Manager Toolkit for the Medication Administration Process

1. Manager Toolkit for the Medication Administration Process

2. Optimizing Medication Administration Project 7/31/09 August September October December January I C A Phase 2 Progress Since Last Update Overview • Process finalized and approved by practice committee and medication safety committee (see attachment A) • Policy modified (see attachment B) • Education plan developed (see attachment C) • Sustainability (Control) plan developed (see timeline and attachment D) • Communicated policy changes and education plan to chairs of respective committees • Linkage to BPE/BP/EFP: Safe and without error • Problem: The current medication administration process is inefficient and prone to error. The current process requires many work steps (total process takes over 8 minutes) and multiple interruptions that cause workflow constraints and nurses not consistently verifying the “7 rights.” (right drug, patient, dose, time, route, rationale, documentation) As a result, there is a greater risk for medication errors. Further, our HCAHPS scores for communication regarding medication was at 58% “top box” in FY2008 (baseline). • Goal/Benefit: Implement a standardized medication administration process which eliminates inefficient work steps, minimizes interruptions, prompts less log-ins, and improves bedside documentation in an effort to better usereal-time information related to the 7 rights of medication administration, reduce errors, improve nurse productivity, and improve patient satisfaction scores to 59%. Phase 2: implement technology to enhance process • Scope: Full house roll-out. • Deliverables: • A safer and more efficient medication administration process • Decrease in medication errors Next Steps • Practice to approve policy (August 4th) • Education to approve roll-out plan (August 4th) • Education plan presented to managers (August 5th) • Workplan and expectations, Tools, Resources, Manager accountability plan • Policy roll-out (August 31st) • Quality Council to approve reg review additions (Sept 1st) (see attachment D) • Podcast out (September- Date TBA) • Unit to complete observations using paper form (September) • Unit to complete observations via regulatory review (October-ongoing) • DMAIC team to conduct staff interviews (September and October) • Staff to complete survey monkey (November- early) (see attachment E) • DMAIC team to f/u re: survey monkey results (November- late) Key Metrics Issues/Concerns/Roadblocks • Total medication errors • Number of near misses • Medication administration time • HCAHPS Communication Regarding Medication Scores Education must reach staff by August 31st Contingency Plan– Check in meetings with managers (A/D/R) Adherence to expectations for non-compliance Executive Sponsors: Janney/Fennessy/Zoph Project Owners: Ashley Currier, Denise Anderson Sponsors: Payson/Dejuras//Jacobsen Improvement Leader: Ryan Inlow

3. Medication Administration Process ImplementationManager Workplan August 2009 September 2009 October 2009 November 2009 December 2009 2010 Education (All RNs) 6th-31st Observations by units and DMAIC team (*use observation form) Observations submitted via the regulatory review *ongoing—5th of every month* check in with manager from team (Ashley, Denise and Ryan) 25th Unit check-in sessions with staff (Ashley, Denise and Ryan) F/U with units re: regulatory review data (Ashley, Denise, and Ryan) Manager & leadership best practice discussion sessions (optional—dates TBA) Survey Monkey to staff (re: interruptions check in) Date TBA F/U with units re: survey results (Ashley, Denise and Ryan) Unit check-in sessions re: action items from survey follow up (Ashley, Denise and Ryan) Policy in effect 31st Encourage Staff to view Sept. podcast Launch Phase 2 (potential technology enhancements/barcoding) Implementation Phase Control Phase

4. Attend Manager meeting to discuss New Policy changes (Main policy and Appendix D) Expectations of manager to assist with education (using toolkit) Copy of Policy *changes highlighted Copy of Appendix D *modified Talking points for managers Changes to highlight Expectations to discuss Observation and reg review plan Case Study ELM (in place of September M and M—tentative) Interruption/distraction action item reminder and follow-up plan (survey) Job Aid and Badge cards Incorporation of observations into regulatory review Observation form distributed Unit check-in sessions (completed by DMAIC team) Manager/leadership help sessions (coaching or observation assistance) Survey Monkey out to staff re: interruptions/distractions check in Education Roll-Out Plan

5. Surveys will be completed by staff to acknowledge interruptions that are still occurring and the impact of these interruptions Survey questions include: In the past month: My patients have had water at the bedside and available for medication administration. I have had the dietary supplies that I need to administer medications. I have had the medications available from the pharmacy. I have minimal interruptions from the care team while passing medications. The computer at the bedside was operational and ready to use during medication administration. I have not been interrupted by the patient to attend to care needs such as turning, cleaning up or assisting to the bathroom during medication administration. I have the equipment I need to administer medications such as infusion pumps and data scopes. These results will be reviewed with the units and/or DMAIC team and action items will result Staff SurveyControl Phase