Collaboration, Communication Needed Between Nursing, Pharmacy Staff

Medication management decisions must be made with clear communication and collaboration between the nursing and pharmacy departments to avoid errors and negative patient outcomes, according to a recent Advanced Healthcare Network for Nurses article written by Executive Nurse Consultants Robin Fowler and Kevon Garrison of Aesynt, a company providing pharmacy automation technology and systems. Additionally, each hospital must find a medication distribution model that fits with its workflow and nurse leaders should have a strong voice in its selection. They write:

“The use of pharmacy technology is important to strategically improving the medication management process, but if decisions are made without nursing input, there can be unforeseen consequences. ... When the pharmacy and nursing departments meet frequently and all stakeholders are focused on the same end-goal, the outcome is a medication management model that produces fewer errors, greater efficiency and better patient outcomes.”

An INQRI-funded study examined acute care hospitals to determine the relationships among characteristics of the nursing practice environment, nurse staffing levels, nurses’ error interception practices, and rates of nonintercepted medication errors. The study, “Nurses’ Practice Environments, Error Interception Practices, and Inpatient Medication Errors,” was published in the June 2012 issue of the Journal of Nursing Scholarship and found that nurses’ error interception practices are associated with lower rates of nonintercepted medication errors.

The INQRI study also found that a supportive practice environment—reflected in factors including teamwork and nurses’ opportunities to participate in hospital- and unit-level decisions—is associated with a higher quality of nursing care.

The study was conducted in a sample of 82 medical-surgical units recruited from 14 U.S. acute care hospitals in New Jersey, and included 686 registered nurses.Linda Flynn and Dong-Churl Suh led the research.

One in Three Nursing Home Patients Are Harmed By Medical Errors

A recent government survey found that approximately one-third of patients who were discharged from hospitals to skilled nursing facilities, were harmed by treatments they received in the facilities. Most of the incidents could have been prevented, according to the report, which was conducted by the U.S. Health and Human Services Department, Office of the Inspector General.

The survey was based on a large sampling of Medicare patients discharged from hospitals to skilled nursing facilities during a one-year period from 2011-2012, NPR reports. Problems observed in the nursing homes included errors related to patient monitoring, and medication errors.

Approximately 60 percent of nursing home residents were harmed by their treatment were readmitted to the hospital as a result, and the report estimates that such readmissions cost Medicare about $2.8 billion a year.

The American Health Care Association, which represents the nursing home industry, responded to the report, telling NPR that this study was conducted before the Association’s quality improvement initiative, which has been showing progress in skilled nursing facilities across the country.

An INQRI-funded study led by Linda Flynn and Dong-Churl Suh examined the “Impact of Nursing Structures and Processes on Medication Errors.” The multidisciplinary research team identified changes in nursing care processes needed to prevent medication errors as well as adjustments in nurse staffing and the practice environment that can facilitate interception of such errors.

Hospital’s Communications, Medical Teams Join Forces to Highlight Medical Errors

By combining the expertise of a multi-disciplinary medical team and the Communications Department, the University of Texas MD Anderson Cancer Center is creating visual story-telling presentations to highlight medical errors, ClinicalOncology.com reports.
 
The Center, based in Houston, Texas, produces “video stories,” which contain recommendations based on adverse drug-related events, in combination with photos, audio recordings and video re-enactments. The presentations are shown during staff and committee meetings and are available on the hospital’s intranet site.

The presentations illustrate gaps in everyday medical processes that can lead to medical errors. For example, a presentation may explore the drug use processes ranging from prescribing to administration and analyze where errors might occur.

Errors are identified every month by a multidisciplinary team that includes a nurse, pharmacist, and patient safety specialist. The group selects three events or topics and then another larger multidisciplinary group of nurses, pharmacists, and mid-level providers choose one topic to be developed into a visual presentation.

Between October 2012 and June 2013, hospital leaders accessed the eight once-monthly videos nearly 3,500 times, according to ClinicalOncology.com. The response from hospital leaders, as well as front-line nurses, pharmacist and physicians, has been overwhelmingly positive, according to the project’s administrators.

An INQRI-funded study led by Linda Flynn and Dong-Churl Suh examined the “Impact of Nursing Structures and Processes on Medication Errors.” The multidisciplinary research team identified changes in nursing care processes needed to prevent medication errors as well as adjustments in nurse staffing and the practice environment that can facilitate interception of such errors.

Information Technology Management Could Lead to Reduced Medication Errors

In order to reduce medication errors, hospitals could try implementing processes through information technology that will mistake-proof the system. Ultimately, advanced use of technology could replace the tradition of identifying and eliminating nurses and doctors making a high number of medical errors, Search Health IT reports. However, such a high-maintenance technological program may not be right for all institutions.

