Spreading a medication administration intervention organizationwide in six hospitals

Area of Science:

• Healthcare Quality Improvement
• Nursing Leadership
• Patient Safety

Background:

• Six San Francisco Bay Area hospitals participated in a 12-month quality improvement project by the Integrated Nurse Leadership Program (INLP).
• A medication administration accuracy intervention was successfully spread from pilot units to all inpatient units across participating hospitals.

Purpose of the Study:

• To evaluate the effectiveness of a nurse-led quality improvement initiative in enhancing medication administration accuracy.
• To assess the scalability of a standardized intervention across multiple hospital units and institutions.

Main Methods:

• A 12-month curriculum was developed by INLP, combining off-site and hospital-based training to equip clinicians with change management skills.
• Nurse-led project and unit teams were established to implement six key safety processes for medication administration.
• Key safety processes included medication-to-MAR comparison, maintaining labeled medications, dual patient identification, patient drug explanation, immediate charting, and minimizing distractions.

Main Results:

• Medication accuracy rates in spread units improved significantly from a baseline of 83.4% to 98.0% one year post-project.
• Overall safety process scores in spread units increased from 83.1% to 97.2%.
• Pilot units also demonstrated continued improvement, with accuracy rising from 94.0% to 96.8% and safety processes from 95.3% to 97.2%.

Conclusions:

• Thoughtful planning and early engagement of staff are crucial for successful enterprise-wide spread of quality improvement initiatives.
• Integrating the "human side of change" with technical improvement methodologies enhances organizational adoption.
• The program necessitated extensive training for frontline staff in problem-solving, leadership, team management, data tracking, and communication.