Setting of Project: Franklin Square Hospital Center, a 380-bed community teaching hospital. Part of MedStar Health Integrated Health System.
Problem addressed: Undesirable compliance rates with patient and medication scanning following implementation of a bar-code medication administration system.
Objectives of project: Evaluate the effectiveness of using structured reports, direct engagement of nursing leadership, and project success linked to performance appraisals in increasing scanning compliance rates.
Intervention or change implemented, if any:
* Creation of Positive Patient Identification (PPID) and Positive Medication Identification (PMID) reports identifying:
* overall unit percentages of scanned/nonscanned patient ID bands and medications
* comprehensive spreadsheet outlining details associated with every medication administration
* Education specialist and management training on how to generate and utilize the PPID/PMID reports
* Comprehensive monthly PPID/PMID reports sent to executive leadership and management
* Executive leadership request of nursing management to achieve a minimum of 85% PPID/PMID compliance rate-tied to manager's performance appraisal process
* Direct engagement of both management and individual nursing performance in safety/quality accountability process
* Creation of multidisciplinary work group to address bar-code medication administration (BCMA) issues
* Increased rounding efforts of the clinical informatics department to identify and address scanning issues
Actions, processes, and methods used to solve the problem and meet the objectives: Weekly PPID/PMID reports run through the months of October, November, December, and January illustrate scanning compliance rates before and after the interventions were implemented.
Data, metrics, and methods used to determine whether the objectives were met:
* Patient scan compliance:
* 76% Preimplementation/92% postimplementation
* Medication scan compliance:
* 74% Preimplementation/89% postimplementation
* Executive leadership developed rating scale:
* 5 (Exceeds standard) >= 90%
* 4 (Exceeds standard) = 86%-89%
* 3 (Meets standard) = 85%
* 2 (Does not meet standard) = 80%-84%
* 1 (Does not meet standard) >= 79%
Outcomes: The postimplementation percentage ratings showed marked improvement with an increase in patient and medication scanning compliance of 15% to 16%. When averaging all units, the 85% scanning compliance mark set by management was met within a week of the final implementation efforts (with most units averaging well above the 85% mark).
Lessons learned (conclusions and recommendations for practice): Creation of the multidisciplinary bar-code medication administration work group has led to enhanced communication between departments affected by BCMA.
Creating a culture of ownership by linking scan compliance to performance appraisal has increased the identification (and in many cases resolution) of issues related to scanning compliance.
Additional measures that are being taken to further increase scanning compliance rates as a result of this project include the following:
* Training follow-up for identified education issues including
* Error messages on handheld/implications for practice
* Revisiting workflow of processes that impact the feasibility of scanning medications (cosigning, immunization administration)
* Administration of specific medications (mini-bag plus system, volume changes for medications that do not match expected order entered by pharmacy)
* Correct process to follow for incorrectly transcribed medications
* Pharmacy generate bar codes for nonformulary medications or medications without a manufacturer bar code
* Evaluation of medication scan failure reports to identify problem medications for pharmacy/nursing testing
* Work with registration to correct any patient ID band-related issues
* Continued monitoring of PPID/PMID reports and work with multidisciplinary group to identify and address ongoing concerns.
Contact the corresponding author: April Saathoff ([email protected])