Improving Medication Administration Safety Assignment

Article is attached 

This is an academic, professionally written exercise consisting of a minimum of 3 to 4 paragraphs in length. 

article is the only reference nothing else 

Each paragraph to contain of a minimum of 4 to 5 sentences.

To consist of 750 to 1000 words. (No Less no more.)

No other reference, can only use article, 0 plagiarism   

Example: INTRODUCTION: First review and summarize the journal article. Describe what the article is about. Present a clear, non-biased understanding of the article’s topic. Mention the article name and source. What makes the article important? “The main topic of this journal article is ….” 

MAIN BODY: Critically review the article. Analyze the evidence. Was the research presented in the article objective or bias? Describe the article’s strength and weakness. Highlight the positive or negative points. “This article presents the material (well / not well) because …

” Do not give your opinion on the article’s topic, we are not experts. Why should or should not the article be recommend reading? Was the article successful or a failure in relaying information based on the topic?  “I (recommend/ don’t recommend) reading this article because…” 

CONCLUSION: Conclude with what you learned from analyzing the article. What knowledge was gained from reading this article? What do the results cited in the article indicate? Do not present new or additional information in the conclusion, stay focused on the article topic at hand. “After reading and analyzing this article I learned that …. “ 

November-December 2017 • Vol. 26/No. 6374

Janet Tompkins McMahon, DNP, RN, ANEF, is Clinical Associate Professor of Nursing, Towson University, Towson, MD; and Nurse Educator-Integration Specialist, ATI Nursing Education.

Improving Medication Administration Safety in the

Clinical Environment

W ork interruptions create danger at the bedside, particularly during med-

ication administration. A work interruption can be as simple as a telephone call, noise, or an invita- tion 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 unneces- sary safety risks (Karavasiliadou & Athanasakis, 2014). Reduction of interruptions and associated errors with medication administration is essential.

Project Site and Reasons for Change

The identified need for change was reduction of errors and distrac- tions during medication administra- tion. The current use of a no-inter- ruption 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 interprofession- al team members appeared unaware of or ignored the purpose of the no- interruption 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. Accord – ing 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 incorpo- rate situation awareness (SA) with the use of a medication safety vest and

signage on the nursing unit and within patient rooms (“Do Not Disturb the Nurse during Medicat – ion Admini stration”). SA refers to a practitioner’s conscious awareness of a circumstance or situation (Stub – bings, Cha boyer, & 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 develop- ing a capstone project for continu- ous 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 com- munication during staff meetings. The project leader attended meet- ings 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 no- interruption zone. According to Sitterding, Ebright, Broome, Patter – son, and Wuchner (2014), the need to understand interruptions with medication administration is neces- sary.

Disposable medication safety vests (Riskologic, LLC) were donat- ed to the project leader for use by the registered nurses (RNs) identi- fied as responsible for medication administration after the education- al 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 sig- nage, 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 Dis trac – tion Observ ation Sheet (MADOS) identified 10 sources of distractions and interruptions (Pape, 2003).

Continuous Quality ImprovementContinuous Quality Improvement

Janet Tompkins McMahon

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.

November-December 2017 • Vol. 26/No. 6 375

pleted and placed in a designated locked box on the nursing unit for the project leader’s collection. To ensure communication for the proj- ect, 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 sur- vey 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 sur- veys in the designated locked box located on the nursing unit.

Adherence Survey 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 re – garding 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 nurs es) were invited and encouraged to be cham- pions for the project.

Champions evaluated medication safety vest use on 12-hour shifts daily by completing The Medication Safety Vest Compliance Report. Designated cham pions collected data every 12- hour 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) cor- responding to a grade of A, B, C, D, or E, respectively. Champions assigned a letter grade to RNs admin- istering medications to patients every 12 hours for the 4-week period. Completed daily reports were placed in designated locked boxes located in the areas identified on the nursing unit during the educational in-ser- vices at the nurses’ station.

Perceptions Survey A perceptions survey was dis-

cussed and reviewed during staff meetings, and administered after

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. 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.

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

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 ses- sions, 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 251- bed regional medical center

Program Objectives • Decrease number of medication errors on the designated nursing unit. • Create situation awareness to reduce distractions and medication errors

during medication administration with use of the medication safety vest and unit signage.

Examples in cluded telephone calls, interactions with patients and visi- tors, wrong dose, missing medica- tions, physicians, and external nois- es. The modified survey tool (used with permission from the publisher) identified nurses’ perceptions of the reasons and frequency of distrac- tions during the medication admin- istration. Nurses also were asked to identify the 10 most frequent dis- tractions (1=most frequent, 10=least frequent). This was ex plained 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.