Hello, My name is Michelle, today’s presentation will discuss medication errors and how promoting a theory of change can prevent more medication errors on a medical-surgical floor. Common sense seems to dictate that, creating a change model will encourage positive changes in the workplace and patients will benefit from dedicated staff wanting to improve patient outcomes. Today I will focus on an approach and methods that can be used to prevent medication errors and promote correct medication administration. Develop a plan to implement an audit tool to monitor medication administration compliance in a particular patient population in the facility.
A medication error is, “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of a healthcare professional” (Cloete, 2014).The change we are introducing is a dual scanning system. You, the nurse would scan your patient’s identification number once at the medication machine then you would see a list of all the medications ordered for that specific patient, select your meds and scan them. At bedside you verify your patient’s information, then you sign into the computer, scan the patients identifying armband and then scan the medication. Kotter’s Change Theory model will be used to foster this change within the workplace because it focuses on the urgency for change. It also focuses on the vision for change and having affective communication and empowerment for employees to facilitate and implement the steps to positive change (Sullivan, 2018).
The strengths of this system include patient safety. Ultimately what is at stake here is the patient safety, thereby double-checking medications we give as their nurses ensures optimal care provided. As nurses, we advocate for the patient and by learning and adapting to new changes we are steps closer to fulfilling these obligations. However, nurses are multitaskers, and our concentration can become divided increasing room for error to occur. For instance, while pulling medications from the omnicell, a co-nurse is clarifying a dosage calculation, or a code blue or RRT announced overhead. That being said any reduction in potential error is necessary for the protection of patients. Incidentally, this includes setting up courses for the nursing staff to take and it will apply to continue education. By creating a safer environment for our patients ultimately we will see our HCAPS scores rise. With this dual scanning system, we can track which meds get scanned and which are entered through by each nurse. In short, this tool can keep track of our users as to how well the system is working.
Weakness as with any change there will be resistance noted. This change is currently in effect, and team members need to be made aware. This is the best thing for our patients. If there is noncompliance to change, those parties will be given an opportunity to express their concerns and be provided more education or assistance if necessary to facilitate change. With most computer systems you have to manage updates and system crashes. We have IT 24hr a day for this reasons. Unfortunately, discrepancies may happen but we can work around that if we need to be working with the pharmacy. There are many opportunities to look forward to, as there will be a compensation bonus for 100% scan rate each quarter, continuing education and becoming a positive educator to new nurses learning the system. Positive attitudes toward this system will benefit you. Threats If there is noncompliance to change, those parties will be given an opportunity to express their concerns and be given more education or assistance if necessary to facilitate change. By implementing this change, this facility would be increasing staff education as well as improving patient safety and satisfaction.
Upon years of research on change within organizations, Dr. John Kotter was able to prove that “70% of all major change efforts in organizations fail” (Construction Financial Management Association, n.d.). He created an 8 step process for organizations to have successful change. The first step is creating urgency by allowing the employees to see the need for change and the urgency to act immediately. Effective leaders inspire their people to make the organization better. The second step is to create a powerful coalition to lead the change. “No one person, no matter how competent, is capable of single-handedly…leading change projects” (Construction Financial Management Association, n.d.). A team of leaders and managers working together, with a level of trust and respect for one another, can make change happen despite the obstacles. Next, is to create a vision for change, to motivate people in the right direction. The vision must be easy to communicate and should be the framework for all the strategies, plans and budgets. Effective visions must be imaginable, desirable, feasible, focused, flexible, and communicable. In addition to, the fourth step is to communicate the vision to all of the staff and strive for them to understand and accept the vision. Communicating the vision takes more than just one email or announcement but instead multiple emails, meetings, and discussions about the vision with the leader leading by example. The vision must be “simple, vivid, repeatable, and invitational” (Construction Financial Management Association, n.d.). Next is to empower others to act by removing any obstacles in their way to the change or that undermine the vision. Sixth is to generate short-term wins because it is essential to identify improvement and reward employees that played a pivotal component to the change. By doing this, it helps keep employees motivated and also shows resistors the improvement in performance due to the change. Seventh is to consolidate changes to prevent regression from the beginning. Continuously produce more change never letting up and keep the vision on the right course.
Kotter’s theory of change model was chosen because it is known to be very useful in the healthcare environment. It is instrumental in creating change because it focuses on every individual apart of an organization and realizes that change is only successful if everyone is supportive of the change. Leaders and motivators can help others to adapt and embrace change which has the highest chance of success. By having a teamwork mentality, there are so many methods of education that can be used to help the organization. It also allows everyone to uphold one another other for accountability and by surrounding oneself with influential people you are brought to a higher level of respect and professionalism. It is always essential in the workplace to surround yourself with positive people, and the Kotter theory fosters that environment. Therefore, patient safety is increased by providing another check and instead of a full list of every medication in the Omni cell once you scan your patients’ medical record number you only see their meds. By increasing patient safety we reduce our risk factor for creating that error.
