Study Definitively Links Nursing "Best Practices" to Medication Administration
Accuracy
Program Establishes Important Leadership Role for Front-Line Clinicians In
Improving Healthcare Quality
SAN FRANCISCO--(Business Wire)--
A 36-month demonstration program at the University of California San Francisco
(UCSF) reported this week an 87.7% reduction in medication administration errors
- increasing medication administration accuracy to 98% at six Bay Area
hospitals. An expanded cohort of 54 units in 9 hospitals showed similar results
over the course of 13 months, from September 2008 to October 2009.
According to the study, the increase in accuracy can be linked directly to
better adherence to six "best practice" procedures for medication administration
identified by CalNOC (the California Nursing Outcomes Coalition). Participating
hospitals showed an 80.5% improvement in adherence to CALNOC best practices.
Combined improvement - for administration accuracy and adherence to best
practices - was 81.4% for the study group. These results confirm earlier results
announced at the program`s 18-month halfway point in February 2008.
"These results prove beyond any doubt that front-line clinicians are
instrumental to improving the quality, safety and efficiency of American
healthcare," said Ed O`Neil, Director of UCSF`s Center for the Health
Professions. "Front-line clinical workers have to be seen as a management
resource, not a cost center. These are experienced essential personnel, who can
identify problems, drive change, and deliver results."
The clinical improvement model was developed and supervised by the Integrated
Nurse Leadership Program (INLP), one of the core research and professional
development programs of UCSF`s Center for the Health Professions.
"Achieving higher quality with lower costs requires investing in people, not
just technology and facilities," said INLP Director, Julie Kliger. "Policymakers
and healthcare institutions need to recognize front-line clinicians as a
tremendous but under-utilized resource that can make a huge difference in
patient care. They have the greatest understanding of recurrent quality issues,
so they are best equipped to lead improvement initiatives. And our research
shows that they can deliver impressive results, when equipped with the right
skills, authority, and executive support."
The preliminary data were released today at an INLP graduation ceremony honoring
284 clinical participants from nine hospitals. The final data results [Kaiser
Permanente Fremont, Kaiser Permanente Hayward, San Francisco General Hospital,
Sequoia Hospital, St. Rose Hospital, and Stanford Medical Center] will be
published next month in the December 2009 issue of The Joint Commission Journal
on Quality and Patient Safety. The INLP`s 36-month program ran from September
2006 to September 2009 and trained front-line clinicians (primarily nurses) to
take a leadership role in developing new clinical protocols, reporting tools and
metrics, and administrative procedures - all focused on medication
administration safety and accuracy.
At every institution in the study group, the initiatives led by INLP
participants resulted in quantifiable improvements in care. Study results also
indicate similar, significant improvements in accuracy when INLP procedures were
extended from a single pilot unit into other medical units within the same
institution. (Data Fact Sheet link.)
"The evidence tells us that the INLP improvement model can be applied across a
broad spectrum of clinical issues and settings," said Kliger. "We would even
argue that the only way to achieve sustainable improvements in our healthcare
system, in general, is to give a leadership role to clinicians on the front
lines."
With a new round of multi-million dollar funding from the Palo Alto-based Gordon
and Betty Moore Foundation (nearly $7 million in May 2008), the INLP has
expanded its research initiative to include other clinical indicators, such as
reducing sepsis through early intervention.
"We are so impressed with the improvements of all the INLP teams and want to
congratulate all of the participants," said George W. Bo-Linn, MD, Chief Program
Officer at the Gordon and Betty Moore Foundation. "We also want to offer
congratulations to the hospitals that invested in their staff to deliver better
and safer patient care, and to UCSF for successfully designing and leading this
improvement effort."
Medication error results in approximately 400,000 preventable drug-related
injuries in hospitals and at least $3.5 billion in extra medical costs annually,
according to the Institute of Medicine, which is part of the National Academies.
The mean "observed" medication accuracy rate for participating institutions
showed continual improvement throughout the study period: from a baseline of
83.8% at the start of the program, to 93% after 18 months, to 98% after 36
months. "Observed" accuracy is the strictest assessment of medication
administration, and 80% is a typical rate for hospitals nationwide, according to
Advances in Patient Safety & Quality-An Evidence-based Handbook for Nurses, from
the Agency for Healthcare Quality and Research.
INLP participants, in partnership with hospital management, focused on CalNOC
"best practices," and this is the first to validate that adherence to the six
process steps delivers significant and measurable improvements in medication
administration accuracy. Adherence to best practices increased from a baseline
of 79.5% at the start of the program, to 95.6% after 18 months, and held steady
at 96% after 36 months.
* Integrated Nurse Leadership Program link.
* Center for the Health Professions link.
* Gordon and Betty Moore Foundation link.
Participating hospitals: Kaiser Permanente (Fremont), Kaiser Permanente
(Hayward), Contra Costa County Medical Center, San Francisco General Hospital,
St. Rose Hospital (Hayward), Stanford University Hospital and Clinics (Palo
Alto), San Mateo Medical Center, UCSF Medical Center, and Sequoia Hospital
(Redwood City). (The INLP initiative is not affiliated with the current IHI
initiative addressing medication reconciliation.)
Integrated Nurse Leadership Program
Julie Kliger, 510-551-3330
or
UCSF Center for Health Professions
Ed O`Neil, 415-476-9486
or
INLP Program Manager
Gina Baleria, 415-370-8945
Copyright Business Wire 2009
