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TABLE OF CONTENTS
TITLE PAGE
ABSTRACT…………………………………………………………………………………………………………………………….………….2
INTRODUCTION………………………………………………………………………………………………………………………….……..3
I. PROBLEM IDENTIFICATION
A. List of Problems…………………………………………………………………………………………………………………….4
B. Problem vs Cause…………………………………………………………………………………………………………………...4
C. Controllability………………………………………………………………………………………………………………………5
D. Verification of Existence of the Problem……………………………………………………………………………………….…..5
E. Significance…………………………………………………………………………………………………………………………..6
F. Prioritization………………………………………………………………………………………………………………………....6
G. Operational Definition ………………………..……………………………………………………………………………………7
H. Scope and Limitation………………………………………………………………………………………………………………..7
I. Problem Statement………………………………………………………………………………………………………...…………7
II. UNDERSTANDING THE PRESENT SYSTEM
A. Process Flowchart…………………………………………………………………………………………………………………..10
B. Keytask ……………………………………………………………………………………………………………………………....11
C. Verification of Keytask ……………………………………………………………………………………………………………...11
D. Objective Statement.................................................................................................................................................................................................11
III. ANALYSIS OF THE PROBLEM
A. Balloon Tree………………………………………………………………………………………………………………………..12
B. Ishikawa Diagram…………………………………………………………………………………………………………………...13
C. Controllability of the Root Causes………………………………………………………………………………………………...14
D. Pareto Chart and Diagram…………………………………………………………………………………………………....……15
IV. SELECTION OF BEST ALTERNATIVE SOLUTION
A. Prioritization Matrix………………………………………………………………………………………………………………..17
B. Plan- Do- Check- Act Cycle………………………………………………………………………………………………………..19
V. SOLUTION IMPLEMENTATION
A. Gantt Chart ………………………………………………………………………………………………………………………..22
B. Potential Problem Analysis…………………………………………………………………………………………………………24
C. Monitoring Plan…………………………………………………………………………………………………………………….26
VI. EVALUATION OF RESULTS
A. Revised Flowchart………………………………………………………………………………………………………………….27
B. Presentation of Comparative Data……………………………………………………………………………………………...…34
C. Conclusion……………………………………………………………………………………………………………………...….37
D. Benefits of the Study…………………………………………………………………………………………………………...…..37
VII. STANDARDIZATION…………………………………………………………………………………………………………………….…38
VII. SELF EVALUATION AND FUTURE PLANNING
A. Pre and Post Test on CQI Methodology…………………………………………………………………………………………..39
B. Self-Evaluation and Future Planning………………………………………………………………………………………………...40
C. Future Plancs……………………………………………………………………………………………………………………….41
REFERENCES……………………………………………………………………………………………………………………………………...42
APPENDICES……………………………………………………………………………………………………………………………………...43
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ABSTRACT
Keywords: Standing Order, Delay, Medication, 30-Minute Rule
Background: Nurses have various responsibilities in the daily direct care for all patients. One of this
responsibilities is giving medications for all patients which usually includes standing order medications.
Standing order medications are like the main stay drug interventions for a patient and they are given on a
scheduled time during the patients stay. Because of the high workload and various responsibilities of
nurses, delays occur in the administration of standing order medications. According to studies, delays in
drug administration can lengthen patient recovery time, prolong admission, and can lead to avoidable
patient harm and suffering.
Objectives: The main purpose of this study is to establish a guideline in the administration of standing
order medications promoting the delivery of safe and quality health care services.
Methods: Initially, direct observation was done to verify the existence of problems. After which, root
causes were identified. A questionnaire was then utilized to be answered by nurses at the in-patient unit
of the Mere Marie Anne Ward. Data collection utilized the “administration of standing order medications
monitoring sheet” which includes the date, scheduled time and time the drug was administered. Moreover,
the administered drugs were classified between the drugs that were given within the 30 minute rule and
those drugs that were considered as delayed.
Results: After implementing the proposed flowchart for the administration of standing order medications,
there was a significant increase in the percentage of drugs that were given within the 30-minute rule.
