“The Stash”: Contributing to a culture of quality and medication safety on            inpatient units    Melanie Rydings, ...
Our Purpose• To explore the use of unauthorized medication  collections (UMCs) on the Medical/Surgical  floors of our comm...
The Problem1. Culture of “stashing” medications on inpatient units poses   patient safety issues2. May lead to drug divers...
Methodology1) Study investigators: (Pharmacy, Professional Practice and Nursing)   conducted a thorough search and collect...
THE STASH!             5
ProjectResults at RH  Reporting included per unit:         oNumber of unique products         oTotal # of medication items...
Number of Medications       by Unit                        7
High Alert and EasilyConfused Medications by Unit                           8
Value of Medications by Unit                 Total Number ofInpatient Unit                     Mean Value   Total Value   ...
High Alert Medications by Unit                 Total Number of    Number of High     % of TotalInpatient Unit             ...
Easily Confused Medications by             Unit                 Total Number of   Number of Easily   % of TotalInpatient U...
Number of Products by Unit                 Total Number    High Alert    Easily ConfusedInpatient Unit                  of...
In SummaryStashes contained:•   Minimal Expired Medications or improperly stored meds.•   High Alert and Easily Confused M...
Focus Groups•   Focus Groups on each of the 5 were conducted by the study investigators. These    groups were focused on e...
Focus Group          Recommendations:• Review the selection of ward stock in the Omnicell and  Nightcupboard to reflect sp...
Action Plans•   Ongoing evaluation plan to monitor the presence of UMCs on the    units.•   Working with pharmacy staff to...
Questions?             17
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E2 Melanie Rydings - “The Stash”: Contributing to a Culture of Quality and Medication Safety on Inpatient Units

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E2 Melanie Rydings - “The Stash”: Contributing to a Culture of Quality and Medication Safety on Inpatient Units

  1. 1. “The Stash”: Contributing to a culture of quality and medication safety on inpatient units Melanie Rydings, Clinical Nurse Educator, 2 South, Richmond Hospital Monica Redekopp, Director, Professional Practice, Richmond Nadine Lambert, Pharmacist, Richmond 1
  2. 2. Our Purpose• To explore the use of unauthorized medication collections (UMCs) on the Medical/Surgical floors of our community hospital.• To develop and implement collaborative action plans to eliminate these collections. 2
  3. 3. The Problem1. Culture of “stashing” medications on inpatient units poses patient safety issues2. May lead to drug diversions by staff3. Adverse drug events related collections may contain: – High Alert Medications* – Easily Confused Medications* – Expired, Recalled Medication – Improperly Stored Medications *as per ISMP 3
  4. 4. Methodology1) Study investigators: (Pharmacy, Professional Practice and Nursing) conducted a thorough search and collection of medications found outside the automated dispensing system (Omnicell) on 5 inpatient units on the same day.2) Analyzed collections and conducted Focus Groups of staff nurses on each unit to share data. Results were reviewed with these groups to determine reasons behind “stashing” culture and to develop action plans to eliminate UMCs. 4
  5. 5. THE STASH! 5
  6. 6. ProjectResults at RH Reporting included per unit: oNumber of unique products oTotal # of medication items oTotal # of different products oTotal dollar amount All medications collected were categorized per unit as: oHigh Alert* oEasily confused* oExpired oImproperly stored oControlled Substances *as per ISMP 6
  7. 7. Number of Medications by Unit 7
  8. 8. High Alert and EasilyConfused Medications by Unit 8
  9. 9. Value of Medications by Unit Total Number ofInpatient Unit Mean Value Total Value Medications Unit 1 617 $1.05 $671.45 Unit 2 247 $1.39 $342.45 Unit 3 28 $1.74 $48.58 Unit 4 44 $0.56 $24.59 Unit 5 84 $1.69 $142.10 TOTAL 1020 $1229.17
  10. 10. High Alert Medications by Unit Total Number of Number of High % of TotalInpatient Unit Medications Alert Medications Number Unit 1 617 48 8% Unit 2 247 16 6% Unit 3 28 5 18% Unit 4 44 1 2% Unit 5 84 6 7% TOTAL 1020 76 7%
  11. 11. Easily Confused Medications by Unit Total Number of Number of Easily % of TotalInpatient Unit Medications Confused Meds Number Unit 1 617 239 39% Unit 2 247 74 30% Unit 3 28 2 7% Unit 4 44 16 36% Unit 5 84 27 32% TOTAL 1020 348 34%
  12. 12. Number of Products by Unit Total Number High Alert Easily ConfusedInpatient Unit of Products Number % Number % Unit 1 127 8 6.3% 41 32.3% Unit 2 70 4 5.7% 17 24.3% Unit 3 10 3 30.0% 1 10.0% Unit 4 13 1 7.7% 3 23.1% Unit 5 33 4 12.1% 12 36.4% TOTAL 253 20 7.9% 74 29.2%
  13. 13. In SummaryStashes contained:• Minimal Expired Medications or improperly stored meds.• High Alert and Easily Confused Medications• Easily Confused Medications accounted for 1/3 of all medications• Multiple different products. No real themes emerged for any unit. Wide variety of medications point toward a culture of “stashing”.• 1 unit was significantly more represented in the data. Reasons for this include: o High turnover of patients o Highly variable patient population 13
  14. 14. Focus Groups• Focus Groups on each of the 5 were conducted by the study investigators. These groups were focused on eliciting reasons for the existence of UMCs and feedback as to the contributing factors. Common themes included: o Availability of medications after pharmacy closes (@ 2000) o Pharmacy verification before able to access medications. o Takes too long to wait for the night cupboard medications (i.e. porter delays, no nursing access at this time). o Medications not transferred with patients from ED, other units. o Not enough doses of certain medications in the night cupboard. o Process of returning medications via Omnicell is onerous and not well understood. o Selection of medications in the dispensing machines (Omnicell’s) may not meet unit needs (i.e. cardiac meds). o General overall belief that medications should be kept “just in case”. 14
  15. 15. Focus Group Recommendations:• Review the selection of ward stock in the Omnicell and Nightcupboard to reflect specific unit needs.• Additional Omnicell units to increase supply of medications available.• Medications transferred with pt from ED, other units.• More awareness of UMC risk to patient safety (i.e. safety huddles)• *Staff expressed appreciation about being “asked and listened to”.• Staff were surprised at the results! 15
  16. 16. Action Plans• Ongoing evaluation plan to monitor the presence of UMCs on the units.• Working with pharmacy staff to review “workarounds” & explore possible solutions (ward stock review, nightcupboard access)• ED: Nurse-to-Nurse Handover report to address transfer of medications to inpatient unit.• Education for staff regarding the implications of UMCs (i.e. Safety Huddles)• Monitoring of adverse patient events involving UMCs (Med Safety Committee)• Development of a formal reporting system to clinical staff and leadership. 16
  17. 17. Questions? 17

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