Abstract
In today’s modern society, patient safety in the hospital setting has evolved to a number one priority. Medication errors account for a great deal of incidents in hospitals. Practicing healthcare professionals must be competent when administering medications; therefore, The Joint Commission has implemented National Patient Safety Goals to prevent patients from being administered the wrong medication. Also, the National Patient Safety Goals holds the practicing healthcare professional accountable for the medications that are given to patients. We intend to explore the similarities and differences in how Florida Hospital Zephyrhills and Edward White Hospital accomplishes the National Patient Safety Goal of Medication Safety and Reconciliation.

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Medication Safety/Reconciliation
The Joint Commission is an organization that accredits and certifies more than twenty- thousand health care organizations and programs in the United States. Their mission is to continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value .(“ About the Joint Commission,” 2013) The Joint Commission established its National Patient Safety Goals in 2002 and they were first implemented January 1, 2003 (“ Facts about the National patient safety goals,” 2013). National Patient Safety Goals are used as a map for healthcare organizations to hold themselves to a higher standard of care. In fact, National Patient Safety Goal #3 can be divided into three sections: 03.04.01 which states that all medications should be labeled, 03.05.01 which states to take extra care of patients who are on blood thinners, and 03.06.01 which states guidelines for medication reconciliation (National Patient Safety Goals).

The standard of care is surveyed by the patients of their particular healthcare organization. The Hospital Consumer Assessment of Healthcare Providers & Systems is a survey that determines the quality of care patients receive in a particular healthcare setting and it helps in determining if organizations are complying with JACHO’s National Patient Safety Goals. Hospitals consider a JACHO accreditation a great achievement. According to a Medicare website, (www.medicare.gov/hospitalcompare) that compares hospital care nationally; the state of Florida averagesabout 63% when it comes to explaining the medications before administering to the patient, Florida Hospital Zephyrhills averages 56%, and Edward White Hospital averages 55%.

Page 2 Medication Safety Paper Essay

Florida Hospital Zephyrhills and Edward White Hospital are accredited by JACHO; as a matter of fact, they have the following similarities in their approachof accomplishing medication safety and reconciliation, by implementing: the bar code system, patient education, and twenty-four hour medication reconciliation.

Bar code System
The purpose of the bar code system is to impact patient safety by reducing medication errors that occur at the time of medication administration. The proper name for this system is Bar Coded Medication Administration (BCMA). JACHO set medication management standards and national patient safety goals that pushed the BCMA in effect in the year of 2007 ( Foote &Coleman, 2008). This system was pushed because an estimated 1.5 million Americans were being injured every year from medication errors (Foote &Coleman, 2008). According to section 03.04.01 of the national patient safety goal number three (Medication Safety), all medications must have the proper patient label.

The BCMA is an evidenced based system that validates the six patient rights of medication administration (right patient, medication, route, time, dose, and documentation/education). The BCMA application is linked to an electronic power-chart; therefore, when the wrist-band of a patient is scanned the patient’s information will populate onto the computer and the nurse can then scan the medications to be administered. If the medications are not due at that time or if the medication is contraindicated at that time the computer will generate an alert. Florida Hospital Zephyrhills and Edward White Hospital have adopted the BCMA technology and as a result, they have significantly improved their scores and fewer patients are complaining of errors; therefore, scores have increased. Patient Education

Patient education is an intricate part of promoting medication safety. Healthcare providers are faced with barriers when it comes to explaining the importance and proper usage of medications. Section 03.05.01 of the National Patient Safety Goal #3 states that patients who are taking blood thinners should be monitored. According to Cranwell, “patients need to be instructed in potential drug interactions, dietary interactions such as vitamin K-rich foods, safety with herbal therapy, the need to watch for signs and symptoms of bleeding” (Cranwell, 2007).

Florida Hospital Zephyrhills and Edward White Hospital are taking the educational approach to promote patient safety in regards to coagulation Therapy. The pharmacy department at Florida Hospital created a brochure that is handed out on every floor to staff members who have patients that are on coagulation therapy. The brochure is titled (Coumadin Warfarin Medications and Your Diet). The information inside of the brochure gives the patient a list of medications to avoid, defines Coumadin, and explains vitamin K, food sources of vitamin K, lab work suggestions, and herbal products to avoid. Edward White Hospital has developed a program for their stroke patients titled “The Teachable Moment”.