Conclusion: With the evaluation of the results of the study, the group found out that use of the proposed
flowchart in the administration of standing order medications was found to significantly increase the
compliance of nurses to the 30-minute rule of medication administration.
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INTRODUCTION
Nursing has a powerful and positive impact on patients’ health and most especially their lives. Due
to its intimate nature, nurses can make the most significant contribution to a patient’s health care
experience, safety, and healing. One responsibility given to nurses is administering medications to patientsfollowing the “10 rights of medication administration". Medication administration is not solely a
mechanistic task to be performed in strict compliance with the written prescription, it requires thought
and professional judgement (Nursing and midwifery council, 2010).
Most medications given within a nurse’s shift are standing order medications. Standing order is
defined as the medications prescribed in force permanently until changed in frequency or dosage
or until canceled by the ordering physician (Merriam - Webster dictionary). Though it should be
given only for an exact duration, it does not mean that nurses are permitted to delay of administration of
such medications.
A major problem encountered by nurses is the delay in medication administration, an essential
item included in the 10 R's as "right time". This is a well know problem that the health care team is
experiencing all over the world (Institute for Safe and Medical Practices, 2010), thus a guideline in
medication administration has been published by Medicare and Medicaid Services, (2011) that medications
should be given 30 minutes before or after the scheduled time. Nurses should take in to consideration
the time that the drug started to take its effect and how much time it will be absorbed and excreted in
the body in order to know the importance of the availability of the next dosage. (National Patient Safety
Agency, 2011).
According to the National Patient Safety Agency (2007), data has revealed that delayed medicine
administration was the second largest cause of incident reports and that delay can have serious and even
fatal consequences. While another research also concluded that delayed medication could lead to
increased morbidity and length of stay at the hospital (Green et al, 2009). The effects then defeats the
role of nurses as patient advocates exposing the patients to possibility of further health risks and
complications.
In the Philippines, a study was done in Pagadian City, Zamboanga Del Sur. The study on staff-
nurses’ perception of medication errors perceived causes and reporting behaviors also took into
consideration the time of medication administration. Results showed that nurses in a specific hospital in
Pagadian City do not perceive the delay in giving medication as a problem contributing to a patient’s health
(Superable, 2011).
In our institution, Notre Dame de Chartres Hospital, data collected through interview and
observation last February 22-26, 2016 shows that 20 of 45 medications or 44% did not meet the 30 minute
rule of medication administration. The study aims to decrease the percentage of delayed medications as
part of the hospitals mission to deliver holistic quality care to patients.
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I. PROBLEM IDENTIFICATION AND PRIORITIZATION
A. List of Problems
1. Delayed Administration of Standing Order Medications at Mere Marie Anne Ward
2. Delay in Signing of Consent for Operation
3. Delay in Decision Making for Cesarean Section Candidates
4. Compliance of Nurses to Handwashing Protocol
5. Use of Amitemp Thermometer vs. Digital Thermometer
6. Risk for Falls in Pediatric Patients
7. Delayed Updating of HMIS for Newly Admitted Patients
8. Nurse’s Cap as a Source of Nosocomial Infection
9. Increased Incidence of Hospital Readmission
10. Refusal of Patients to Medicines
B. Problems or Cause
List of Problems Problem / Cause
1. Delayed Administration of Standing Order Medications at Mere Marie
Anne wardProblem
2. Delay in Signing of Consent for Operation Problem
3. Delay in Decision Making for Cesarean Section Candidates Problem
4. Compliance of Nurses to Handwashing Protocol Problem
5. Use of Amitemp Thermometer vs. Digital Thermometer Problem
6. Risk for Falls in Pediatric Patients Problem
7. Delayed Updating of HMIS for Newly Admitted Patients Problem
8. Nurse’s Cap as a Source of Nosocomial Infection Cause
9. Increased Incidence of Hospital Readmission Problem
10. Refusal of Patients to Medicines Problem
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D. Verification of Existence of the Problem
List of Problems Initial Data Collected
Delayed Administration of Standing Order
Medications at Mere Marie Anne Ward
Last February 22-26, 2016, during the7-3 and 3-11
shifts out of 45 standing order medications, 20 or
44.44% drugs were delayed according to the 30-
minute rule of medication administration.
