1. Clinton Hospital MAK Quality Improvement
Telana Fairchild, MSN, DNP student
University of Massachusetts at Worcester
Graduate School of Nursing

2. Review & discuss observation experience
Agenda
Review & discuss observation experience
Identify 2-3 objectives for educational material
View student SBAR audio ppt
Goals for next meeting |
Clinton MAK QI |
11/27/2018

3. Calling pharmacy before checking intervention tab.
When reviewing orders nursing not clicking interventions first, instead call pharmacy.
Orders being scanned down without proper order requirements.
ex. lidocaine patch dose: unknown, MD circled order, nursing scanned incomplete order down.
ex. advil dose: unsure, then clarified in chart four more times, creating multiple steps for nursing and pharmacy.
Standard times for medications not acknowledged my nursing or MDs.
Pain medication: if more than one need severity score. Also prn antiemetics.
ex. if morphine and ibuprofen ordered for pain prn, then morphine is given for pain 6-10 & ibuprofen for pain 1-5 OR zofran given prn for nausea & reglan if no effect after 15mins of use of zofran.
Pink slip sent to floor with every intervention to help alert nursing and MDs.
Not verifying d/c's medications
6-8 steps for each intervention from error to resolved.
With MAK, pharmacy is new to entering standard administration times.
ex. cardiac and respiratory meds ordered BID, but not standard time of 9A &5P, instead 9A & 9P.
Nursing depends on pharmacy to catch errors now.
Most errors from MED recs and ER nursing staff are the ones most often completing, Teresa reported they were trained 2mo ago.
If first dose ordered after standard time of administration then need to indicate when next dose is due.
ex. pt admitted at 8pm, most bid meds are past due, need order for now then resume standard admin times
Respiratory meds also entered in sorian so respiratory therapist are aware, nursing/secretaries responsibility.
8-10 steps for each intervention from error to resolve, cost $3.60 for each intervention on overnight
Protocols not being followed, nursing giving okay not to give medication
Ideas: * Can secretaries be responsible to continue to review medication orders before scanning? * Is the pink slip necessary or helpful? * Key to remind everyone the number of steps it takes when orders are correct (6+) * Bring ER nursing up to par with completing med rec * Is there a way to keep incomplete orders from being circled by MD? * Is there a better way to address respiratory meds? * Put standard admin times paper on/near each computer. Education:
Nursing & MD- how to correctly complete med rec
Yellow triangle appears next to intervention tab
Remind to check intervention tab before calling pharmacy
Review standard admin times
Review prn medication scales, cardiac and respiratory meds
Review need next dose time order time is after standard admin time
All medication orders must be verified even if d/c'd
Process:
Calling pharmacy before checking intervention tab.
Improper orders being scanned down.
Pink slip sent to floor to alert team of intervention.
Not verifying d/c’d medications.
Pharmacy is new to entering stand administration times.
If first does ordered after standard time than need to indicate next dose time.
Protocols not being followed
Structure:
Nursing and MD not acknowledging standard medication administration times.
For same class prn medications, there needs to severity score.

4. Process: Structure: Outcome:
Calling pharmacy before checking intervention tab.
Improper orders being scanned down.
Pink slip sent to floor to alert team of intervention.
Not verifying d/c’d medications.
Pharmacy is new to entering stand administration times.
If first does ordered after standard time than need to indicate next dose time.
Protocols not being followed
Nursing depends on pharmacy to catch errors
Most errors from Med Rec Forms.
Respiratory medications have to be entered into sorian.
Structure:
Nursing and MD not acknowledging standard medication administration times.
For same class prn medications, there needs to severity score.
Nursing depends on pharmacy to catch errors.
Respiratory meds entered into sorian by nursing or secretaries.
ER completes most Med Rec Forms and don’t understand MAK process.
Outcome:
Reduce interventions.
Improve Med Rec forms by all.

5. Observation: Nursing
Nursing not checking intervention tab before calling pharmacy
Orders being scanned down without proper order requirements.
Standard times for medications not acknowledged by nursing or MDs.
Pain medication: if more than one, need severity score. Same for other prn meds.
Pink slip sent to floor with every intervention to help alert nursing and MDs.
Not verifying d/c's medications
6-8 steps for each intervention from error to resolved.
Clinton MAK QI
11/27/2018

6. Observation: Pharmacy
Pharmacy is new to entering standard administration times.
Nursing depends on pharmacy to catch errors now.
Most errors from MED recs. ER nursing staff are most often completing. Teresa reported they were trained 2mo ago.
If first dose ordered after standard time of administration, then need to indicate when next dose is due.
Respiratory meds also entered in sorian so respiratory therapist are aware, nursing/secretaries responsibility.
Protocols not being followed
8-10 steps for each intervention from error to resovled, cost $3.60 for each intervention on overnight
Clinton MAK QI
11/27/2018

7. Ideas
Can secretaries be responsible to continue to review medication orders before scanning?
Is the pink slip necessary or helpful?
Key to remind everyone the number of steps it takes when orders are correct (6+)
Review how to complete a med rec accurately
Is there a way to keep incomplete orders from being circled by MD?
Is there a better way to address respiratory meds?
Can we put standard admin times paper on/near each computer

8. Educational Goals Verification Review process/workflow Yellow triangle
Use before calling pharmacy
All orders including d/c’d meds
Medication Reconciliation
Review how to complete
What to do if incomplete order
Standard Times
Review what they are
Place at all stations
If after std time, need next dose time
Cardiac & Respiratory Medications

9. Time line Observation Review findings Make goals
Create Educational module
Share module with group
Educate staff
Observe changes
Revise
Educate