The Teachable Moment is the period of time soon after a patient has had a stroke. Studies have shown that post stroke patients are more prone to listen and follow their healthcare provider’s treatment plan. The healthcare providers take every opportunity to implement the aggressive therapy of medications like anti-thrombotics, anti-coagulation, DVT prophylaxis and they do this by communicating with the patient at the bed-side and at the time of discharge. Also, the patients are discharged with pertinent information about the blood conditions previously stated ( Edward White Hospital Abut Us, 2013).

Medication Reconciliation
Medication reconciliation is to obtain a list of medications that the patient is currently taking and compare it to the new medications that the doctor has prescribed. The nurse is responsible for inputting every medication into the patient’s electronic chart. After the medications are documented, the physician can determine which medications the patient should continue, decrease, increase, or discontinue while they are in the hospital and when they get discharged. Medication Reconciliation can be found under Safety Goal #3 in section 03.06.01 of the National Patient Safety Goals. According to the Safety Goals, healthcare professionals are responsible keeping their patients updated on their medications.

The process of medication reconciliation is crucial in reducing medication errors and it involves all disciplines of the patient’s healthcare team ( Ripley & Vieira, 2013). A recent study was done at Trinity Health Care Center from 2010-2012 and the results were astonishing, (overall increase of17% in electronic medication reconciliation) (Ripley & Vieira, 2013). Although, medication reconciliation is a continuous process, Florida Hospital and Edward White Hospital strive to establish a medication history of all their patients within the first twenty-four hours of admission. If the patient is not conscious, then both facilities are active in obtaining information from their family members or care-givers. Quite often, patients are admitted through the Emergency Room and the base-line of their medication list is documented at that time. When the patient comes to the floor, the nurse investigates, and makes additional changes to the medication record. Nursing Considerations

“Since 1999 when the Institute of Medicine reported that approximately 7000 deaths occurred annually as a direct result of medication errors, health care professionals have been identifying and implementing interventions to improve medication safety”(Miller, 2003). Medication safety is very important and the entire healthcare team is responsible for ensuring the patient’s safety. The major role of the nurse in promoting medication safety is to follow all protocols and safety measures such as utilizing the six rights of medication administration: right drug, time, route, patient, dose and documentation.

The nurse should always check the medication order against the MAR before pulling the medication. After checking the medication, she should check the drugs with the patient’s chart and then the patient’s chart to the patient’s wrist band. Also, to promote medication safety the nurse should tell the patient the name of the medication, why they are receiving the medication, and possible side effects of the medication. In addition to the nursing considerations previously stated; it is very important in the hospital setting to listen to your patient.

They may tell you that the medication you are about to give them is not their usual medication, and they may be right. If there is a question with any order the nurse is responsible for asking the physician to clarify the order. Another consideration that should be taken account for is the patient’s age. The body function of an older patient verses a younger patient is different; for example, an older patient is more prone to develop medication toxicity because their metabolism is slower. Also, the patient’s mental status and developmental stage should be taken into consideration. The nurse should obtain a full history that includes all medications taken at home, even herbals and OTC drugs because many drugs can interact with each other.

Improvements
There are a few errors in the BCMA system that leaves room for improvement. Barcodes are not working, therefore, medications have to inputted manually into the chart. Suggestions have been made to enlarge the barcodes so that it will be read easier by the scanner. Medication reconciliation is a continuous process that is done quickly, and efficiently as possible at Florida Hospital Zephyrhills and Edward White Hospital; therefore, there are no improvements to be made to this system. On the other hand, Florida hospital pushes nurses to be accountable for their medications when obtaining them from the pyxis. When medications are taken from the pyxis, it asks how many are in the slot where the drug is taken from.

We found that nurses have found a way to by-pass this step (medication counting) by simply hitting that all the medications are there. Falsifying any healthcare information is illegal and all medications in the slot should be counted before they are drawn from the pyxis by the nurse. In the same fashion, some of the nurses at Florida Hospital are pulling all their medications at the beginning of the day and as a result, insulin, syringes, and other medications have been left on top of a workstation on wheels (W.O.W). Whenever drugs are left unattended, anyone could pick them up and the results could be deadly. Medications should be pulled and given to each patient according to the time the medication is due; this will help reduce the possibility of medication errors in the healthcare environment. Medication can be very dangerous; therefore, patient safety should be nurses’ number one priority.

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