Compliance of Nurses to Handwashing Protocol
Through observation, there is low compliance of
nurses to the handwashing protocol. Last February
22, 2016, one nurse did handwashing thrice for theentire shift while another did handwashing twice
for the entire shift.
Risk for Falls in Pediatric Patients No data collected
C. Controllability of Problems
List of ProblemsControllable, Uncontrollable,
or Interface
Delayed Administration of Standing Order Medications at MereMarie Anne Ward
Controllable
Delay in Signing of Consent for Operation Uncontrollable
Compliance of Nurses to Handwashing Protocol Controllable
Delay in Decision Making for Cesarean Section Candidates Uncontrollable
Use of Amitemp Thermometer vs. Digital Thermometer Interface
Risk for Falls in Pediatric Patients Controllable
Delayed Updating of HMIS for Newly Admitted Patients Interface
Increased Incidence of Hospital Readmission Interface
Refusal of Patients to Medicines Uncontrollable
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F. Prioritization (Nominal Group
List of ProblemsInitial Data Collected
TotalA B C D E F
Delayed Administration of Standing Order Medications at MereMarie Anne Ward
3 3 3 3 3 3 18
Compliance of Nurses to Handwashing Protocol 3 2 3 3 3 3 17
Risk for Falls in Pediatric Patients 3 3 2 2 2 3 15
Legend:
A= Critical Importance of the Problem
B= Social Importance of the Problem
C= Identifiability of the Problem
D= Potential for Improving Current Process
E= Feasibility of Carrying Out Remedial Action or Solution
F= Potential Overall Impact of the Study
Scale
3= High 2= Medium 1= Low
Priority Problem: Delayed administration of standing order medications at Mere Marie Anne ward
E. Classifications of Problems According to Significance
List of Problems Initial Data Collected Significance Action Plan
Delayed Administration
of Standing Order
Medications at Mere
Marie Anne Ward
Last February 22-26, 2016, 7-3 and 3-11
shift out of 45 standing order medications
25 drugs were given within 30 minutes
from the scheduled time while 20 weredelayed.
Significant Go
Compliance of Nurses to
Handwashing Protocol
Through observation, there is low
compliance of nurses to the handwashing
protocol. Last February 22, 2016, one
nurse did handwashing once thrice for the
entire shift while another did handwashing
twice for the entire shift.
Significant Go
Risk for Falls in Pediatric
PatientsNo data collected Significant Go
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G. Operational Definition:
Standing order- Standing order is defined as medications that should be given in a regular basis on
a specific period of time to help improve the patient's condition unless there is an order needed
for changes in time, frequency and route.
Delay - To impede the time on administering medication.
Medication - A chemical substance that has physiological effect when used to treat, cure, prevent,
diagnose a disease or promote well-being.
30- Minute Rule – It is the time defined by Medicare and Medicaid Services that medications should
be given beyond 30 minutes will be considered as a delay in administration of standing order
medications.
H. Scope and Limitation
The study utilized the 30 minute rule by the nursing and midwifery council to all standing order
medications following the standard flow chart of medication administration taking into consideration the
drug, dosage, time and patient.
The study includes all standing orders in the MMA ward of Notre Dame de Chartres Hospital
from February 22-26, 2016 during the 7-3 and 3-11 shift through observation and interview. These
medications include only the patients that were assigned to the staff and did not include the patients
assigned to the trainees. The study had several limitations. First, the researchers was not able to assess
the medication administration of the 11-7 or night shift. Second, the researchers were not able to observe
the effects of delayed medication administration to the patient.
I. Problem Statement
Last February 22-26, 2016, 20/45 drugs or 44.44% of the medications were not given within the30 minute rule of medication administration.
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Database of Administration of Standing order Medications at the Mere Marie Anne Ward
(February 22-26, 2016 / 7-3, 3-11 Shift)
Time Scheduled Drug Time Given Delayed?
