Improvement Plan Tool Kit

Introduction

This improvement plan tool kit is intended to assist nurses in implementing and sustaining safety enhancement procedures in health care surroundings in medication administration. The tool kit has four categories, each containing three annotated resources. These categories include general organizational safety and quality best practices, environmental safety and quality risks; staff-led preventive strategies; and best practices for reporting and improving environmental safety issues.

Annotated Bibliography

General Organizational Safety and Quality Best Practices

Marian Smeulers, Lotte Verweij, Jolanda M Maaskant, Monica de Boer, C T Paul Krediet, Els J M Nieveen van Dijkum, & Hester Vermeulen. (2015). Quality indicators for safe medication preparation and administration: a systematic review. Plos One, 10,4. Retrieved from https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0122695

The article helps identify evidence-based indicators of quality (outcome, structure) for safe drug administration and hospital preparation. It identifies 21 quality indicators, out of which five were structural pointers, such as high alert medication and safety management. Eleven were process pointers, such as protocols and verification, and five outcome pointers, such as death and harm. The article explains that the identified indicators can be used as a tremendous starting position for more creation of quality indicators for nursing. This resource can help nurses understand evidence-based quality pointers better to be applied in medication preparation and administration. The resource can be used in determining the level of safety in preparation and administration of medication.

Nadin Yousef & Farah Yousef (2017). Using total quality management approach to improve patient safety by preventing medication error incidences. Bmc Health Services Research, 17, 1, 1-16. Retrieved from https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-017-2531-6#Abs1

The article uses six sigma approach to suggest a way to reduce medication errors to be less than one percent of administered doses through the improvement of healthcare professionals’ education and more clear handwritten prescriptions. It generates guideline recommendations to be adhered to by healthcare professionals. This source can help nurses understand the right guideline better to follow to avoid medication errors related to dosage. Nurses can use the recommended guideline during drug prescription and administration.

Institute for Safe Medication Practices (ISMP)(2020) ISMP Targeted Medication Safety Best Practices for Hospitals; 2020. https://www.ismp.org/sites/default/files/attachments/2020-02/2020-2021%20TMSBP-%20FINAL_1.pdf

This is an updated report that outlines sixteen consensus-based best practices for ensuring safe administration of medication, such as vincristine diluted solutions in minibags and with standardized metrics for patient weight. The recommendations of Best Practice present in this guidance reports are according to the reports of medication errors that come to the National Medication Errors Reporting Program of ISMP and assessed by an outside professional consultative panel, as well as accepted by the Institute for Safe Medication Practices Board of Trustees. This source can assist nurses to understand the best practices for safe medication administration better. Nurses can learn from the evidence of previous errors committed in the profession and use the recommended guideline during drug prescription and administration.

Environmental Safety and Quality Risks

Francisco, G. F. P., Márcia, B. C. A., Ricardo, L. S., Eugenie, D. R. N., Gerdane, C. N. C., & Joselany, A. C. (2018). Environmental variables and errors in the preparation and administration of medicines. Revista Brasileira De Enfermagem, 71, 3, 1046-1054. Retrieved from https://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-71672018000301046

The resource identifies the correlation between environmental aspects and errors during the administration and preparation of antibacterial medications (Joselany, 2018). It identifies that physical space used during medication preparation, temperature, items illumination, and noise affect medicine preparation. However, noise variations and illumination do not significantly cause dose error or misuse of medication during administration. The article explains that physical structure aspects have to be considered, making it necessary to know the specific legislation regarding space planning, to promote a safe environment. However, it is observed that spaces adaptation is practiced, usually ignoring the factors of illumination, dimension, noise, and an ideal working environment for the nursing team. This resource can help nurses to better understand the factors to be considered when developing a working environment in the preparation and administration of medication. Knowing the factors that contribute to medication errors during the preparation and administration, nurses can determine the level of safety and quality in preparing and administering medication.

