Medication Management
The issue that I have chosen is the management of medication at the place I work. In medication management, the issue that I have identified is how the physician fills in the medicines to the right MAR. In an assessment of how medications are administered in our facility, the surveyors discovered that the physicians are not filing in the orders in the proper routine MAR. The surveyors discovered that the medications were not charted in the right MAR, and this made the healthcare providers not be able to follow up with effectiveness. The surveyors felt that for the safest and best practice, offering medications on a routine basis compared to patients requesting for the medication.
According to policy, my workplace is a self-administration treatment center, we should document and observe medications requested by the clients according to the transcribed MAR from the physician’s orders. Our treatment center doesn’t provide 24-hour nursing services, but there is licensed staff who work daily in our treatment center to provide these various services. These licensed staffs work from 7 am to 3 pm. After 3 pm, there is substance abuse staff that are trained to transcribe the ordered medications from the chart after the medicines have been sent from the pharmacy. Because we work at an 8hour shift, there isn’t always enough time for the nurses to chart all the medications in the right. This issue applies to my workplace since this policy of medication administration has been in existence for many years. This issue is relatable in every healthcare sector since they all deal with medication and the public health well-being and the overall health of the nation.
After the survey in our treatment health center, I managed to complete an audit of the charts and the MAR, where I found that medication management is a significant problem that needed a solution. During the review, I noticed that from the ordered medication bottle, the nurses and other technicians were transcribing that medication from the pharmacy and were not verifying the chart’s order. I additionally noted that some of the MAR sheets were placed in the wrong order, and even after staff had pointed out that the sheets were in the wrong order, they then drew a line on top of the form. They then used to change it is to PRN to routine, and this didn’t allow the right medication to follow up to be conducted. It was also difficult for me to understand the differences between the two MARs. The only difference was that the PRN MAR has a section that could allow for a response in follow up, but the two MARs were printed in a white sheet. Moreover, all the medications were stored in the patients’ box altogether. There was confusion because there were no indications or directions of which drugs to be administered routinely or which medicines to be ordered.
The above-identified issue was from the findings from a survey conducted by the joint commission. This issue was categorized as high risk because these medication chatting errors were found in more than one patient. The problem was also cited and identified as a pattern that enhanced the need to improve the current practice and the existing practice regarding medicine management in the health care sector.
This is a significant issue that needs to change not only in our treatment center but also in other healthcare providers that deal with the management of patients’ medications. There is a need for change in how our treatment center manages patients’ medications to offer quality services to patients and ensure that the Joint Commission offers our treatment center the right accreditation. These medical errors of the wrong chatting of medication can cost the health and the life of a patient. It is estimated that four out of ten patients undergo some form of harm in outpatient and primary healthcare. Additionally, investing in inpatient care can lead to high financial savings, where medical errors and unsafe medication practices harm millions of patients. This leads to losses of billions of U.S. dollars annually (WHO, August 2019). From the current data, the survey, and my investigation, this is a clear indication that the medication management process needs a lot of revision, change, and attention.
The outcomes of a poll undertaken by the joint commission revealed the problem previously mentioned. As a result of these drug chatting errors being discovered in more than one patient, this issue has been classified as high risk. Furthermore, the problem was stated and identified as a trend, which increased the need to improve the current practices and existing practices surrounding medicine management in the health care sector, which was previously mentioned.
This is a critical issue that requires attention not only at our treatment center, but also at other healthcare facilities that are involved in the administration of patients’ drugs on an ongoing basis. It is necessary to make changes in the way our treatment center manages patients’ medications in order to provide high-quality services to patients and ensure that our treatment center receives the appropriate accreditation from the Joint Commission. These medical errors, such as the incorrect administration of medication, can be detrimental to the health and even the life of a patient. In outpatient and primary care settings, it is believed that four out of ten patients suffer some type of damage. Medical errors and dangerous pharmaceutical practices cause millions of patients to suffer as a result of inpatient care, and investing in inpatient care can result in significant savings. Every year, billions of dollars in damages are incurred as a result of this (WHO, August 2019). This is a clear indicator, based on the current data, the survey, and my inquiry, that the medication management process need significant revision, adjustment, and attention.
