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● Workstations/Carts Preventing medication


administration errors Lockable, computerized medication administration carts help hospitals avoid errors and reduce costs. By Deb Stroud, R.N., CHTS-PW


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reventable medication administration errors cost the U.S. healthcare system $21 billion annually, ac- cording to a 2010 report from the National Quality Forum National Priorities Partnership. In addition,


a 2012 study of community hospitals estimates that each preventable adverse drug event increases costs by $3,511 per patient and increases each length of stay by 3.37 days. To help avoid these errors, most hospitals have implemented


electronic medication administration record (eMAR) systems. While helping nurses work more effi ciently, eMARs must be paired with the proper workfl ow and equipment infrastructure to reap the full benefi ts. We learned this at Mayo Regional Hospital in Dover-Foxcroft, Maine, during the years after we implemented our eMAR system in 2008. In our experience, most administration errors decreased after adopting the system, but delays grew. Leadership discovered that with the need to remove one patient set of medication at a time from the dispensing station and the increased time to administer medication with bedside scanning, the electronic medication administration process was creating workfl ow issues. It was even prompting some nurses to take shortcuts to deliver the medications more effi ciently and on time. After testing and abandoning our new workfl ow and subsequently investigating best practices, these challenges were resolved with the implementation of computerized medication carts equipped with barcode scanners and lock- able drawers. With our carts and refi ned workfl ow, nurses were able to administer medications promptly during each shift with fewer delays or interruptions. T e results have been more effi cient medication administration, safer patients and higher quality care.


Safety emphasis prompts eMAR implementation Mayo Regional is one of the more than 1,330 certifi ed critical-access hospitals (CAHs) in the United States, and was named one of the top 100 CAHs in the country by iVantage. Like many other CAHs, Mayo Regional faces the same fi nancial, IT and personnel resource limitations. Safe and high-quality patient care, however, has always been the top priority among Mayo Regional’s 26 physicians, six family nurse practitioners,


18 November 2013


Deb Stroud, R.N., Clinical Specialist in the IT department at Mayo Regional Hospital in Dover-Foxcroft, Maine. For more on


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fi ve physician assistants and 498 hospital/clinic employees. With new federal government fi nancial penalties imposed


on preventable adverse drug events, Mayo Regional needed to update its medication administration process to inhibit these potentially costly errors. After the implementation of eMAR bedside barcode medication verifi cation and improved workfl ow process, error rates did improve. But a signifi cant percentage of medications were delivered more than one hour after the ordered time, making “wrong time” the most com- mon medication error. In 2011, as a result, the Institute for Safe Medicine Practices (ISMP) and the Centers for Medicare and Medicaid Services (CMS) recommended changing the 30-minute rule for medication administration and removing the time constraints on nurses, thus decreasing the feeling of pressure to take shortcuts to comply with the rule. While studying workfl ow, Mayo Regional’s clinical IT nurse


discovered that their current system limited medication collec- tion to one patient at a time, causing nurses to line up at the dispensing cabinet. When a physician would order a new drug, the nurse would be required to walk back to the cabinet, often being interrupted by other clinicians or visitors, causing more delays. T is prompted some nurses to take shortcuts, such as retrieving drugs for more than one patient and even bypassing the barcode scanning verifi cation step. Moreover, nurses were not able to securely store the medica- tions on their carts, increasing the risk for error or loss. T is information was discussed with the chief nursing offi cer, and she authorized redesigning the workfl ow process with the implementation of secure medication carts.


Secure carts solve workfl ow issues Research has shown that when nurses are more satisfi ed with the medication administration process, they are less likely to deviate from the protocol. T e results of a survey from two acute care hospitals in the Midwestern United States over six months showed that “exhausted” nurses were less likely to engage in workarounds when they were satisfi ed with the process. At Mayo, the fi rst attempt to solve these challenges involved assigning a single nurse for all medication administration over a two-hour span in the morning. T is solution was tested on


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