Nursefriendly.com: medication administration

Thursday, January 13, 2011

CMS 30-minute rule for drug administration needs revision, ISMP.org

In our June 17, 2010 newsletter, we covered a precarious topic best known as the “30-minute rule”—a requirement in the Centers for Medicare & Medicaid Services (CMS) Conditions of Participation Interpretive Guidelines to administer scheduled medications within 30 minutes before or after the scheduled time (see pages 174-175 at: www.cms.gov/manuals/Downloads/som107ap_a_hospitals.pdf). In our July 2010 nursing newsletter, Nurse Advise-ERR, we asked frontline nurses who are most directly affected by the 30-minute rule to weigh in on the issue by completing a short survey. And WOW, did they ever! More than 17,500 nurses responded to our survey, providing more than 8,000 additional comments (see Table 1 on page 2 of the PDF version of the newsletter), making it very clear that the issue is of great significance to nurses.
Respondent profile and compliance rates
Almost half of the responding nurses work on medical/surgical units, and the other half work in critical care, telemetry, or specialty inpatient units. Most nurses feel that the 30-minute rule is unsafe, unrealistic, impractical, and virtually impossible to follow. Approximately three out of four respondents (70%) told us their organization enforces such a policy. Of these nurses, only five of every 100 (5%) were always able to comply with the policy, while more than half (59%) were infrequently or only sometimes compliant (see Graph 1 on page 6 of the PDF version of the newsletter). Why nurses find it difficult to comply with the 30-minute rule was expressed by many (see Table 2 on page 3 of the PDF version of the newsletter), including a nurse who sent a pragmatic yet eloquent account of a Day in the Life of a Nurse (see Sidebar that follows this article).

via ismp.org

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Wednesday, November 17, 2010

Children's Hospital launches 'zero errors' initiative

Reeling from the deaths of two children due to medication errors, the staff of Seattle Children's Hospital devoted Saturday to special training designed to prevent a recurrence of the tragedies.

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"It's so very important that we never forget that we harmed these children," said Pat Hagan, president of Children's Hospital. "We were all devastated by this when it happened. It struck us at our core."

Hagan said the patient deaths have been a "great, great tragedy for these families," and "a profound tragedy" for the hospital staff.

"We never want to forget how this feels. That feeling is going to be what drives us to continue to find ways to improve what we do here," he said.

Over 550 doctors, nurses, pharmacists and other staff members gathered at Children's for a special Patient Safety Day to address the medication errors that caused two deaths over the past 18 months.

More than 28 patient safety sessions were held, including 11 devoted to medication safety.

But first, participants gathered together in the morning to remember the two small patients who died.

"How we emerge from this situation today and over the coming months will be the real test of us as an organization," said Thomas Hansen, the hospital's CEO. "As I look around this room, I'm confident that we have the best and brightest people to rise to this challenge."

He told the staff "we must strive for zero errors, this must be our promise."

The day's sessions included topics such as decreasing verbal orders and increasing the safety of verbal orders when they are necessary, standardizing medications located on care units, ordering, dispensing and administration of high-risk medications, interruptions, provider-to-provider hand-offs and communication, ambulance transport and patient safety training using simulation.

Hospital spokesperson Louise Maxwell said Children's also is fully cooperating with state investigations of the recent medication errors and has made a number of improvements to decrease the chance of errors.

The hospital has also initiated a re-evaluation of the entire medication delivery system and launched a detailed analysis to determine why usual safety processes failed in each of the medication error cases.

Hospital officals said Saturday's special training did not affect care for patients or others needing urgent or emergency services.