Workflow Redesign for Medication Administration by https://padlet.com/adubiel2/f1lcrwztbc3ybwo7 Team Members - Angel Dubiel BSN, RN and Catherine Brown BSN, RN en-us 2021-07-28 12:55:57 UTC 2023-01-24 22:49:24 UTC hello@padlet.com https://padlet.net/icons/png/1f48a.png adubiel2 https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1663353377 2021-07-28 18:28:11 UTC https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1663353377 adubiel2 https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1663370516 2021-07-28 19:01:00 UTC https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1663370516 Discussion Board Questions adubiel2 https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1663371391 1. What is a common workaround you see at your place of employment? Are there any steps being taken to eliminate these workarounds? 
2. What is an example of a patient safety issue you have witnessed or heard of created by a workaround?]]> 2021-07-28 19:02:53 UTC https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1663371391 Workflow Redesign Paper adubiel2 https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1663373677 2021-07-28 19:07:23 UTC https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1663373677 Workflow Redesign Objectives adubiel2 https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1663373764
  • Appraise the percentage of accurately scanned medications in the NICU at NJHS and increase this percentage to 80%
  • Investigate instances of medication administration issues resulting in patient harm and decrease this percentage to 0%. 
  • Analyze the cause of self-reported workarounds by the end-user and work to eliminate these causes. 
    • ]]>     2021-07-28 19:07:33 UTC https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1663373764     Testing adubiel2 https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665085087
  • The new workflow will first be tested in a test environment using a testing production of the current EHR. 
  • Test patients and three of the most commonly given medications will be added to this environment. 
  • Management and 2-3 volunteer staff nurses will test  these changes by completing a medication administration in the testing environment. 
  • Testing will conclude with the subjects completing a questionnaire answering what part of the intended changes they found useful and what still needs to be changed. 
  • If any changes are made re-testing must occur.

    • ]]>     2021-07-30 15:50:08 UTC https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665085087     Training adubiel2 https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665085124
  • Simulation in a training environment will be utilized. 
  • The first half of the class will be didactic and cover every facet of the intended changes. 
  • The second half of the class will include a simulation experience and focus on practicing the new medication administration process on the new WOWs with attached wireless scanners. 
    • ]]>     2021-07-30 15:50:11 UTC https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665085124     Go-live adubiel2 https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665085155
  • Once testing and education are performed a date for the go-live period will be finalized.
  • Multiple departments will be included in the implementation process including the informatics department, pharmacy, leadership, and representatives from the EHR.
  • The implementation team will be focused on end-user acceptance, system performance, ongoing maintenance, and the support plan. 
    • ]]>     2021-07-30 15:50:13 UTC https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665085155     Analysis adubiel2 https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665085642
  • The metrics previously identified should be tracked and monitored over the next six months to ensure there were no new barriers or interruptions in workflow created by these modifications or changes in practice. 
  • The long-term goal of this single unit roll out would be to implement these changes with custom adjustments to the entire hospital in the future.
    • ]]>     2021-07-30 15:51:08 UTC https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665085642     Lessons Learned adubiel2 https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665085675
  • Although more computers were available with the addition of the WOW, the batteries needed to be charged every shift. A future suggestion is to have extra WOWs and battery packs. 
  • The wireless scanners were reliable but had connectivity issues. If the end-user clicked a button too many times or walked too far from the WOW, the wireless scanner would disconnect. A solution was quickly formulated to remedy this issue by securing laminated, step-by-step instructions to each WOW of how to resynchronize the scanner to the chosen computer. 
  • The integrity of the post-implementation surveys was questioned. Due to the immaturity of the research project staff were concerned there would be consequences of reporting workarounds. In the future an observed component of data collection relating to workarounds would be added.
    • ]]>     2021-07-30 15:51:13 UTC https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665085675     Project Description adubiel2 https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665088377 This project aims to create a more streamlined workflow during medication administration in the NICU which will decrease the instance of nurse workarounds thus increasing patient safety. ]]> 2021-07-30 15:55:34 UTC https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665088377 Schedule adubiel2 https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665088577 Start date - July 8, 2021. 
    The LEAN project charter will be approved by July 15, 2021. 
    The current state workflow will be completed by July 25, 2021.
