Healthcare Delivery Systems Process

Improvement Project:
Medication Administration
❧ ❧
Maddi Eckert, Lena Chesnut, Kevin Olivares, Ali McGee, Arianna
Barragan Johnson

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Overview of Patient Care Delivery System

❧ Southern Arizona VA Health Care System

❧ Cardiovascular Telemetry Unit (3 North)

❧ Focus: Process improvement related to

medication administration

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Microsystem Model:
Leadership

❧ Transformational Leadership: “Treat people with

care and compassion, encourage followers to be
more creative and innovative, and inspire others
with their vision.”
o Leader shares information and discusses values to
achieve a shared goal
o Leader collaborates with the team on their decisions
with others
o Improves team member self-esteem through
empowerment
Marquis, B.L. & Huston, C.J. (2017). Leadership roles and management functions in nursing: Theory and
application (9th ed. pp. 50-51). Lippincott Williams and Wilkins. ISBN Number: 13: 978-1-4511-9281-0.
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Microsystem Model:
Organizational Culture and Support

❧ VA Vision: “To provide veterans the... highest standards

of compassion, commitment, excellence,
professionalism, integrity, accountability, and
stewardship.”

❧ Leadership support: nurse manager, clinical nurse

leader, charge nurse

❧ Huddle at beginning of shift

o Addresses patient acuity, patient safety, and quality
improvement

❧ Rapid Response Team

US Department of Veterans Affairs, & Veterans Health Administration. (2018). About the Southern Arizona VA Health 4
Care System. Retrieved from https://www.tucson.va.gov/about/index.asp
 Microsystem Model:
Patient Focus & Staff Focus

❧ Patient-centered care: “... Care should be organized first

and foremost around the needs of the patient.”
o Integrative nursing principles, holistic care, and
continuity of care

❧ Staff Focus: “Selective hiring of the right kind of people,

integrating new staff into culture and work roles.
Expectations of staff are high regarding performance,
continuing education, professional growth, and
networking.”
o Continuing education, advancement opportunities, and
self-care activities
Marquis, B.L. & Huston, C.J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed. pp. 364-365). Lippincott

5
Williams and Wilkins. ISBN Number: 13: 978-1-4511-9281-0.
Nelson, E. C., Batalden, P. B., Hubert, T. P., Mohr, J. J., Godfrey, M. M., Headrick, L. A., & Wasson, J. H. (2002). Microsystems in health care: Part 1.
Learning from high-performing front-line clinical units. Joint Commission Journal on Quality Improvement, 28(9), 472-493.
Microsystem Model:
Interdependence of Care Team

❧ Interdependence of Care Team: “The interaction

of staff is characterized by trust, collaboration,
willingness to help each other, appreciation of
complementary roles, and a recognition that all
contribute individually to a shared purpose.”
o Pharmacist on the unit
o Case management
o Providers
o Other disciplines

Nelson, E. C., Batalden, P. B., Hubert, T. P., Mohr, J. J., Godfrey, M. M., Headrick, L. A., & Wasson, J. H. (2002).
Microsystems in health care: Part 1. Learning from high-performing front-line clinical units. Joint Commission Journal on
Quality Improvement, 28(9), 472-493.
6
Microsystem Model:
Use of Information and Healthcare Technology

❧ Nurses use “information and technology to

communicate, manage knowledge, mitigate error, and
support decision making.”

❧ Electronic Health Record for patient charting and

medication administration
o CPRS and BCMA

❧ Continuous telemetry evaluation

❧ Abundant technology
o Workstation on wheels (WOWs)
o Resources
Marquis, B.L. & Huston, C.J. (2017). Leadership roles and management functions in nursing: Theory and application 7
(9th ed. p. xix). Lippincott Williams and Wilkins. ISBN Number: 13: 978-1-4511-9281-0.
Microsystem Model:
Process for Healthcare Delivery Improvement

❧ Healthcare quality: “The degree to which health

services for individuals and populations increase
the likelihood of desired health outcomes and
are consistent with current professional
knowledge.”
o Benchmarking
o Staff evaluation
o Quality Improvement Projects

Marquis, B.L. & Huston, C.J. (2017). Leadership roles and management functions in nursing: Theory and application
(9th ed. p. 612-614). Lippincott Williams and Wilkins. ISBN Number: 13: 978-1-4511-9281-0.
8
Microsystem Model:
Staff Performance Patterns

❧ Performance Appraisal: review process that

discusses job performance and expectations of
the organization to improve patient care, safety,
and outcomes

❧ Appropriate Staff Ratios

❧ New protocol education

❧ Policy availability
Marquis, B.L. & Huston, C.J. (2017). Leadership roles and management functions in nursing: Theory and
application (9th ed. p. 647-649). Lippincott Williams and Wilkins. ISBN Number: 13: 978-1-4511-9281-0. 9
Specific Aspect Targeted for Improvement

❧ Unorganized medication dispensary access points

❧ Evidence-based Journal: Effect of automated drug
distribution systems on medication error rates in a short-
stay geriatric unit
o Conclusion: Utilize Pyxis instead of WOW to prevent
medication errors
❧ Improvements resulting from study
o Patient safety
o Ensures correct dosing
o Prevents sound-alike medication confusion

Cousein, E., Mareville, J., Lerooy, A., Caillau, A., Labreuche, J., Dambre, D., Odou, P., Bonte, J., Puisieux, F., Decaudin, B., & Coupé,
P. (2014). Effect of automated drug distribution systems on medication error rates in a short-stay geriatric unit. Journal of Evaluation in
Clinical Practice, 20(5), 678-684. doi:10.1111/jep.12202 10
 Leading the Plan for Healthcare Delivery
Improvement
❧ Medication errors still prevalent
❧ Motivation to learn: educate staff about how this will
improve patient safety so it motivates them to implement
Pyxis use for medication distribution
o Presented as an in-service on the unit
❧ Timeline of Events
1 month 3-4 5-6 9-12 >1 year
months months months

Root- Research Educate Implement Evaluation of

Cause and gather staff on change on change on the
analysis evidence procedure the unit unit
change
Marquis, B.L. & Huston, C.J. (2017). Leadership roles and management functions in nursing: Theory and
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application (9th ed. p. 415-416). Lippincott Williams and Wilkins. ISBN Number: 13: 978-1-4511-9281-0.
References

❧ Cousein, E., Mareville, J., Lerooy, A., Caillau, A., Labreuche, J., Dambre,
D., Odou, P., Bonte, J., Puisieux, F., Decaudin, B., & Coupé, P. (2014).
Effect of automated drug distribution systems on medication error rates in a
short-stay geriatric unit. Journal of Evaluation in Clinical Practice, 20(5),
678-684. doi:10.1111/jep.12202
❧ Marquis, B.L. & Huston, C.J. (2017). Leadership roles and management
functions in nursing: Theory and application (9th Edition). Lippincott
Williams and Wilkins. ISBN Number: 13: 978-1-4511-9281-0.
❧ Nelson, E. C., Batalden, P. B., Hubert, T. P., Mohr, J. J., Godfrey, M. M.,
Headrick, L. A., & Wasson, J. H. (2002). Microsystems in health care: Part
1. Learning from high-performing front-line clinical units. Joint Commission
Journal on Quality Improvement, 28(9), 472-493.
❧ US Department of Veterans Affairs, & Veterans Health Administration.
(2018). About the Southern Arizona VA Health Care System. Retrieved from
https://www.tucson.va.gov/about/index.asp

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