Improving Medication Administration Safety in the Clinical Environment

November-December 2017 • Vol. 26/No. 6376

Continuous Quality Improvement

the 4-week project. The tool cap- tured RN perceptions of the medica- tion safety vest, signage, and educa- tional sessions. The survey was developed by the project leader with the assistance and feedback of content experts on the DNP com- mittee.

Evaluation and Action Plan Data from the Medication Var –

iance Reporting System (MVRS), which tracks medication errors in the hospital, were evaluated for 3 months before and 4 weeks after the project. Results of the MADOS surveys also were reviewed and ana- lyzed. Perceptions of medication safety vest and signage use, educa- tional session, and reference binder effectiveness were analyzed. Ad – herence to safety vest use was eval- uated as well. Project results were shared with the unit nurse manager and RNs as well as the CNO to begin discussions about potential change based on results.

Results and Limitations

Results MVRS results identified an 88%

decrease in medication error rates after implementation of the med- ication safety vest. Nine medication errors were reported by unit nurses 3 months before the project. Use of

the medication safety vest and sig- nage contributed to a clinically sig- nificant reduction to one medica- tion error during the 4-week project period. Importantly, the single error was related to a patient’s cardiac arrest when the safety vest was not in use.

Per MADOS survey results, exter- nal noises demonstrated a signifi- cant change (p=0.03). A two t-test was performed on the MADOS results because of the small sample size (see Figure 1).

Perceptions of the project were favorable (n=17). For 82% of RNs, signage in the patient rooms was always or often effective. Signage in the medication areas was always or often effective in 89% of cases. The medication safety vest was reviewed favorably 4% of the time. No nega- tive responses were recorded by RNs.

Adherence results for use of med- ication safety vests were above aver- age on both shifts (n=42). RNs used the medication safety vest 86% of the time over the 4-week period as evaluated by champions and the project leader. This result demon- strated above-average use of the medication safety vest during med- ication administration (see Figure 2).

Field Log Visits The random eight field log visits

by the project leader identified sub- jective feedback from nurses during the 4-week medication safety vest

use. Visits occurred on all shifts and on weekends. RNs stated they liked wearing the vest, and noted it worked. Some RNs admitted they would forget to use the vest during medication administration. Two RNs noted staff from other departments did not like the vest. They stated interprofessional team members expressed frustration when they could not interrupt the nurse during medication administration to re – trieve patient information. One RN indicated a patient’s family member asked for a safety vest for the use of her daughter (an RN at another hos- pital) because she thought it was a wonderful idea for patient safety. Two RNs did not want to stop wear- ing the vest after the project ended; they noted it worked in decreasing interruptions and helped them become more efficient.

Limitations Limitations included the sample

size (n=28), response time, and incomplete sets of MADOS surveys. A sample size should be greater than 30 when using central limit theorem to allow increased variability and distribution of results (Cooper & Schindler, 2003). In addition, results could have been affected if nurses changed behavior and wore the vest when the project leader made rounds for the observation and field log. Finally, the tele- phone was a potential distraction

FIGURE 1. The Frequency of Distractions Ranked on 1-10 Scale