    The future state workflow will be developed by July 26, 2021.]]>     2021-07-30 15:55:56 UTC https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665088577     Interdepartmental Support adubiel2 https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665088652
  • Pharmacy: Pharmacists and Pharmacy Technicians 
  • NICU Leadership 
  • Quality Improvement
  • Risk Management
  • IS/Informatics Department 
  • NICU Registered Nurses 
  • Engineering
    • ]]>     2021-07-30 15:56:03 UTC https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665088652     FDA Working to Improve Med Errors adubiel2 https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665127285 2021-07-30 17:07:17 UTC https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665127285 BCMA Factsheet adubiel2 https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665128544 2021-07-30 17:10:04 UTC https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665128544 How to Protect Yourself from Med Errors adubiel2 https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665130309 2021-07-30 17:13:48 UTC https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665130309 Current Process - 10 Steps adubiel2 https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665134157
  • End-user enters patient chart and accesses the Medication Administration Record (MAR).
  • End-user must highlight and double-click the medication that is being administered.
  • End-user will now be prompted to scan the patient’s identification bracelet. This must be repeated to continue.
  • Once the patient is scanned, the end-user is prompted to hit the ‘Enter’ key. The MAR simply states, ‘Hit Enter Now’. No other information is available on this screen.
  • The MAR prompts the end-user to check if the conditions are met to proceed with medication delivery. This screen will show regardless of if there are actual parameters for medication administration. The nurse must choose either ‘Yes’ to continue or ‘No’ to exit. 
  • The nurse is again prompted to hit ‘Enter’ on an otherwise blank screen.
  • The end-user is now prompted to scan the medication.
  • The end-user will now be prompted to choose to either ‘Administer Now’ or ‘Exit’.
  • The end-user is prompted to ‘Accept’. 
  • The medication is now successfully scanned and is ready for administration. 
    • ]]>     2021-07-30 17:20:52 UTC https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665134157     Process Scope adubiel2 https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665135471 1. Evaluate the current medication administration workflow within the NICU at North Jersey Health System. 
    2. Describe all steps that are taken when administering a medication. 3. Identify common workflow interruptions, barriers, and workarounds within the medication administration process. This will be done by anonymous 
    questionnaires to the end-users. 
    4. Identify improvement opportunities and develop a plan to implement changes.
    5. Provide training and education to affected staff members.
     6. Contact the informatics team to discuss and implement changes within the EHR. 
    7. Evaluate the implemented changes.
     8. Provide support to affected staff with the use of super-users and a support phone number that can be always accessed.
    ]]>     2021-07-30 17:23:16 UTC https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665135471     Business Case adubiel2 https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665136438
  • Medication errors create an opportunity for financial burden on a healthcare institution both immediately and over time. 
  • These costs include the medication, procedures, and treatments needed to address the potential adverse reactions in patients and prolonged hospitalizations resulting from these errors. 
  • The financial burden of improper medication administration and poor documentation can directly impact budgets and reimbursement resulting in financial loss.
    • ]]>     2021-07-30 17:24:26 UTC https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665136438     Benefits adubiel2 https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665136476
  • Internal customers include nurses and physicians within the network.
  • External customers include patients and the surrounding community. 
    • ]]>     2021-07-30 17:24:31 UTC https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665136476     Systematic Review of HIT on Nurses' Time adubiel2 https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665138251 2021-07-30 17:27:47 UTC https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665138251 Nurses' Satisfaction with Med Administration after Introduction of EHR adubiel2 https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665138722 2021-07-30 17:28:47 UTC https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665138722 Workarounds and Med Administration adubiel2 https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665139639 2021-07-30 17:30:29 UTC https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665139639 Simulation and Med Administration adubiel2 https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665140038 2021-07-30 17:31:17 UTC https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665140038 Impact of EHR on Nurses' Time adubiel2 https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665144146 2021-07-30 17:39:38 UTC https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665144146 Proposed Process - 7 Steps adubiel2 https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665730005
  • Access patient record. 
  • Review allergies with patient, select ‘Mark as reviewed’. 
  • Open MAR. 
  • Scan patient’s identification band and verify patients full-name and DOB. 
  • Scan medication that is due.
  • Verify drug name, correct dose, correct route, and correct time. 
  • Select ‘Administer now’. 
  • The medication is now scanned and ready to be administered to the patient. 
    • ]]>     2021-08-01 02:04:35 UTC https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665730005     Support for Go-live adubiel2 https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665749978
  • After testing has occurred, the informatics team will ask for at least two RN volunteers to become superusers to aid the staff once the changes have occurred. 
  • A command center will be established made up of both IT technicians and informaticists.
  • The command center will make sure project specific support is available 24/7 for technical support for the first month following go-live. 
    • ]]>     2021-08-01 03:19:39 UTC https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665749978     adubiel2 https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665753935 2021-08-01 03:33:33 UTC https://padlet.com/adubiel2/f1lcrwztbc3ybwo7/wish/1665753935