8:00 AM OMX 1 capsule 8:00 AM No
Zinc Sulfate 1 ml 8:00 AM No
Zinc Sulfate 3.5 ml 8:03 AM No
Paracetamol 120mg/5ml, 1 ml 8:05 AM NoParacetamol IV 0.4ml 8:10 AM No
Erceflora 1 respule 8:15 AM No
Hidrasec 1 sachet 8:15 AM No
Cefuroxime IV 250 mg 8:20 AM No
Follic Acid Supension 0.7ml 8:25 AM No
Oxacillin 500 mg 8:35 AM Yes
Colvan Syrup 1.2 ml 8:35 AM Yes
Trimetazidine 35 mg 8:35 AM Yes
Metronidazole 500 mg/ cap 8:35 AM Yes
9:00 AM Ketorolac 300 mg 9:15 AM No10:00 AM Clindamycin 600 mg IV 10:00 AM No
Fluimucil 1 sachet 10:30 AM No
Ceftriaxone 1g IV 10:40 AM Yes
Metronidazole 500 mg IV 10:45 AM Yes
11:30 AM Regular Insulin 10 mg SubQ 11:30 AM No
12:00 PM Paracetamol IV 0.4ml 12:30 PM No
Paracetamol suspension 1ml 12:45 PM Yes
1:00 PM Humalog 1:00 PM No
Clopidogrel 75 mg 1:10 PM No
Hidrasec 1 sachet 1:35 PM YesColvan Syrup 1.2 ml 1:40 PM Yes
2:00 PM Cefuroxime IV 750 mg 2:10 PM No
Mupirocin Ointment 2:40 PM Yes
3:00 PM Ketorolac 60 mg IV 3:40 PM Yes
4:00 PM Paracetamol IV 0.4ml 4:00 PM No
Paracetamol suspension 1ml 4:15 PM No
Cefuroxime IV 250 mg 4:35 PM Yes
Clindamycin 600 mg IV 4:40 PM Yes
5:30 PM Regular Insulin 5:30 PM No
6:00 PM Hidrasec 1 sachet 6:15 PM NoColvan Syrup 1.2 ml 6:30 PM No
Zinc Sulfate 1 ml 6:40 PM Yes
Metronidazole 500 mg/ cap 6:42 PM Yes
Humalog 6:45 PM Yes
Erceflora 1 respule 6:46 PM Yes
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8:00 PM Paracetamol IV 0.4ml 8:20 PM No
Paracetamol suspension 1ml 8:30 PM No
Simvastatin 40 mg 8:40 PM Yes
Diphenhydramine 50 mg 8:41 PM Yes
10:00 PM Mupirocin Ointment 10:00 PM No
Cefuroxime 750 mg IV 10:39 PM Yes
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Documentation
Waste Management
Administration of
Medication
Validation of the drug
Preparation of
medication
Claiming ofmedications and
supplies
Charging of
medications
Endorsement
II. UNDERSTANDING THE PRESENT SYSTEM
A. Problem Flow Chart Activity
Person in charge Flow Chart Responsibilities
Charge Nurses and StaffNurses
The nurse endorses all the patients,activities and medications (Charge to
Charge and Charge to Staff)
Nurse on DutyThe nurse charges the medications on
the HMIS.
Nurse on duty, Nurse
auxiliary, pharmacists
The person in charge goes to the
pharmacy claims and checks thesupplies and medication received.
Nurse on duty
The nurse prepares the drugs
according to the route of
administration.
Nurse on Duty
The nurse applies the “10 R’s of
medication administration” andchecks the doctor’s orders.
Nurse on Duty
The nurse proceeds to the patient’s
room, explains the medication and
administers it to the right route.
Nurse on Duty The nurse applies the 7S of NDCH
Nurse on Duty
The nurse records the time and date
of administration at the medication
sheet.
Start
End
30-60 min
3-5 min.
5-10 min.
3-5 min.
1-2 min.
1-15 min.
1-3 min.
1-2 min.
