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Redesigning From Work-as-Imagined to Work-as-Done: A Systems Safety Approach to Bedside Medication Storage
Kerri Kuntz1, Matthew T Nare2, April Assee3
1Quality, Safety, and Human Factors, Children's Mercy, Missouri.
Journal of Patient Safety
|January 23, 2026
Summary
Implementing new locked medication boxes in pediatric care improved medication storage and accessibility. This quality improvement initiative enhanced safety and efficiency by addressing gaps between policies and practice.
Area of Science:
- Healthcare Quality Improvement
- Pediatric Patient Safety
- Medication Management Systems
Background:
- Challenges in medication storage and accessibility exist in acute pediatric care settings.
- Current processes may have gaps between organizational policies and actual frontline practices.
Purpose of the Study:
- To address medication storage and accessibility challenges in pediatric care.
- To enhance medication availability and reduce errors through new locked storage boxes.
Main Methods:
- A quality improvement study in a 38-bed pediatric medical-surgical unit.
- Included preintervention, simulation, and postintervention phases with audits and surveys.
- Assessed success rates, task times, workload, and confidence during simulated medication storage tasks.
Main Results:
- The intervention process showed a higher task success rate (89%) compared to work-as-done (60%).
- Perceived workload and task time decreased with the new lockbox system.
- Confidence in task completion remained high, with slightly decreased difficulty.
Conclusions:
- Identifying and addressing practice gaps with frontline staff engagement is crucial.
- New medication lockboxes significantly improved storage, enhancing safety and efficiency.
- A collaborative, systems-based approach drives meaningful healthcare improvements and better patient outcomes.
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