2.50
Hdl Handle:
http://hdl.handle.net/10755/162511
Type:
Presentation
Title:
A "Back to Basic" Approach to Reduce ED Medication Errors
Abstract:
A "Back to Basic" Approach to Reduce ED Medication Errors
Conference Sponsor:Emergency Nurses Association
Conference Year:2009
Author:Blank, Fidela, RN, MN, MBA
P.I. Institution Name:Baystate Medical Center
Title:Research Coordinator IV
Contact Address:759 Chestnut Street, Springfield, MA, 1199, USA
Contact Telephone:413-794-8680
Co-Authors:Judith Tobin, RN, BSN; Sandra Macomber, RN, BSN, CEN; Marcia Jaouen, RN; Myra Dinoia, RN, MSN
[Annual Conference Research Poster] Purpose: Medication error is the most frequently reported error in the emergency department (ED). Nationally, 36% of medication errors occur in the administration phase. The purpose of this performance improvement project is to reduce medication administration errors in the emergency department by reinforcing basic medication administration procedures.

Design: This quasi-experimental study examined a 3-month educational intervention using a nonrandomized, single group comparing pre-post outcome variables.

Setting: The study site is a 50-bed emergency department of an academic, tertiary care facility, serving as a level 1 trauma and pediatric referral center, with annual census of over 105, 000 patient visits.

Sample: Of 127 nurses, 95 (75%) volunteered in this IRB-approved study. Participants were 85% female, 62% full-time and 78% Level II nurses.

Methodology: The educational intervention, available as a 20 page educational flipchart, and as a power point presentation, is titled "Preventing Medication and IV Administration Errors." The content describes current error-producing practices in the emergency department, and provides concrete recommendations for reducing medication errors.
Outcomes assessed pre-post intervention were: a) knowledge of medication administration procedures using a 10-item test; b) behaviors reflecting the recommended medication practices; nurses responded with the frequency they practiced recommended guidelines using a 5-point Likert scale; Survey results were analyzed using Wilcox on Rank-Sum test. c) medication administration errors, identified via chart review and voluntary error reports. Chart reviews used a standardized data collection form and achieved 90% agreement in scoring. Analysis was completed using Fisher's exact test and non-parametric procedures.

Results: Ninety-one percent achieved perfect post-test scores on the knowledge exam compared with 69% on the pre-test (p=.0001). Despite current recommendation of "no verbal orders unless it is a true life/death situation," 22% indicated they would accept verbal orders. After intervention, 78% (14/18) who answered incorrectly changed their responses to follow the recommendation.
Pre-post survey results showed a positive change. The best improvement was in Item 8 ("I have the chart with me when I give report to the next shift."): 71% responded "all" or "most" of the time in the post-intervention vs. 60% of nurses in the pre-intervention. The percent of nurses responding that they follow the recommendations "all" or "most" of the time increased in 8 of the 10 survey questions. However this positive changes did not reach statistical significance (p= .98).
Chart reviews of 299 charts (pre) and 295 (post) revealed little pre-post change in total medication errors: 25% vs. 24% (p=.78). Two specific errors changed in opposite directions: "Meds ordered, but not given" worsened from 3% to 7.1% (p=.04); while "Incomplete documentation" dropped from 14% to 7.4% (p<.01). Voluntarily reported medication errors dropped from 1.28 errors/1000 patients to .99 errors/ 1000 patients.

Conclusions: This educational intervention successfully reinforced medication administration recommendations. Even though the intervention improved knowledge, it did not produce a significant change in practice. More research is needed to identify conditions that will modify behavior in clinical settings.
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleA "Back to Basic" Approach to Reduce ED Medication Errorsen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162511-
dc.description.abstract<table><tr><td colspan="2" class="item-title">A &quot;Back to Basic&quot; Approach to Reduce ED Medication Errors</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2009</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Blank, Fidela, RN, MN, MBA</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Baystate Medical Center</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Research Coordinator IV</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">759 Chestnut Street, Springfield, MA, 1199, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">413-794-8680</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">Del.Blank@bhs.org</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Judith Tobin, RN, BSN; Sandra Macomber, RN, BSN, CEN; Marcia Jaouen, RN; Myra Dinoia, RN, MSN</td></tr><tr><td colspan="2" class="item-abstract">[Annual Conference Research Poster] Purpose: Medication error is the most frequently reported error in the emergency department (ED). Nationally, 36% of medication errors occur in the administration phase. The purpose of this performance improvement project is to reduce medication administration errors in the emergency department by reinforcing basic medication administration procedures. <br/><br/>Design: This quasi-experimental study examined a 3-month educational intervention using a nonrandomized, single group comparing pre-post outcome variables. <br/><br/>Setting: The study site is a 50-bed emergency department of an academic, tertiary care facility, serving as a level 1 trauma and pediatric referral center, with annual census of over 105, 000 patient visits.<br/><br/>Sample: Of 127 nurses, 95 (75%) volunteered in this IRB-approved study. Participants were 85% female, 62% full-time and 78% Level II nurses.<br/><br/>Methodology: The educational intervention, available as a 20 page educational flipchart, and as a power point presentation, is titled &quot;Preventing Medication and IV Administration Errors.&quot; The content describes current error-producing practices in the emergency department, and provides concrete recommendations for reducing medication errors.<br/> Outcomes assessed pre-post intervention were: a) knowledge of medication administration procedures using a 10-item test; b) behaviors reflecting the recommended medication practices; nurses responded with the frequency they practiced recommended guidelines using a 5-point Likert scale; Survey results were analyzed using Wilcox on Rank-Sum test. c) medication administration errors, identified via chart review and voluntary error reports. Chart reviews used a standardized data collection form and achieved 90% agreement in scoring. Analysis was completed using Fisher's exact test and non-parametric procedures.<br/><br/>Results: Ninety-one percent achieved perfect post-test scores on the knowledge exam compared with 69% on the pre-test (p=.0001). Despite current recommendation of &quot;no verbal orders unless it is a true life/death situation,&quot; 22% indicated they would accept verbal orders. After intervention, 78% (14/18) who answered incorrectly changed their responses to follow the recommendation. <br/> Pre-post survey results showed a positive change. The best improvement was in Item 8 (&quot;I have the chart with me when I give report to the next shift.&quot;): 71% responded &quot;all&quot; or &quot;most&quot; of the time in the post-intervention vs. 60% of nurses in the pre-intervention. The percent of nurses responding that they follow the recommendations &quot;all&quot; or &quot;most&quot; of the time increased in 8 of the 10 survey questions. However this positive changes did not reach statistical significance (p= .98). <br/>Chart reviews of 299 charts (pre) and 295 (post) revealed little pre-post change in total medication errors: 25% vs. 24% (p=.78). Two specific errors changed in opposite directions: &quot;Meds ordered, but not given&quot; worsened from 3% to 7.1% (p=.04); while &quot;Incomplete documentation&quot; dropped from 14% to 7.4% (p&lt;.01). Voluntarily reported medication errors dropped from 1.28 errors/1000 patients to .99 errors/ 1000 patients.<br/><br/>Conclusions: This educational intervention successfully reinforced medication administration recommendations. Even though the intervention improved knowledge, it did not produce a significant change in practice. More research is needed to identify conditions that will modify behavior in clinical settings.</td></tr></table>en_GB
dc.date.available2011-10-27T10:29:26Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:29:26Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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