The first method of communication emails to present the upcoming change and to allow staff to begin to process this new information. Meetings would then be had to discuss the upcoming change and share the vision of the organization. It would also include a presentation that is both simple yet effective. An opportunity would also be given for staff to ask questions or express their thoughts or concerns. Required education would then be given to focus on the new vision and would outline the basis for the change. It will give an opportunity to show the benefits of this change including patient safety and satisfaction. It would also help nurses and doctors by allowing for accurate medication prescriptions to be given if the doctor places the order himself. After the staff understands the importance, they will then be educated on the steps and methods required of them to achieve this vision.
The contingency approach allows for leadership styles to change and adapt concerning the changing situations. As leaders, this would be a practical approach since the goal is to create change within the organization. The transformational leadership style focuses on the importance of interpersonal relationships. The concern is of creating lasting and effective change within the organization. This leadership style best suits Kotter’s Change Theory because it focuses on creating lasting impact within an organization. Transformational leadership focuses on “merging the motives, desires, values, and goals of leaders and followers into a common cause” (Sullivan, 2018). “Transformational leadership in nursing has been associated with high-performing teams and improved patient care” (Fischer, 2016).
Planning: includes a 4 stage process; 1. establish goals 2. evaluate present situation and predict future goals and events 3. formulate a planning statement 4. convert the plan into action(Sullivan, E., p. 46)Planning is imperative for the organization as a whole down to the individual employee. Preparing everyone for the change that is going to take place. Important questions Directing addressed that most will have like, what, why, where, when, how and by whom all? Budgets, staffing, and the organizational structure are all taken into play as well. -Organizing: “organizing is the process of coordinating the work to be done (Sullivan, E., p. 46). Includes establishing who will do what work, dividing the workload, assigning authority and a chain of command for everyone to follow. -Directing: “Directing is the process of getting the organization’s work done” (Sullivan, E., p. 47). Directing includes the manager delegating tasks, communication skills, proposing the change theory. The manager would also coach along the way. -Controlling: “Controlling involves comparing actual results with projected results” (Sullivan, E., p. 47).Controlling includes establishing the standard of care, and the performance of the employees, in a measurable format, comparing the 2 and providing feedback.
The manager would encourage staff to each set aside some time and allow team leader to follow them in there medication pass, so this way they can work together as collectively to iron out any problems they may be having. Open communication is critical, to make this work. If there is an adjustment that we need to make we want to know.
Budgeting is an important process that helps control an organization and ensures that “resources needed to achieve objectives are available at the appropriate time” (Sullivan, 2018, p. 226).The staffing budget must first be reviewed for implementing change. The number of labor hours needed for educating the new staff as well as maintaining the staffing needs of the unit during this time should be considered when creating a budget (Sullivan, 2018).The capital budget should also be assessed because it is used to meet long-term goals. Ensuring safe medication administration and preventing errors is a long-term goal for an organization. Decisions would have to be made on how much to allocate for improved technology and software to audit medication inventory, prescriptions, and administration. The nurse manager plays a role in prioritization and must decide what is most important for their unit (Sullivan, 2018).
This change process is extremely cost effective. Low budget due to the fact that we will need less that 15 new scanners and the Omni program that needs to be installed to connect to the computers will be completed in a week.
1. Communicate often.
Communicate throughout the planning and implementation of the changes through email, staff meetings, or flyers
Describe the benefits that will occur because of the change
Explain correctly the how the changes will influence each person
Prepare everyone for the change
2. Drive out rumors
Rumors cause scare
Answer questions willingly and honestly
Deal with problems that arise during the change process instantly
Relate the need for change back to working requirements and the benefits the organization will acquire
3. Opportunity for involvement
Empower action from the employees by making them feel at ease and positive about the change
Provide lots of opportunity and a variety of ways to be involved that’s accommodates everyone
Have floor managers provide day-to-day direction in daily huddles so that everyone is on the same page
Evaluate effectiveness :
Make sure each step throughout the process is monitored. Make sure that the results are measurable both in financial and qualitatively so that success and failure can be measured accordingly. Identify undesired outcomes and a means to fix them.
Stabilize the change : Develop ways to sustain the change; integrate it into the culture, guarantee an operational feedback system. Ensure management is adequate and effective. Continue to support and provide training and education as needed.
The modules are connected to our computer systems, and they can indicate whether or not the medication was actually scanned or entered into the system manually. In doing this, we can see how well the staff is and if they are appropriately using the machine. The staff meeting will let us know if there are adjustments to be made.
Effective: Lewin’s force field model of change is straight to the point and very easy to understand. I think it works for such a large unit of people. It clearly shows the restraining roles and driving forces of an organization. Therefore it is easily spotted on what needs to be worked on, eliminated, and changed.
Ineffective: The lack of detail in the model as compared to some of the other ones. I felt that the more detailed models are adequate for smaller organizations. In the future, I feel I would still use the Lewin’s Model, but I would customize it to fit my unit exactly.