Strategies to improve medication safety
Across the nation, nurses on the front line often face the challenge of documenting individual dose adjustments for titratable medications while simultaneously providing urgent and emergent care to their patients. This dual responsibility can lead to potential errors during critical moments of medication administration.
In April 2024, The Joint Commission (TJC) released a list of the most frequently cited standards and elements of performance based on its analysis of surveys performed Jan. 1-Dec. 31, 2023. The findings from TJC underscore the critical importance of medication safety in healthcare settings. The challenge related to the safe administration of medications (specifically MM.06.01.01 EP 3) emphasizes the need for hospitals, including critical access facilities, to enhance their practices surrounding medication safety.
Key strategies to consider regarding medication safety related to titrations include:
- Titration orders: Ensure clarity and completeness of titration orders. It’s essential
to follow a specified structure and include all required elements. Here is a breakdown of each element to help
in crafting a complete titration order:
- Medication name: Clearly state the medication being administered.
- Initial rate of infusion: Specify the starting dose and unit of time for the infusion.
- Incremental units: Indicate the amount by which the infusion rate can be increased or decreased.
- Frequency of changes: Define how often the infusion rate can be adjusted.
- Maximum rate or dose: Clearly state the highest allowable dose or infusion rate.
- Objective clinical measure: Specify the clinical parameters that will guide adjustments to the infusion rate.
- Policy alignment: Verify titration orders are aligned with organizational policies and protocols and ensure the policies and protocols are reviewed regularly by an interprofessional team of clinicians, nursing and pharmacy.
- Optimization of block charting: Optimize the use of block charting documentation. This
is crucial for nurses, especially in specific urgent/emergent situations where time is of the essence. Some
approaches to enhance the effectiveness of block charting include:
- Policy: Develop or update a policy that:
- Defines specific urgent/emergent situations when block charting is an acceptable form of documentation.
- Establishes the required documentation elements.
- Restricts block charting for use in critical and procedural areas.
- Standardized templates: Develop standardized block charting templates that streamline documentation and include required elements that must be documented in each block charting episode. This can reduce the time spent on data entry and ensure all required information is captured consistently.
- Training and familiarization: Provide regular training sessions for nursing staff on block charting as this can improve proficiency. Familiarity with the documentation process allows nurses to navigate and update charts quickly during urgent/emergent situations.
- Integration with electronic health records (EHRs): Ensure that block charting integrates seamlessly with EHRs. This allows for real-time updates and access to patient information, facilitating quicker decision-making.
- Mobile access: Implement mobile or tablet access to complete block charting. This enables nurses to update patient information at the point of care and reduces delays and inaccuracies in documentation.
- Quick reference guides: Create quick reference guides or cheat sheets for commonly used medications and interventions. This can assist nurses in making rapid decisions and documenting changes efficiently.
- Feedback mechanism: Establish a feedback mechanism for nurses to provide input on the block charting process. Continuous improvement based on user feedback can enhance usability and efficiency.
- Prioritization of critical information: Train nurses to prioritize critical information in block charting. Highlighting required data elements can help nurses quickly identify important details during urgent/emergent situations.
- Simulated drills: Conduct regular simulation drills to practice block charting during urgent/emergent situations. This can help nurses become adept at rapid documentation while managing patient care.
- Policy: Develop or update a policy that:
- Order clarification: Empower and support nurses in clarifying orders especially when titration parameters are not meeting the individual needs of their patients. Encourage collaboration through interdisciplinary rounds where nurses can discuss patient needs and clarify orders with physicians, advanced practice providers and pharmacists. Consider standardized documentation templates that prompt nurses to document clarification discussions and new orders within the EHR.
- Chart reviews and timely feedback: Establish a robust process to conduct chart reviews, provide just-in-time feedback to staff, and facilitate open discussions about missed opportunities and their importance to improving patient safety. This can help identify trends and areas for improvement.
Prioritizing proactive strategies along with a focus on fostering a culture of safety is critical to creating a healthcare environment that significantly improves patient care and safety. By integrating these strategies, healthcare organizations will not only enhance compliance with medication safety practices but also empower nurses to provide high-quality patient care while managing the complexities of medication administration. This holistic approach ultimately leads to better patient outcomes and a more resilient healthcare system.