A Collaborative Approach to Improving Medication Safety in Acute Care
Nanaimo Regional General Hospital
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Nanaimo Regional General Hospital (NRGH) implemented barcode scanning of patients and medications in March 2016 but scanning rates stayed low within its acute care site. Knowing the potential of barcode scanning to improve patient safety and reduce medical errors, NRGH’s acute care site began a quality improvement initiative to implement the technology.
A Closed Loop Medication System requires four components to function properly: an active medication order, an electronically identified provider, an electronically identified patient, and a barcoded and scanned unit dosed medication. High barcode scanning rates for patients and medications during bedside administration has been linked to reduced medication errors.
By September 2018, only 2.5 years after scanning technology had gone live, scanning rates were unsatisfactory. The positive patient identification rates at the hospital’s acute care ward had dropped to 52% and positive medication identification rates were at 70%. To understand why there were differences between units, as well as for the site as whole, a root cause analysis was performed. There were 22 barriers identified to scanning of patients and medications related to workflow, equipment and human factors.
In response, an interprofessional working group was created to understand the context and look at what could be done to improve the rates. The group used the Institute for Healthcare Improvement’s Model for Improvement framework to guide its work by setting goals, establishing measurements, understanding the problem, generating ideas and testing change through small cycles of continuous improvement.
To identify options for barcode scanning compliance and ensure sustainability, the team had several brainstorming sessions to find ideas that could be implemented easily and have a high payoff. The proposed changes were tested through three consecutive Plan-Do-Study-Act cycles. The first cycle aimed at raising awareness of the importance of this work and encouraging communication and discussion of scanning performance among clinical staff. The second cycle focused on learning how to tap into corporate resources and include other disciplines to improve care together, and the third cycle targeted supporting staff in non-punitive ways by reviewing individual scanning rates and following up with nurses.
As a result of this work, positive patient identification rates increased to 64% and positive medication identification rates increased to 78%. Three months after the project ended, the rates remained sustained at 63% and 79%, respectively.
As maintaining improved quality is a key challenge in many health care changes, the team wanted to ensure that any improvement was maintained after its work was completed. The role of leadership, ongoing use and examination of data, continuous education and regional spread were identified as the most critical components for sustainability; they are continually reviewed and assessed.
The impressive increase in patient and medication scanning has improved the quality of care for patients at Nanaimo Regional General Hospital and provided many valuable learnings around utilizing barcode scanning technology as well as the process of engaging staff in a site-wide initiative. Patients are receiving safer care, with fewer risks of medication errors. The project has been so successful that Island Health is using its learnings to inform strategic planning across its region.