Improving medication safety practice at a community hospital: a focus on bar code medication administration scanning and pain reassessment

Abstract

Introduction: In the USA over 30% of medication errors occur at the point of administration. Among non-surgical patients in US hospitals exposed to opioids, 0.6% experience a severe opioid-related adverse event. In September 2018, Sierra View Medical Center identified two areas of opportunity for quality improvement: bedside bar code medication administration (BCMA) and pain reassessments. At baseline (April 2018 to September 2018) only 81% of medications were scanned prior to administration with pain reassessments completed only 41% of the time 1 hour postopioid administration.

Objective: To improve BCMA scanning rates (goal ≥95%) and pain reassessments within 1 hour postopioid administration (goal ≥90%).

Methods: Implementation methods included data transparency, weekly dashboards, education and plan-do-study-act (PDSA) cycles informed by feedback from key stakeholders.

Results: Following a series of PDSA cycle implementations, barcode medication administration (BCMA) scanning rates improved by 14% (from 81% to 95%) and pain reassessments improved by 50% (from 41% to 91%), sustained 17 months postproject implementation (October 2018 to February 2019). The number of adverse drug events (ADEs) related to administration errors decreased by 17% (estimated annual cost savings of $120 750-239 725 per year) and opioid-related ADEs decreased by 2.6% (estimated annual cost savings of $72 855-80 928 per year).

Conclusion: Adopting John Kotter's model for change, developing performance dashboards and sustaining engagement among stakeholders on a weekly basis improved bar code medication scanning rates and pain reassessment compliance. The stakeholders created momentum for change in both practice and culture resulting in improved patient safety with a favourable financial impact.

Keywords: PDSA; medication safety; nurses; pharmacists; quality improvement.

Figure 1

Scanning compliance postintervention. LCL, lower control limit; RN, registered nurse; PDSA, plan-do-study-act; SPC, statistical process control; UCL, upper control limit.

Figure 2

Pain reassessment post-intervention. LCL, lower control limit; MAR, medication administration record; RN, registered nurse; PDSA, plan-do-study-act; SPC, statistical process control; UCL, upper control limit.

Figure 3

Average doses administered per user per week.