Joint pharmacy/nursing procedure for monitoring unit dose distribution and unadministered doses

This article describes a procedure that uses a multidisciplinary approach to quality assurance in a unit-dose distribution system. The procedure described here uses an assigned nurse and one member of the pharmacy staff (pharmacist, technician/intern) on each nursing unit to check the physical contents of medication cassettes as well as compare pharmacy patient profiles with nursing medication administration records. In examining data from a 184 calendar day period, there was an average of 822 doses of medication per day, including IV admixtures and piggybacks, checked using this system. The time spent in the checking process was approximately 40 minutes per day for each of the three pharmacy staff members performing the check. The average daily census during this period was 60 patients, located on two medical/surgical nursing units, a combined short-procedure unit/detox unit, and an eight-bed critical care unit. The procedure presented also includes a mechanism for the nursing staff to easily document unadministered doses in a manner that provides the pharmacy department with this information. The procedure described makes it extremely difficult for certain types of medication errors to extend beyond a 24-hour period. It also controls missing doses. We found during the 184-day period that only 12 doses were reported missing from the cassettes after the check process. The low number of missing doses reported can be attributed to the fact that the assigned nurse and member of the pharmacy staff verify the presence of a 24-hour supply of medication.