A growing number of hospitals are training their staff in Lean Six Sigma, a management philosophy developed by Motorola that emphasizes setting extremely high objectives, collecting data, and analyzing results to a fine degree, according to the article. One way that Six Sigma could improve patient outcomes is by preventing the administration of a medication to the wrong patient by building in certain error-proof steps into medication dispensing:

• The patient wristband has a barcode and a location-based tracker.
• The medication administration cart uses location-based tracking and will only dispense the medication after the nurse scans the patient's barcode.
• The medication administration cart displays a photo of the pill and a photo of the patient to serve as a reminder for the nurse.
• The cup that holds the dispensed medication uses location-based tracking to ensure that it is in the correct patient's room.
• The patient's bedside computer has a camera that images the pills and displays the drug name and dosage on the screen so that both the nurse and patient can perform a final check and confirm that the patient is about to receive the proper medication.

While some of these error-proofing steps have already been widely implemented, many hospitals are constrained by lack of access to all of the technologies, or concerns that some steps are time-consuming and would significantly hinder workflow. Using big data analytics, the process of examining large amounts of data to uncover hidden patterns, may provide hospital executives with the information they need to decide on how to both optimize workflow and minimize errors, according to the article.

An INQRI-funded study led by Linda Flynn and Dong-Churl Suh examined the “Impact of Nursing Structures and Processes on Medication Errors.” The multidisciplinary research team identified changes in nursing care processes needed to prevent medication errors as well as adjustments in nurse staffing and the practice environment that can facilitate interception of such errors.

Bedside Shift Changes for Nurses Can Reduce Errors, Improve Patient Satisfaction

Performing nurses’ shift changes at the patient’s bedside can reduce potential medical errors and increase patient satisfaction, according a new study highlighted on ScienceDaily.com.  The study findings were published in the Journal of Nursing Care Quality.

Traditionally, nurses exchange patient information between shifts through recordings or verbal briefings. With the bedside handover method, nurses exchange pertinent patient information such as clinical conditions, allergies, and care plans with the patient in his or her room. With this system, nurses and patients see each other sooner and patients are able to ask questions and clarify information with both the nurse leaving for the day, and their new nurse. This process can relieve anxiety and improve patient satisfaction, according to the article.

Study participants described bedside handover as engaging, personal, and informative. However, researches noted the importance of recognizing and being sensitive to patients’ preferences, which often differ. Bedside handover can be beneficial for nurses as well, since they can assess all patients’ conditions and prioritize care within the first 15 minutes of a shift.

An INQRI-funded study led by Linda Flynn and Dong-Churl Suh examined the “Impact of Nursing Structures and Processes on Medication Errors.”  The multidisciplinary research team identified changes in nursing care processes needed to prevent medication errors as well as adjustments in nurse staffing and the practice environment that can facilitate interception of such errors.

Using Technology to Help Nurses Spend More Time on Direct Patient Care

A study published in 2008 found that medical-surgical nurses spent 19.1 percent of their time involved in patient care activities, but 35.3 percent on documentation. A blog on Advance for Nurses by Michael Wong of the Physician-Patient Alliance for Health & Safety discusses the ways that nurses can use technology to improve patient safety and allow them to spend more time providing direct care.

The blog is based on the recommendations of three nurses who spoke at the Patient, Safety Science & Technology Summit held in January of this year. Those nurses are: Lillee Gelinas, vice president and chief nursing officer of VHA, Inc.; Linda Groah, executive director of the Association of perOperative Registered Nurses; and Juliana Morath, chief quality and safety officer at Vanderbilt University Medical Center.

Their recommendations include: using monitoring technology as a patient safety net; using monitoring technology that incorporates multiple parameters into a single system as opposed to monitoring things separately; and ensuring that technology is nurse-friendly. Wong also recommends that nurses be an integral part of the process of selecting and implementing the use of the technology they will use and interact with.

An INQRI-funded study led by Linda Flynn and Dong-Churl Suh found that nurses were better able to intercept medication errors when they worked in a supportive environment, including opportunities to participate in hospital decisions and continuity of patient care assignments, among other factors.

Minimum Nurse Staffing Ratios, Mentoring Programs Are Part of New Senate Bill

Earlier this week, U.S. Senator Barbara Boxer (D-CA) introduced the National Nursing Shortage Reform and Patient Advocacy Act, aimed at improving patient care and addressing the nursing shortage. 

The bill would:

• establish minimum nurse-to-patient staffing ratios;
• invest in nursing mentorship demonstration programs; and
• provide for whistleblower protections to allow nurses to report violations of minimum standards of care without fear of reprisal.

 In a statement, Boxer said, “I am proud to introduce legislation that will help save the lives of countless patients by improving the quality of care in our nation’s hospitals. We must support the nurses who work tirelessly every day to provide the best possible care to their patients.”

Several INQRI studies (as well as numerous other studies) have established that higher nurse staffing levels improve patient outcomes, including research led by Mary Blegen and Tom Vaughn, and Linda Flynn and Dong-Churl Suh.