I feel that this issue is occurring because some of the staff lack the right education and training. Since our treatment center has unlicensed personnel who transcribe medication orders, they might not have the right educational background and training to carry out the task, leading to more errors. They might not understand why this process is fundamental and how it may affect the patient if errors are made. Furthermore, we lack an auditing committee that is supposed to evaluate if all the staff follow up on all the steps of transcribing the medication orders. According to Huynh et al.’s (2016) research, they highlight that it is essential to examine the system factors that are linked to medication errors.
The solution that I propose to this issue is first to train and re-educate the staff responsible for the self-administration and transcribing process. During training, it is essential to educate the staff on the background information of the issue and stress the consequences that may follow if the right protocols are not followed. If the medicine is received, the patient’s chart should be placed near the staff to chart the correct information on the MAR. This routine will ensure that the other staff can clarify whether the order is PNR or it is routine. Also, the PNR and routine orders should be printed on different sheets of paper to avoid confusion while filing. I also suggest that the PNR MAR have a separate section for before medication and after medication, so that follow up can be done to check whether the medication administered was effective or not. The training offered should be clear and straightforward for them to understand.
My investigation established a lack of educational background made some staff not understand the importance of adequately transcribing medication. The majority of staff reproduced information from medication bottles instead of getting the right information from the doctors’ orders. There was no auditing committee to evaluate whether all the medication dispensing processes were followed. It is suggested that most medical errors are due to lack of understanding, and most staff may not report if an error occurs because they are afraid of being punished (Rodziewicz & Hipskind, 2020). My solutions would fix these issues, which would ensure quality services are offered to patients, and their health is put at risk for the wrong medication.
The resources that can be used in this solve this problem is an audit sheet. This audit sheet would help the nurse in monitoring any mistakes in the medication administering process so that more training can be offered where necessary. Additionally, different colors of MAR sheets need to be purchased. The only additional cost during the implementation of the solution would be allowances to be paid to staff during training and purchasing new colored papers.
First week: New papers would be purchased, and new formed would be obtained.
Second week: The newly completed forms would undergo approval by the center’s director and the committee. Third week: All the staff responsible for the medicine management process would be trained. They would then be informed regarding the new forms and the way to fill them. All the old forms should be discontinued. The fourth week: All the weekly audits should start where all the daily information chart checks must be reported to the nurse in charge. If there are any continued errors, they should be reported, and further training will be scheduled.
It is crucial to involve every staff during a decision-making process in an organization. Some staff may take longer to accept change, but they should be informed of the importance of these changes. The medical directors and other persons in leadership positions should offer their support by listening to the staff’s feedback regarding the change. This will ensure a smooth and successful transition.
From my proposal, I have received a lot of support from my facility’s leadership. They also offered me feedback, their support, and more inputs on the way forward to stop this issue. In my treatment center, I enjoy working with my staff-mates because they make an excellent team.
I intend to work with the medical director, the pharmacist, and the risk manager since they are the leading role players in medication management. They would ensure an improved process and policy change regarding their issue. Conducting audits in this center would ensure that the correct outcomes and performance are provided. I am also welcome to any suggestions that they feel will lead to better services.
My suggested solution’s implementation could begin as the committee, and the medical director have approved all the suggested policies and forms. The above weekly plan shows that reserved time for each activity. For the change to be a success, weekly, the audits must be forwarded to the risk manager. The risk manager will then monitor the process and report the results to the nurse in charge who will offer recommendations.
As a scientist, I was trying to identify the existing problem and then come up with a step by step process for the solution. As a detective, I searched and investigated the leading cause of the problem and then collected information that I used to find the remedy. As a manager of a healing environment. As a nurse, it is my role to be a leader in finding answers to issues that may impact the health and safety of patients.
References
Huynh, N., Snyder, R., Vidal, J. M., Sharif, O., Cai, B., Parsons, B., & Bennett, K. (2016). Assessment of the nurse medication administration workflow process. Journal of Healthcare Engineering, 2016. https://doi.org/10.1155/2016/6823185.
Rodziewicz, T. L., & Hipskind, J. E. (2020). Medical error prevention. In StatPearls [Internet]. StatPearls Publishing.
World Health Organization. (2019, August). 10 facts on patient safety. Retrieved June 23, 2020, from https://www.who.int/features/factfiles/patient_safety/en/.
