Empowering frontline nurses: a structured intervention enables nurses to improve medication administration accuracy

Seven hospitals from the San Francisco Bay Area participated in an 18-month-long Integrated Nurse Leadership Program, which was designed to improve the reliability of medication administration by developing and deploying nurse leadership and process improvement skills on one medical/surgical inpatient unit.

Each hospital formed a nurse-led project team that worked on six safety processes to improve the accuracy of medication administration: Compare medication to the medication administration record, keep medication labeled from preparation to administration, check two forms of patient identification, explain drug to patient (if applicable), chart immediately after administration, and protect process from distractions and interruptions.

For the six hospitals included in the analysis, the accuracy of medication administration (as measured by the percent of correct doses administered) improved from 85% in the baseline period to 92% six months after the intervention and 96% 18 months after the intervention. The sum of the six safety processes completed also improved significantly, from 4.8 on a 0-6 scale at baseline to 5.6 at 6 months to 5.75 at 18 months.

This study suggests that frontline nurses and other hospital-based staff, if given the training, resources, and authority, are well positioned to improve patient care and safety processes on hospital patient units. Frontline clinicians have the unique opportunity to see what is and is not working in the direct provision of patient care. To address the sustainability of the program's changes after the official project ended, each team was required to develop a sustainability plan entailing monitoring of progress, actions to ensure the improvements are built into the organizational infrastructure, and staff's interaction with leaders to ensure that the work could continue.