Roya Kaboodmehri, Farideh Hasavari, Masoome Adib, Tahere Khaleghdoost Mohammadi, & Ehsan Kazemnejhad Leili. (2019). Environmental Factors Contributing to Medication Errors in Intensive Care Units. Journal of Holistic Nursing and Midwifery, 29, 2, 57-64. Retrieved from file:///C:/Users/hp/Downloads/Environmental_Factors_Contributing_to_Medication_E.pdf

The article determines the environmental aspects that cause medication errors according to the views of the ICU nurses. It determines that high noise intensities, poor lighting, and unsuitable room temperature are the most common contributing factors to medication errors. Insufficient space for medicine preparation was a less significant environmental aspect as it is established in other studies. Roya et al. (2019) explain that hospital authorities and managers should mitigate and prevent medication errors and enhance patients’ safety by adjusting the environmental aspects. The resource information can be used by nurses to consider the environmental factors that lead to medication errors. Nurses can use the information to design strategic plans, equipment, and staff training, leading to patient safety in medication.

Abdelkader, M. A. M., Mohammed, A. A. D., Mohamed, A. E., AbdelShakour, A. S. B., Abd, E. N. A. R., Mohamed, H. B. E. H., Abdu, M. E. R., Gamal, A. A. R. (2020). Using Quality Tools to Improve Medication Safety in AL-Herafeen Healthcare Unit in Port Fouad City. Medicine Updates, 3, 3, 1-11. https://journals.ekb.eg/article_107624_6fb681540a75346d5b1619d396baf023.pdf

Identifies types of medical errors, use quality standards organizing workplace, and establishes a risk management plan. The resource looks at ways of attaining timely, effective, and effective use of medication in healthcare, particularly in pharmacy, reducing the medication error rates, specifically the administration and prescription error and determine a method for recognizing and tracing medication errors. It explains that the most regular medication errors were administration errors, and the aspect that considerably influences safe medicine administration is the limited storage area and space. Nurses can use this resource’s information to implement changes in the medication storage area to raise safety and quality in medication administration.

Staff-Led Preventive Strategies

McLeod, M., Barber, N., & Franklin, B. D. (2015). Facilitators and Barriers to Safe Medication Administration to Hospital Inpatients: A Mixed Methods Study of Nurses’ Medication Administration Processes and Systems (the MAPS Study). Plos One, 10, 6. Retrieved from https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0128958

The article identifies system facts that allow or prevent effective administration of medication centered on three inter-related areas, including nurse workflow, practices and walkarounds, and distractions and interruptions. McLeod et al. (2015) identify task-focused behaviors as contributors to a smoother workflow with little interruptions, whereas patient-interaction focused conduct appeared to empower patients and acts protection barrier against medication errors through becoming information sources and a double-checker. The information provided in the resource will be useful in facilitating change in behavior in nursing staff. For example, it will help task-focused nurses see the benefits and importance of patient-interaction focused strategy and vise versa. Nurses can thus balance between the two approaches for the effective administration of medication.

Gorgich, E. A., Barfroshan, S., Ghoreishi, G., & Yaghoobi, M. (2016). Investigating the Causes of Medication Errors and Strategies to Prevention of Them from Nurses and Nursing Student Viewpoint. Global Journal of Health Science, 8, 8. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5016359/

The article investigates what causes medication errors and approaches used to prevent them from the nurse students’ and nurses’ viewpoints. It explains that the most significant way of preventing medication error was decreasing work pressure through rising staff, proportional to condition and the number of patients, and using a unit as medication calculation. Nurses can use the resource to gain insight into how to implement safety improvement initiatives by resolving human resource issues, offering working knowledge about medication administration, pharmacology, drug side effects, as well as providing workshops.

Samundeeswari, A. (2018). Nurses Knowledge on Prevention of Medication Error. Journal of Medical Science and Clinical Research, 6, 3. Retrieved from file:///C:/Users/hp/Downloads/JMSCR.pdf

The article looks at nurses’ knowledge in relation t the prevention of medication errors. Samundeeswari (2019) establishes that nurses did not have adequate knowledge on the prevention of medication errors. It is explained that there is a need to adopt the right measures to increase knowledge on medication errors. This resource’s information will be useful to nurses understand that medication error in medication administration happens because of a lack of knowledge on certain drugs, memory-based error, action-based error, and rule-based error. Nurses can thus determine areas that they require improvements to reduce or eliminate drugs administration errors.

