Guest Column | November 30, 2011

Improving Medication Compliance In A Critical Access Hospital

By Deb Stroud, RN, Mayo Regional Hospital

Like many of the 1,305 certified Critical Access Hospitals (CAHs) in the United States, the nursing, pharmacy and other professional staff at Mayo Regional Hospital in Dover-Foxcroft, Maine, are continually challenged to do more with less. Adding staff is not an option, so to protect patients we must become more efficient. In our hospital, medication administration has been a big patient safety challenge—as it is nationwide.

According to a 2010 report from the National Quality Forum National Priorities Partnership, preventable medication errors cost the U.S. healthcare system $21B annually, with about $16B from inpatient settings alone (NQF Action Brief: A Roadmap for Increasing Value in Health Care. Preventing Medication Errors: a $21B Opportunity, November 2010). A 2006 Institute of Medicine (IOM) report shows that medication errors are the eighth leading cause of death. When all types of errors are accounted for—including late administration and skipped doses that do not lead to obvious injuries—it is estimated that there is at least one medication error per hospital patient per day.

Studies suggest (New England Journal of Medicine. Effect of barcode technology on the safety of medication administration, 2010 May 6) that electronic medication administration recording (eMAR) systems that use bar coding to verify medication delivery can reduce errors; so in April 2008, we implemented an eMAR system. Our medication error rate did decrease, but the system revealed a significant percentage of our medications were delivered more than one hour after the ordered time, making "wrong time" our most common medication error.

Most hospitals are familiar with the problem we faced. Nurses spend so much time walking back and forth from the bedside to the automated dispensing device—and waiting in line at the machine— that they fall behind. We're often interrupted when we cross paths with other nurses or visitors, exacerbating medication delays. When audits observed nurses trying to "catch up," time saving steps such as retrieving medications for more than one patient and leaving medications unsecured between patient rooms were noted. Some nurses even bypassed the medication verification system. These issues presented significant patient risks for medication error.

Our first attempt at a solution was a "one time med pass" by a dedicated medication nurse for the 18 beds in our medical surgical unit (surg unit). I was personally tasked to deliver the 9:00 a.m. meds for 13 patients in the unit, but was only able to deliver about half within one hour of the prescribed time.

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