Improving Outpatient Medication Administration Safety

Background: As with most ambulatory care settings, this academic institution lacked safe patient medication administration technologies available to the inpatient areas that reinforced best practices of scanning medications or vaccinations upon administration at the bedside. Errors of wrong medication and vaccination being administered to patients in the outpatient setting were identified through reporting from the medication safety committee when orders did not match medication administration documentation. A new EHR implementation prompted ambulatory care services to request barcode medication scanning technology for all ambulatory care clinics to facilitate safe patient medication administration.

Methods: Barcode medication administration was implemented in all 26 outpatient clinics in an academic institution to facilitate medication safety practices and reach 95% compliance congruent with LeapFrog standards of success. Monitoring and tracking the utilization of barcode medication scanning upon implementation identified that there were systemic issues with nursing knowledge in utilization of the technology, the importance for safe patient medication administration practices, and importance of adherence to identified workflows. Pre-data showed that medications were only being scanned approximately 35% of the time and immunizations 65% of the time. This led to a project manager being assigned to improve nursing practice in medication administration which adheres to prevention of errors and safe administration of medications to patients through utilization of barcode scanning.

Analysis: Post-evaluation of baseline metrics, a re-competency program for all existing nursing staff was developed to include skills return demonstration, problem-solving strategies on equipment, processes for reporting equipment, medications that do not scan, or workflow impediments. This education was integrated into the new-hire orientation for all oncoming staff. Identification of barriers and gaps led to process improvement changes and communication to nursing staff that did not adhere to workflows. Monthly metrics were presented to ensure constant feedback. Ongoing issues were discussed in a governance structure with pharmacy and nursing operations to create sustainability in the project.

Outcomes: Ambulatory care nurses have achieved and maintained compliance >95% for medication and vaccination administration from August 2021 to March 2023. Medication administration safety practices are adhered in the outpatient setting and continue to improve the patient experience and safety in a fast-paced environment.