Best Practices for Reporting and Improving Environmental

Prakash, S., Mullick, P., Pawar, M., & Kumar, A. (2018). Safe labeling practices to minimize medication errors in anesthesia: 5 case reports and review of the literature. A and a Practice, 10, 10, 261-264. Retrieved from https://sci-hub.do/10.1213/XAA.0000000000000680

The article reports five cases of medication error that are caused by inappropriate or wrong labeling. It explains that strict use recommendations and labeling guidelines are critical in reducing medication errors and increasing patients’ safety. From the information of this resource, nurses learn the importance of labeling. They better understand that learning safe medication administration methods ought to be part of the formal nursing curriculum.

Hanifin, R., & Zielenski, C. (2020). Reducing Medication Error through a Collaborative Committee Structure: An Effort to Implement Change in a Community-Based Health System. Quality Management in Health Care, 29, 1, 40-45. Retrieved from https://sci-hub.do/10.1097/QMH.0000000000000240

This resource explains a technique that can be applied in the execution and sustainability of constant quality development plans through committees intended to reduce medication error rates. It explains that an important part in influencing change and lowering medication errors is in offering the frontline workers a role in leadership in collaborative quality enhancement from the identification of concerns to developing and assessing solutions. The resource can help nurses understand that they are well-positioned as frontline staff in the improvement of safety in medical administration. Nurses can help indentify gaps in the provision of patient care.

Lotta, S., Kirsi, A., Kirsi, K., Anna-Riia, H., Lasse, L., Outi, L.-R., Raisa, L., Marja, A. (2019). Strategies for improving medication safety in hospitals: Evolution of clinical pharmacy services. Research in Social and Administrative Pharmacy, 15, 7, 873-882. Retrieved from https://sci-hub.do/10.1016/j.sapharm.2019.02.004

The article explains the degree and range of involvement in clinical pharmacy in the promotion of medication safety. It reports that pharmacists’ involvement care of patients and system based medication safety has increased more in hospitals since 2011. That improvement is in adherence to the patient safety plan program, and it should continue. This resource can help nurses understand the need for collaboration with clinical pharmacists in the administration of medication to prevent errors. They will thus strive to develop an environment that involves other professionals for increased patient safety.

References

Marian Smeulers, Lotte Verweij, Jolanda M Maaskant, Monica de Boer, C T Paul Krediet, Els J M Nieveen van Dijkum, & Hester Vermeulen. (2015). Quality indicators for safe medication preparation and administration: a systematic review. Plos One, 10,4. Retrieved from https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0122695

Nadin Yousef, & Farah Yousef (2017). Using total quality management approach to improve patient safety by preventing medication error incidences. Bmc Health Services Research, 17, 1, 1-16. Retrieved from https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-017-2531-6#Abs1

Institute for Safe Medication Practices (ISMP)(2020) ISMP Targeted Medication Safety Best Practices for Hospitals; 2020. https://www.ismp.org/sites/default/files/attachments/2020-02/2020-2021%20TMSBP-%20FINAL_1.pdf

Francisco, G. F. P., Márcia, B. C. A., Ricardo, L. S., Eugenie, D. R. N., Gerdane, C. N. C., & Joselany, A. C. (2018). Environmental variables and errors in the preparation and administration of medicines. Revista Brasileira De Enfermagem, 71, 3, 1046-1054. Retrieved from https://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-71672018000301046

Roya Kaboodmehri, Farideh Hasavari, Masoome Adib, Tahere Khaleghdoost Mohammadi, & Ehsan Kazemnejhad Leili. (2019). Environmental Factors Contributing to Medication Errors in Intensive Care Units. Journal of Holistic Nursing and Midwifery, 29, 2, 57-64. Retrieved from file:///C:/Users/hp/Downloads/Environmental_Factors_Contributing_to_Medication_E.pdf

Abdelkader, M. A. M., Mohammed, A. A. D., Mohamed, A. E., AbdelShakour, A. S. B., Abd, E. N. A. R., Mohamed, H. B. E. H., Abdu, M. E. R., … Gamal, A. A. R. (October 01, 2020). Using Quality Tools to Improve Medication Safety in AL-Herafeen Healthcare Unit in Port Fouad City. Medicine Updates, 3, 3, 1-11. https://journals.ekb.eg/article_107624_6fb681540a75346d5b1619d396baf023.pdf McLeod, M., Barber, N., & Franklin, B. D. (2015). Facilitators and Barriers to Safe Medication Administration to Hospital Inpatients: A Mixed Methods Study of Nurses’ Medication Administration Processes and Systems (the MAPS Study). Plos One, 10, 6. Retrieved