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D. Objective statement
1. General Objective Statement:
This study aims to decrease the incident of delay from 44.44% to 0%. Data collection from
February 22-26, 2016 shows that 44.44% of the medications are being delayed thus the study
aims to decrease the percentage by March 1 to 16, 2016.
2. Specific Objectives:
To formulate solutions in minimizing interruptions in medication administration
To decrease the percentage of delayed medications from 44% to 0-10%
To formulate a flowchart that will help in minimizing the delay of administration of
standing order medications
B. Key Task
Key Task Standard Performance Measurement Target
Administration of standingorder medications within 30
minutes
The nurse administers
standing ordermedications within 30
minutes from the
scheduled time
number of standing
order given within 30minutes
number of standing
orders
X100 100%
C. Verification of Key Task
Key Task Standard Performance Measurement Indicator Target
Administration
of standing
order
medications
within 30
minutes
The nurse administers
standing order
medications within 30
minutes from the
scheduled time
number of standing order
given within 30 minutes
--------------------------------
number of standing ordersX100
25/45
X
100%
=
55.55%
100%
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III. ANALYSIS OF THE PROBLEM
A. Balloon Tree
Root cause
Key task
Main problem
Delay In medication
administration of standing
orders at the MMA wards
Stock is notavailable at the
nurse’s station
NOD is unable to
claim medications
at pharmacy
Drug is not
available at
pharmacy list
Drug is not yet available
Delay in carrying
out orders
Charging limit/
account close
Slowmedication
preparation
Interruptions during
medication
preparation
Shifting of
medication
Gossiping of
nurses
Scarcity of supply
such as syringe,
soluset
Doctor’s rounds
NOD is lazy
NOD is not
knowledgeable
about drug
preparation
Lack ofknowledge
by nurse
Patient
condition
Sleeping,
Eating/NPO
Refuses
to take
any drug
Lack of drug
information
Legends:
Taste of the
medication
Patient undergo
surgery
Unable to
carry out
doctor’s
orders
Unable to read
doctors order
Lack of time
for nurses on
duty Lack of staff
Lack of
strategies
Skipped to
carry out
doctors’ order
Unable to
update
kardex and
medication
Too much
workload (toxic)
UDDS policy is not
observed
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B. Fish Bone Diagram (Ishikawa) Method
# of stock being ordered
on system
Unable to recognize the
medication needed to correctly
administer on the said shiftGossiping of nurses
Interuptions during
meds preparation
Lack of staff
Uneven nurse over
patient quantity
Material
Scarcity of
supply
Not available at the
pharmacy
Unexpected
doctors rounds
Man
EnvironmentPatient
condition
Unfamiliar &lack of
information about the
drug
Patient undergoprocedure
Specific instruction
&schedule time
EnvironmentNo specific AP’s
work flow
A need of verification of
doctor’s order
Illegible writing
Delay in carrying out
doctor’s order
NOD not knowledgeable
about drug preparation
Unable to carry out
doctor’s orders
UDDS not followed
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C. Probable Root Causes and Controllability
Data base for Validation of Probability cause ( February 22-25 2016)
Total number of respondents: 14
Questions from the Root Causes YES NO
Unavailable Unit Stock of the Medication 14 0
Gossiping of Nurses 2 12
Charging of Medications at the HMIS System 14 0
Slow Medication Preparation 1 13
Slow IV Push Administration 13 1
Number of Patients 14 0
Patient’s Condition 10 4
Validation of Probable cause
Root cause
Validation
method Findings Controllability Conclusions
Unavailable
Unit Stock of
the
Medication
Observation and
Questionnaire
14 out of 14 staff nurses considered
that the unavailable medications of
their patients can cause a delay in
giving the drug.
controllable True cause
Gossiping
during
EndorsementsObservation and
Questionnaire
2 out of 12 staff nurses considered that
gossiping during endorsement can
divert the attention of the receiving
staff and it also consumes the time
allotted for the administration of
medications to their patient.
controllable True cause
Charging of
Medicines
Using the
HMIS System
Observation and
Questionnaire
14 out of 14 staff nurses considered
that charging of medications through
the HMIS system should be done and
prepared for the next shifts by the
ongoing night duty nurses so that
standing medications will be given on
time.
