Data Tracking & Management

 

A hospital-wide dashboard was used by each participating hospital to track data at the unit level, and determine hospital-wide averages. This dashboard, which was updated monthly and trended data over time, was used by the Core Resource Team (CRT) to assess improvement or performance lags. Additionally, it was used to update hospital leadership, and inform project communications hospital-wide.

 

An excel data tracking worksheet was developed by INLP, and used by each participating hospital to capture:

 

• Meeting attendance

• Completed tests of change

• Performance on the six safety processes for improving medication administration accuracy [1]

 

Data Collection Team/Resource Requirements

 

• Core Resource Teams spent at least 4 hours a month conducting tests of change on unit.

• A Data Analyst/Quality Improvement (QI) person on each Core Resource Team (CRT) spent at least 8 hours a month collating and reviewing unit data.

• Staff conducting naïve medication administration observations and review allowed for 96 hours (32 hours each) for three (3) 100 dose observation measurements per qualified unit (all adult medical, surgical, intensive care and telemetry units).

• Participation in CalNOC medication administration safety measurement initiative.

 

The CalNOC (Collaborative Alliance for Nursing Outcomes) method of direct observation was used for the medication administration project. This method was combined with the review of patient records, in order to deem medication dose administration accuracy. Between 2-8 staff nurse observers were chosen by each hospital, who were then trained by CalNOC personnel in using the naïve-observer methodology for observing medication administration.

 

The naïve-observer methodology includes the following stages:

 

1. Random observation of nurses (who have consented to observation) during each stage of medication administration:

   • Medication preparation

   • Administration to the patient

   • Documentation

2. Patients chart review (by the observer); notes medications ordered. The patient’s medication orders are not shared with the observer until after the observation and chart review is completed to avoid confirmation bias.

3. Observed doses compared with ordered doses

 

Medication administration accuracy rate

 

Two primary measures were derived from the data in order to evaluate the impact of the INLP QI projects.

 

1.  Data was recorded (and subsequently available) regarding the accuracy of each dose administered. Doses were classified as either correct or incorrect. Errors were classified as one or more of the following:

 

• Unauthorized drug (not ordered)

• Wrong dose

• Wrong form

• Wrong route

• Wrong technique (use of an inappropriate procedure or improper technique in the administration of a drug)

• Extra dose

• Omission

• Wrong time (greater than 60 minutes before or after the scheduled time for the drug)

• Drug not available

 

Correct doses/Total # of doses = Accuracy Rate

 

 

2.  Accuracy of the safety processes used by the staff nurse to improve medication administration included:

 

• Checking two patient IDs

• Checking the medication against the medication administration record

• Explaining the drug to the patient

• Keeping the medication labeled throughout the process

• Charting the medication immediately after administration

• Interruption/distraction of the nurse during the preparation and administration of the medication [2]

 

Overall safety process score: The sum of the six safety processes (valued at 0-6) 

(Captured through 20 naïve random observations monthly per unit)