(12), 1021–1030. https://doi.org/10.1136/bmjqs-2021-013223

Stolldorf, D. P., Ridner, S. H., Vogus, T. J., Roumie, C. L., Schnipper, J. L., Dietrich, M. S., Schlundt, D. G., & Kripalani, S. (2021). Implementation strategies in the context of medication reconciliation: a qualitative study. Implementation Science Communications, 2(1), 1–14. https://doi.org/10.1186/s43058-021-00162-5

Trakulsunti, Y., Jiju Antony, & Douglas, J. A. (2021). Lean Six Sigma implementation and sustainability roadmap for reducing medication errors in hospitals. TQM Magazine, 33(1), 33–55. https://doi.org/10.1108/TQM-03-2020-0063

Waldron, C., Cahill, J., Cromie, S., Delaney, T., Kennelly, S. P., Pevnick, J. M., & Grimes, T. (2021). Personal electronic records of medications (PERMs) for medication reconciliation at care transitions: a rapid realist review. BMC Medical Informatics and Decision Making, 21(1), 1–17. https://doi.org/10.1186/s12911-021-01659-8

Westbrook, J. I., Sunderland, N. S., Woods, A., Raban, M. Z., Gates, P., & Li, L. (2020). Changes in medication administration error rates associated with the introduction of electronic medication systems in hospitals: a multisite controlled before and after study. BMJ Health & Care Informatics, 27(3). https://doi.org/10.1136/bmjhci-2020-100170

Whitfield, K., Coombes, I., Denaro, C., & Donovan, P. (2021). Medication utilization program, quality improvement and research pharmacist—implementation strategies and preliminary findings. Pharmacy, 9(4), 182–. https://doi.org/10.3390/pharmacy9040182