controllable True cause
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Slow
Medication
Preparation
Observation and
Questionnaire
1 out of 14 staff nurses considered that
one of the least factors in slow
medication preparation is when the
nurse is not knowledgeable about the
medication.
controllable True cause
Slow IV Push
Administration
Observation and
Questionnaire
13 out of 14 staff nurses considered
that it is necessary to give some IV
medications in Slow IV push for the
safety of the patient.
uncontrollableNot true
cause
Number of
Patients
Observation and
Questionnaire
14 out of 14 staff nurses considered
that the nurse and patient ratio in the
wards can cause a delay in giving
medications since the institution is
currently under staff and nurses cannot
predict the amount of drugs that will
be ordered by their doctors.
uncontrollableNot true
cause
Patient’s
Condition
Observation and
Questionnaire
10 out of 14 staff nurses considered
that the patient’s condition will affect
the time rendered for their medications
because of their different care
demands prior to giving their
medication.
uncontrollableNot true
cause
D. Pareto table and chart
Causes Frequency Cumulative
Frequency
Percentage Cumulative
Percentage
A 0 0 0% 0%
B 0 0 0% %
C 1 1 7.14% 7.14%
D 1 2 7.14% 14.28%
E 1 3 7.14% 21.42%%
F 4 7 28.58% 50%
G 7 14 50% 100%
LEGEND:
A. Slow IV Push Administration
B. Patient’s Condition
C. Number of Patients
D. Gossiping of Nurses
E. Slow Medication Preparation
F. Charging of Medications Using the HMIS
G. Unavailable Unit Stock of the Medication
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The graph shows the root causes of delayed administration of medications with unavailable drugs
having the most votes and gossiping and slow medication preparation as the least. Using the 80-20%
rule, problems regarding unavailability of drugs and charging of medications as the focus of the study.
LEGEND:
A. Slow IV Push Administration
B. Patient’s Condition
C. Number of PatientsD. Gossiping of Nurses
E. Slow Medication Preparation
F. Charging of Medications Using the HMIS
G. Unavailable Unit Stock of the Medication
0%
20%
40%
60%
80%
100%
120%
0
1
2
3
4
5
6
7
8
A B C D E F G
Root Causes of Delayed Administration of Standing Order
Medications
Frequency Cumulative Percentage
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IV. SELECTION OF BEST ALTERNATIVE SOLUTION
A. Prioritization Matrix
True Causes Alternative Solution Controllability Advantage Disadvantage Criteria Total Decision
A B C D
Slow IV Push
Administration
If a medication is
required to be
administered via
slow push, the nurse
should administer
the medications first
or if possible
administer via
soluset.
Controllable
If the nurse prepares
the medications that
requires slow iv push
first then delays
would be minimized
and if per soluset the
nurse can already
administer other
medications to the
other patients.
Soluset use may be
considered as a
drawback to
patients because of
its additional cost.
4 4 4 4 16 Go
Patient’s
Condition
If a patient’s
condition requires
delay in medication
administration the
nurse should check
every 5 minutes if
the patient is ready
to take the drug.
Controllable
Frequent checking
will minimize delay in
medications
especially that some
patients tend to
forget to update
nurses about their
present condition.
Constant following
up of 1 patient can
cause delay to
medication
administration to
other patients.
4 3 3 4 14 Go
Number of
Patients
If the unit has a lot of
patients the nurse
should start
preparing
medications 30
minutes before the
scheduled time.
Controllable
If the nurse prepares
ahead of time the
nurse would be able
to minimize delays
especially with a
great number of
patients.
Due to high
workload nurses
would tend to
forget to prepare
medications 30
minutes before
administration.
4 3 3 4 14 Go
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Gossiping of
Nurses
The nurses should
avoid any kind of
interruption during
drug preparation and
administration.
Controllable
If unnecessary
conversations are
minimized delay of
administration of
medications would
be prevented.
This habit is hard to
break thus
implementation
would be difficult.
