Presentation
An RN, a PhD, and a RpH walk into a medication room... the pilot and implementation of bedside medication storage
DescriptionPrevious research has demonstrated that physicians and nurses alike support patient self-administration of certain medications. However, there lies a gap in what has been supported and what patients have experienced while being inpatient (Mohsin-Shaikh et al., 2014). Additionally, there is evidence that self administration can help with medication adherence, satisfaction, and transition to home while staying consistent (Sørensen et al., 2020). Despite this evidence, many hospitals are (understandably) reluctant to relinquish control, citing concerns around medication errors, underutilization or inappropriate use. While some medications may never be self-administered, there are opportunities where patients and families alike can participate. One such example, and the focus of our work, is around bulk medications. Whether it’s a teenager with a body wash or a baby with diaper rash, there are some instances where (with appropriate education) patients and families are perfectly capable of handling some aspects of care. However, hospital policies may prevent or even prohibit the smallest amount of normalcy, while subsequently costing nursing staff valuable time and resources to run a diaper cream from a medication room to patient room 10 times in one day. How, in this case, is the policy helping anyone at all?
Our study was built on the premise of “work as imagined”, demonstrating how policies and procedures were impossible to follow, how workarounds dominated the environment, how poor storage created constant near miss events, how much time was wasted in this “work as imagined” world, and how we were inadvertently creating unsafe situations by not addressing any of poor design factors impacting the system.
This team of panelists worked together to create a myriad of system changes including changes in policy, changes in the EMR, and trialing new medication storage boxes that could be kept at the bedside. Driven by Human Factors methods and framework, we will first discuss the methods required to demonstrate to leadership and administration the need to purchase and trial new boxes (spaghetti diagrams, audits and near miss event counts). We then created a pre and post simulation opportunity with nurses carrying a number of medications from medication rooms and patient rooms, once before the boxes were installed and then afterwards. Because the new pilot boxes were installed live on the unit, our methods included in situ simulation on rooms that were available, which added an unpredictability issue that actually brought up more areas for opportunity. Our results demonstrated that the new boxes decreased the number of near miss events, took significantly less time than the policy mandated ‘work as imagined’, and facilitated space for appropriate storage. The success demonstrated in this trial was then brought back to leadership who want to spread it to the other medical surgical floors.
This panel will discuss the trials and tribulations of trying to navigate the multidimensional issues with empowering patients and families to own certain aspects of their care, reduce unnecessary work for nurses already overstretched, addressing infection prevention issues with medications being taken back and forth between isolation rooms, while convincing a hospital to pay for it.
The takeaways from this panel include:
1. Implementing change on a hospital floor is not easy. The goal of this panel is to demonstrate the perspective of each of the roles in the process and the work required of each of them to move this forward.
2. Demonstrating why change is necessary to leadership is also not easy. Being equipped with data, ROI, and a plan can be used to justify the cost of a trial, as well as the cost if nothing changes.
3.Doing a project such as this is easy if you have buy-in and a good, interdisciplinary team. This pilot did not run smoothly, we had to educate and then re-educate, we showed up and the floor was too busy, facilities refused to mount our boxes where we wanted to, and we still have to figure out how to spread this to the entire hospital. However, despite all of that, we managed to make a make a difference for the patients and staff.
Our study was built on the premise of “work as imagined”, demonstrating how policies and procedures were impossible to follow, how workarounds dominated the environment, how poor storage created constant near miss events, how much time was wasted in this “work as imagined” world, and how we were inadvertently creating unsafe situations by not addressing any of poor design factors impacting the system.
This team of panelists worked together to create a myriad of system changes including changes in policy, changes in the EMR, and trialing new medication storage boxes that could be kept at the bedside. Driven by Human Factors methods and framework, we will first discuss the methods required to demonstrate to leadership and administration the need to purchase and trial new boxes (spaghetti diagrams, audits and near miss event counts). We then created a pre and post simulation opportunity with nurses carrying a number of medications from medication rooms and patient rooms, once before the boxes were installed and then afterwards. Because the new pilot boxes were installed live on the unit, our methods included in situ simulation on rooms that were available, which added an unpredictability issue that actually brought up more areas for opportunity. Our results demonstrated that the new boxes decreased the number of near miss events, took significantly less time than the policy mandated ‘work as imagined’, and facilitated space for appropriate storage. The success demonstrated in this trial was then brought back to leadership who want to spread it to the other medical surgical floors.
This panel will discuss the trials and tribulations of trying to navigate the multidimensional issues with empowering patients and families to own certain aspects of their care, reduce unnecessary work for nurses already overstretched, addressing infection prevention issues with medications being taken back and forth between isolation rooms, while convincing a hospital to pay for it.
The takeaways from this panel include:
1. Implementing change on a hospital floor is not easy. The goal of this panel is to demonstrate the perspective of each of the roles in the process and the work required of each of them to move this forward.
2. Demonstrating why change is necessary to leadership is also not easy. Being equipped with data, ROI, and a plan can be used to justify the cost of a trial, as well as the cost if nothing changes.
3.Doing a project such as this is easy if you have buy-in and a good, interdisciplinary team. This pilot did not run smoothly, we had to educate and then re-educate, we showed up and the floor was too busy, facilities refused to mount our boxes where we wanted to, and we still have to figure out how to spread this to the entire hospital. However, despite all of that, we managed to make a make a difference for the patients and staff.
Event Type
Discussion Panel
Oral Presentations
TimeWednesday, March 2711:00am - 12:00pm CDT
LocationSalon A-1
Hospital Environments