Improving Medication Safety and Nursing Care

Patient safety is one of the key aspects of healthcare delivery and a critical component in determining the quality of healthcare services. Patient safety is influenced by many factors including medication safety, which is identified as one of the most common type of errors in nursing practice (Getnet & Bifftu, 2017). Given the increased focus on patient safety and better outcomes, nurses face the need to enhance medication safety and nursing care. However, the healthcare environment is characterized by numerous interruptions that could compromise medication safety and nursing care. Nurses experience different kinds of interruptions in their work including during medication administration. Therefore, reduction of interruptions in nursing work is vital to improve medication safety and nursing care. This quality improvement project demonstrates how this can be achieved by using Plan-Do-Study-Act methodology.
Problem Statement
Patient safety is widely recognized as a crucial component that influences the quality of care, which in turn affects patient outcomes. As a result, nurses face the need to enhance patient safety while providing care to diverse patient populations. Nursing staff play a vital role in improving patient safety since they are involved in direct care and support to patients and their families (Monteiro, Avelar & Pedreira, 2015). Despite its significance in improved healthcare quality and patient outcomes, patient safety remains a major issue in the modern healthcare field. Patient safety is compromised by various factors that occur within and outside the healthcare environment. While nurses play a critical role in promoting patient safety, their work is characterized by numerous interruptions. Nurses encounter various interruptions when carrying out nursing work, which in turn threatens patient safety and the quality of care. Healthcare organizations have established various measures to help enhance the quality of care. However, many organizations lack proper policies and practices to prevent interruptions during nursing work. Such interruptions continue to be the cause of medication errors and other mistakes in nursing care. In most cases, patient care measures focus on direct care practices but fail to address interruptions in nursing work to improve medication safety and nursing care.
Research Question
This quality improvement project seeks to address the issue of improving medication safety and nursing care through lessening interruptions in nursing work. To achieve this purpose, the project seeks to answer the following research question:
How can reduction of interruption in nursing work be implemented to improve medication safety and nursing care?
Intervention
According to Getnet & Bifftu (2017), nursing care involves various activities including medication administration, which is multi-faceted process. Medication administration is one of the nursing care activities and involves preparation, administration and documentation. These steps are carried out in a continuous procedure through a series of actions that require no interruption. However, interruptions in nursing care affect the continuity of nursing care activities and medication administration by breaking or distracting task performance. This quality improvement project seeks to promote reduction of such interruptions using a Plan-Do-Study-Act cycle.
Plan
The proposed quality improvement project will commence with a pilot study to be carried out in a nursing unit at an inpatient setting for a two-month period. This pilot study commenced with the establishment of a Medication Safety Team (MST) at the inpatient setting. The team was mandated with the task of conducting an assessment of interruptions that occur during nursing work and their impact on medication safety and nursing care. MST was also required to identify the causes of the interruptions and the nature of their associated clinical errors. MST would also recommend suitable interventions for preventing the interruptions based on their causes and impact on medication safety and nursing care.
Do
Following the assessment, MST proposed an Interruption Intervention consisting of three bundled elements i.e. “do not interrupt” medication vest, staff training on the intervention, staff education, and reminders during medication rounds (Westbrook et al., 2016). “Do not interrupt” medication vests were created within a two-week period. Nurses were then educated on the purpose of the intervention and required to wear the vests when preparing and administering medications and when carrying out other nursing care activities. Reminder posters and stickers were placed in prominent places to remind them of the intervention.
Study
After the two month pilot study period, data on medication errors and nursing care was collected. A survey was carried out among nurses and other clinicians to obtain their views regarding the intervention and its impact on medication safety and nursing care. Patients’ feedback forms were also analyzed. The survey and data from patient feedback was then examined to determine the overall effectiveness of the intervention and identify areas requiring improvement.
Act
Analysis of the results demonstrated that the intervention had positive effects on improving medication safety and nursing care. The analysis showed that interruptions during nursing work reduced by 30% within the unit. Given the reduction of interruptions during nursing work, medication safety and nursing care significantly improved as evidence in better patient outcomes and satisfaction. Consequently, the intervention was standardized and implemented in the entire inpatient setting under the guidance and supervision of MST.
PDSA Cycle vs. Nursing Theoretical Model
As shown in is project, PDSA is a suitable quality improvement tool that can be used to address issues in the healthcare field and other disciplines. In comparison to a nursing theoretical model, PDSA promotes action-oriented learning when conducting a quality improvement project. On the contrary, a nursing theoretical model focuses on providing a theoretical foundation for nursing practice. This implies that the application of a nursing theoretical model is a relatively complex process in comparison to PDSA cycle. Some of the benefits of using PDSA methodology in comparison to a nursing theoretical model include structured experimental learning in which changes are tested prior to full implementation (Taylor et al., 2013). Additionally, PDSA incorporates different steps that are carried out systematically and comprehensively unlike a nursing theoretical model.
In conclusion, patient safety is at the core of initiatives to enhance the quality of healthcare services. Patient safety incorporates different components including medication administration and nursing care activities. Nursing work is characterized by various interruptions that compromise medication safety and nursing care. The proposed intervention to improve medication safety and nursing care through reduction of interruptions in nursing work is an Interruption Intervention comprising three elements. The intervention, which was implemented in a systematic and comprehensive manner, reducing nursing work interruptions. PDSA methodology provided a framework for action-oriented learning unlike a theoretical model.
References
Getnet, M.A. & Bifftu, B.B. (2017, November 20). Work Interruption Experienced by Nurses during Medication Administration Process and Associated Factors, Northwest Ethiopia. Nursing Research and Practice. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5735655/
Monteiro, C., Avelar, A.F.M. & Pedreira, M.G. (2015, Jan-Feb). Interruptions of Nurses’ Activities and Patient Safety: An Integrative Literature Review. Revista Latino Americana de Enfermagem, 23(1), 169-179.
Taylor, M.J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D. & Reed, J.E. (2013). Systematic Review of the Application of the Plan-Do-Study-Act Method to Improve Quality in Healthcare. BMJ Quality & Safety, 23(4), 290-298.
Westbrook, J.I., Li, L., Hooper, T.D., Raban, M.Z., Middleton, S. & Lehnbom, E.C. (2016). Effectiveness of a “Do not Interrupt” Bundled Intervention to Reduce Interruptions During Medication: A Cluster Randomized Controlled Feasibility Study. BMJ Quarterly & Safety, 26(9), 734-742.