4 3 3 4 14 Go
Slow
Medication
Preparation
The nurses must be
well trained and
skilled to prepare
medications that
would be
administered within
the shift.
Controllable
The process of
medication
preparation done is
more efficient thus
decreasing time
needed to do so.
Being well trained
and skilled to do a
certain task requires
experience and
rigorous training.
4 4 4 4 16 Go
Charging of
Medications
Using the HMIS
The UDDS policy or
system should be
implemented with
strict compliance.
Controllable
The UDDS policy was
created in order to
correctly prepare and
charge medication
before each shift.
This policy is
implemented mostly
by the pharmacy
department.
4 4 4 4 16 Go
Unavailable
Unit Stock of
the Medication
The outgoing nurses
should have charged
the patient’s
medication for the
incoming shift.Controllable
This help the nurses
focus on the
preparation and
administration of
medications instead
of worrying to chargethe medications
needed.
Sometimes nurses
are busy and lack
time at the end of
the shift because of
the various tasks
required of them.
4 4 4 4 16 Go
Criteria: Legend Rating:
A – Effectiveness of Solution 4 - Excellent
B – Probability of Success 3 - Satisfactory
C – Ease of Implementation 2 - Good
D – Reasonable Cost 1 – Poor
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B. Plan-Do-Check-Act
Root Cause # 1 Slow IV Push Administration
Plan To formulate a flowchart regarding standing order medication administration. If the drug is
required to be pushed slowly the nurses should prepare the medications first or if possible just
administer it via soluset.
Do To submit a proposed flowchart for approval by the nursing service director. The flowchart
would include the use of soluset if possible for medications requiring slow IV push in order to
avoid delays in medication administration.
Check The group will monitor the administration of standing order medications by the staff nurses.
This would be check through direct observation, flowchart should be followed regarding the
administration of medication requiring slow IV push.
Act Introduction of the flowchart to the unit for strict compliance.
Root Cause # 2 Patient’s Condition
Plan To formulate a flowchart regarding standing order medication administration. If the patient’s
condition requires delay in medication administration the nurse should check every 5 minutes to
update the patient’s condition.
Do To submit a proposed flowchart for approval by the nursing service director. The said flowchart
would include the rule of checking every 5 minutes especially because some patients ten to
forget to inform the nurse if they are ready to take the drug.
Check The group will monitor the administration of standing order medications by the staff nurses.This would be checked through direct observation in compliance of the 5 minute rule.
Act Introduction of the flowchart to the unit for strict compliance.
Root Cause # 3 Number of Patients
Plan To enforce time management in order to accommodate all patients regarding standing order
medication administration. The nurses should start preparing and administrating medications 30
minutes before the scheduled time of administration in order to avoid delays.
Do To submit a proposed flowchart for approval by the nursing service director. The said flowchart
would include the 30 minute rule which would imply nurses to start preparing and administering
medications 30 minutes before the scheduled time.
Check The group will monitor the administration of standing order medications by the staff nurses.
This would be check through direct observation of nurses if they are complying to the 30 minute
rule as said in the flowchart.
Act Introduction of the flowchart to the unit for strict compliance.
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Root Cause # 4 Gossiping of Nurses
Plan To formulate a flowchart regarding standing order medication administration. The nurses should
avoid any unnecessary interruptions in medication preparation and administration. Also,
discussion on the 10 R’s of medication administration.
Do To submit a proposed flowchart for approval by the nursing service director. The said flowchart
would enforce nurses to focus on medication preparation and administration. Also, discussion of
proper medication preparation and administration techniques to groups of nurses at a time.
Check The group will monitor the administration of standing order medications by the staff nurses.
This would be check through direct observation wherein the flowchart and topics relayed during
the discussion should be strictly followed by all nurses.
Act: Introduction of the flowchart and discussion to the unit for strict compliance.
Root Cause # 5 Slow Medication Preparation
Plan To formulate a flowchart regarding standing order medication administration. The nurses should
avoid any unnecessary interruptions in medication preparation and administration. Also,
discussion on the 10 R’s of medication administration.
