Authors (including presenting author) :
Lee CS(1)
Affiliation :
(1) Orthopaedics and Traumatology, Caritas Medical Centre
Introduction :
Nurses must comply five rights to ensure medication safety. Leaving topical medications at bedside is contrary to the concept of safety culture and it might induce incidents of wrong patient, wrong drug and/or wrong dosage which can be preventable. Several silent surveys with 80 drug administration episodes were conducted in Orthopaedic department in May 2019, 33.3% of which were observed with patient inhalers, ointment/cream, eye/ear/nasal drops being left unattended at bedside. Nurses expressed the difficulties in complying proper storage of topical medications in drug trolley included (1) not enough space in patient own drug drawer; (2) infection control consideration; (3) patient insisted to keep bring-in medication at bedside.
Objectives :
1. To establish a safe culture in medication safety. 2. To align practice in four orthopaedic wards. 3. To prevent medication incidents due to improper storage of medication(s). 4. To maintain high quality nursing care.
Methodology :
An improvement project on “Safe Management of the Prescribed Topical Medications” was implemented in June 2019 to change the nurse behavior and to enhance the system for safe management of topical medications. The actions included: 1. Formulation of a flowchart 2. Redesign of medication trolleys to facilitate proper storage of topical medications 3. Preparation of alcohol wipes to cleanse the after-use topical medication(s) 4. Education on patient with reinforcement on risks of medication incident if patient insisted in keeping medication(s) 5. An individual 15 minutes briefing session was conducted in each ward by workgroup members 6. An audit was performed from 15 to 22 July 2019 and after 20:30 medication round daily to assess effectiveness 7. All patients with topical medication(s) being prescribed in IPMOE were included 8. Patient own drawer or designated drawer of the drug trolley and patient bedside were checked for topical medication(s) 9. Patient IPD was reviewed for documentation if patients insisted in keeping medication(s)
Result & Outcome :
In the first week of the implementation of the project, a flowchart with dialogue of “Patient Education” and eight drug trolleys, each with a designated drawer for topical medications, were prepared. The concept of the project was introduced to four wards based on the flowchart. In July 2019, an audit with a total of 250 drug administration episodes was conducted in four wards. The results indicated that (1) the proper storage rate of topical medications was increased by 30.4% (from 66.7% to 97.1%); (2) high usage rate of designated cabinets was noted; (3) nurses had high compliance in the guidelines of the flowchart; (4) nurses had high alertness in proper storage of medications and changed their behaviors to store the topical medications in the designated cabinets of drug trolleys. A safety culture in topical medication administration was established in department.
