Date of Award

Spring 5-16-2016

Degree Type

Final Project

Degree Name

DNP Doctor of Nursing Practice

Department

Nursing

Advisor

Maryellen Roberts, DNP

Committee Member

Maureen Byrnes, DNP

Committee Member

Crystal Hobbs

Abstract

Purpose: To ensure quality healthcare, it is necessary to provide safe medication administration. The specific goal is the reduction of medication errors in the hospital setting with concentration in the emergency room (ER). Bar-code medication administration (BCMA) has proven to be effective on the in-patient units in the hospitals researched and visited as part of this project, but the issue still remains that the emergency rooms exhibit a decreased compliance rate. The purpose of this Doctor of Nursing Practice (DNP) project, is to reverse the situation in a local community hospital that has a 50 bed emergency room, promoting increased compliance to affect improved medication safety measures. This was done by educating the nursing staff in the emergency room regarding the addition of an application related to verbal orders which increases with high acuity levels. The application will automatically profile the verbal order so that the nurse can use the BCMA and therefore increase compliance.

Significance of the Project: “Thirty-four percent of all medication errors in hospitals occur in the administrative phase of the medication process and less than 2 percent of these errors are intercepted before execution” (Voshall, Piscotty, Lawrence, & Targosz, 2013, p. 530). In addition to causing possible harm or even death to a patient when an adverse event occurs, it is also a devastating economic factor. This is a nurse-driven change and to make it a success the nursing staff must perceive that the goals are realistic and that this will improve their practice. To insure a positive outcome it is essential to establish systems standards which are compatible with nursing needs and expectations, and which facilitate development of Information Technology (IT) systems which are supportive of nursing practice (Zadvinskis, Chipps, & Yen, 2013).

Methods: Four goals were established for this project that was named: The Medication Quality Initiative. The first was to improve the compliance of BCMA utilization in the ER since they were averaging 70.9% BCMA usage following implementation, and had recently declined to 41.1 percent (RWJUH, 2015). Through careful research of the daily ER patient logs and the weekly data utilization sheets for BCMA, it had been determined that verbal medication orders increase in relationship to the increased patient activity and acuity levels, decreasing compliance. Because of this occurrence medications cannot be profiled in a timely manner and the nurses use work-arounds. The second goal was to meet with the team that consisted of the Chief Nursing Officer (CNO), ER Medical Director, ER Nursing Director, IT, Executive Informatics Nurse, IT Pharmacist, Nursing Educator, and the project preceptor. It was unanimously approved to turn on the application called CARE ADMIN in the Medication Administration Record (MAR) portion of the Patient’s Electronic Health Records (EHR) System so that verbal orders can be immediately profiled. Figure E3, in Appendix E, shows the “Create Order and Document” button which is only available to ER Users of this system to allow the automatic profiling process to take place.

For the third goal, this author conducted an in-service program for 52 ER nurses so that they had a proper understanding of this new application, as well as the importance of BCMA compliance. In addition, they were given a pre-survey to determine their overall perceptions and use of this technology. The fourth goal was instituting the project, which was on-going for eight weeks. During that period, the data utilization sheets were reviewed weekly to determine project success and sustainability. At the conclusion of the eight weeks, the staff completed a post-survey to determine their perceptions after having used the new verbal order process. This post survey looked at both pre and post education perceptions.

Project Outcome: The overall response was positive. The five levels of nursing practice “From Novice to Expert” related to the core of the emergency room staffing matrix. This was an advantageous time for this project because the mentors were teaching medication administration via the BCMA to new graduates as well as incorporating how to use the verbal order application. The overall consensus was that it does improve nursing practice since it does rapidly profile the medications, thereby improving patient care. Additionally, it has been subsequently, observed that many of the physicians have become more time sensitive in transcribing their medication orders in the computer.

Clinical Significance: As a result of this project, it was noted that the percentage of BCMA use has increased. The Director of the Emergency Room will continue to have the nurses utilize the application. The sustainability of this project enhances medication administration in the emergency room. This procedure has become an integral part of the ER orientation to new staff members given by the nurse educator and nurse preceptors.

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