Transcript powerpoint - Virginians Improving Patient Care and Safety

Charles A. Cannon, JR.
Memorial Hospital
MAR VERIFICATION BY
PHARMACISTS & NURSES
Spring 2003
History of Hospital and Unit
• Cannon Memorial Hospital
• 2 rural hospitals merged and built a new
facility 3 years ago
• 70 bed acute care facility in the NC
mountains
• 20 bed behavioral health unit with 20 beds
• Unit is predominantly geriatric psych
Pharmacy
• Pyxis dispensing and patient profile system
• Dairyland computer system
• Orders entered both by pharmacists and
pharmacy technicians
• Limited hours
Cannon Memorial Hospital Goals
• Patient Safety
• Patient Satisfaction
• Medication Process Safety
FMEA Topic
Medication Administration
Process
Improvement Opportunities
Identified via FMEA
• Reduce problems relating to medication order transcription
accuracy
 Pharmacist verifies MAR changes by nursing each day
 Pyxis Connect scanning technology improves legibility
 Unacceptable abbreviations list
 Improved method of daily MAR verification by nursing
• Timely review of medication orders by the pharmacist
• Improve medication administration practices
 Medications removed from unit dose package at
bedside
 Medications not charted until administered
Purpose
• The primary purpose of the study was to
decrease MAR discrepancies on the
Behavioral Health Unit by directly
involving pharmacists and nursing in the
MAR verification process.
Statement of the Problem
• New MARs and IS system
• DFS and JCAHO surveys pending
• Air of mystery among pharmacy and
nursing
• Medication errors due to MAR
discrepancies
• Current system of MAR verification often
did not reach pharmacy
Objectives
• Improved documentation
• Increased accuracy of MAR
• Prevention of medication errors related to
incorrect MAR
• Develop team atmosphere between
pharmacy and nursing
• Better understanding between pharmacy
and nursing of each others roles and
challenges
Methods
• Pharmacists go to unit to check MAR each
day.
• Pharmacists pull new orders and compare
them to current MAR.
• Pharmacists look for handwritten correction
by nursing as “triggers” to MAR
discrepancies.
Methods
•
•
•
•
•
MAR verification tool for nursing
Discussed at BHU staff meetings
Education done with nursing on tool
Instructed to use tool every night shift
“Actual discrepancy”-duplication, time, omission,
confusing presentation on MAR due to computer
glitch
Room #
101
MAR Verified By:
Notes:
102A
102B
103
104A
105
106A
106B
107A
107B
108A
108B
109A
109B
110A
110B
111A
111B
112A
112B
Date:_______________________________
Challenges
• Reliance on memory nursing to complete
MAR verification form and fax to pharmacy
• Reliance on memory of pharmacists to
check verification form to make changes
• Length of time that elapses between MAR
printing and the verification form reaching
pharmacy
• Nursing and pharmacy difference of opinion
of what constitutes a MAR discrepancy
Challenges (cont.)
• Pharmacists not using tool to document
their MAR verification
• Occasionally pharmacists unable to do
MAR checks in person due to workload
• Nurses view that “this is just one more form
to fill out and we are busy!”
Results from Nursing Verification
• 35/53 days the MAR verification form was
completed on Behavioral Health Unit for a
completion rate of 60%
• 123 comments were made on the MAR
verification form by nursing.
• 30 comments were deemed by pharmacy as
true MAR discrepancies for a rate of 24%.
MAR Discrepancies By Category
10
5
0
time
order not duplicate computer
scanned order
glitch
Computer Glitches Discovered
• Future order will not show on MAR.
• Order with frequency less than every day
cannot show on MAR without time showing
on MAR as well- cannot do XXXXX on
days not due.
• Hold orders do not show on MAR unless
default to hide hold orders is inactivated.
Interesting Uses of the Tool
• Notified pharmacy when medication was
not loaded on Pyxis, but on patient profile.
• Informed pharmacy when one form of drug
was preferred, such as concentrate instead
of pill form.
• Nurses questioned substitutions they need
more education about.
• Became a “catch all” communication tool
between nursing and pharmacy.
Suggested Changes to the Tool
• Have nurse put date and time completed.
Difficult to determine real date sometimes
due to night shift.
• Have patient initials on form for
pharmacists quick access.
• Have patient account number on form for
retrospective use.
WORK IN PROGRESS
Conclusions
• Pharmacists can document many of their MAR
findings as interventions.
• Difficult to quantify pharmacist impact without paper
documentation.
• Reinforcement with nursing staff is crucial to receiving
forms.
• MAR administration times- nurses and pharmacists
may have to learn to agree to disagree.
• Nursing may need education to clarify what
discrepancies are.
Conclusions (cont.)
• Nursing MAR verification form can easily be used
on other units- quick and specific and nurses
already working with the MARs.
• Difficult to do pharmacist MAR verification on
larger units and couldn’t handle more than one
unit at a time due to workload.
• Even if only one serious error is caught a month,
pharmacists and nurse MAR verification is worth
doing
• The most important discovery was...
Nurses and pharmacists can work and play well together.