Standardizing medication administration process measures improves accuracy and creates a culture of safety

Purpose:
The Medication Administration Accuracy Project (MAAP) is a performance improvement project that aims to increase the reliability of nursing compliance with standardized medication administration processes by engaging direct-care nurses in order to ensure medication is administered accurately.

Significance:
Many serious medication errors are preventable and threaten patient safety & quality of care. Med admin accuracy is a “core of quality” measure yet is often not utilized as a performance improvement tool. Engaging direct-care staff in measuring their own data is critical to a culture of safety.

Strategy and Implementation:
Administering medications accurately is achieved by standardizing the administration process and is essential to eliminating nursing medication errors. It is critical to engage direct-care staff in the process since the role that nurses play in patient care places them in a unique position to prevent medication administration errors and gives them the insight necessary to drive significant change at the unit level. Using the PDSA model of performance improvement, each adult inpatient unit nominated direct-care nurses whose role is to facilitate improvement strategies based on medication administration observation data. These Unit Team Leads (UTLs) coordinate observation studies that involve direct-care nurses observing each other administering medication and documenting adherence to the standardized processes. Nurses use observation data to identify opportunities to improve process reliability and perform monthly rapid improvement cycles, implementing changes on their units.

Evaluation:
By standardizing the medication administration process and ensuring that all nurses were educated and accountable for the process(building a culture of safety), the med admin error rate has decreased. Over a 4 year period, the medication administration error rate decreased from 5.6% to 1.2%.

Implications for Practice:
MAAP demonstrates that standardizing the med admin process improves outcomes (ensuring that the 5 rights are met) and ultimately decreases errors. Direct-care nurses are essential in identifying opportunities for improvement on their units as well as establishing and sustaining best practices.