Do To submit a proposed flowchart for approval by the nursing service director. The said flowchart
would enforce nurses to focus on medication preparation. Also, the group would conduct
discussion on medication preparation techniques.
Check The group will monitor the administration of standing order medications by the staff nurses.
This would be check through direct observation wherein the flowchart and topics relayed during
the discussion should be strictly followed by all nurses.
Act Introduction of the flowchart and discussion to the unit for strict compliance.
Root Cause # 6 Charging of Medications Using the HMIS
Plan To formulate a flowchart regarding standing order medication administration. The nurses should
be knowledgeable on the Unit Dose Drug Distribution System
Do To submit a proposed flowchart for approval by the nursing service director. The said flowchart
would include charging of medications using the HMIS, the UDDS policy should be strictly
followed by the nurses.
Check The group will monitor the administration of standing order medications by the staff nurses.
This would be check through direct observation where the UDDS system should be strictly
followed by the nurses on duty.
Act Introduction of the flowchart to the unit and UDDS for strict compliance.
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Root Cause # 7 Unavailable Unit Stock of the Medication
Plan To formulate a flowchart regarding standing order medication administration. The outgoing
nurses should charge the medication needed by the incoming shift. The nurses must include the
availability of the due medications.
Do To submit a proposed flowchart for approval by the nursing service director. The said flowchart
would enforce nurses from the outgoing shift to charge due medications for the incoming shift.
Also, endorsement of the availability of the due medications should be practiced.
Check The group will monitor the administration of standing order medications by the staff nurses.
This would be check through direct observation and kardex review is done to check the
compliance to the endorsement of due medications.
Act Introduction of the flowchart and charging policy to the unit for strict compliance.
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V. SOLUTION IMPLEMENTATION
A. Action Plan and Gantt Chart
Solution What Who Where When Whom How How Much
1. Printing andposting of
“Administration
of Standing
Order
Medication”
flowchart at
MMA Ward
-Flowcharts on
“Administration of
Standing Oder
Medications” will be
posted on the
medication
preparation area of
the MMA ward
where it will
readable and
accessible.
-Flowchart of
“Administration of
Standing Order
Medication” will
facilitate timely
administration of
standing order
medication
Kuchen,
Recyl,
April,
Charrise,
Celine
MMA Ward of
Notre Dame de
Chartres
Hospital
March 1, 2016
to
March 16, 2016
Nurses on Duty,
Members
Posting of
“Administration ofStanding Order
Medications” will
be posted at the
medication
preparation area of
MMA Ward where
it will be readable
and accesible
50 Pesos
2. Staff
Interview and
Daily Direct
Observation
Staff interview was
initially done andthen daily direct
observation was
done to see the
compliance of nurses
to the 30 minute rule
of medication
administration
Kuchen,
Recyl,
April,
Charrise,
Celine
MMA Ward of
Notre Dame de
Chartres
Hospital
March 1, 2016
to
March 16, 2016
Nurses on Duty,
Members
Interview was done
to collect initialdata from the
nurse of the MMA
ward then daily
direct observation
was done by the
members who
were assigned to
the unit
10 Pesos
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Gantt Chart
Activity
Person
in
Charge
DateFeb
22
Feb
23
Feb
24
Feb
25
Feb
26
Feb
29
Mar
1
Mar
2
Mar
3
Mar
4
Mar
7
Mar
8
Mar
9
Mar
10
Mar
11
Mar
14
Mar
15
Mar
16
Mar
17
Identification of Probable ProblemsAll
Members
Projected
Date
Actual
Date
Data CollectionAll
Members
Projected
Date
Actual
Date
Evaluation of Data CollectedAll
Members
Projected
Date
Actual
Date
Revisions are DoneAll
Members
Projected
Date
Actual
Date
Planning for ImplementationAll
Members
Projected
Date
Actual
Date
Formulation of FlowchartAll
Members
Projected
Date
Actual
Date
Implementation at MMA WardAll
Members
Projected
Date
Actual
Date
Evaluation of ResultsAll
Members
Projected
Date
Actual
Date
Formulation of Final OutputAll
Members
Projected
Date
Actual
Date
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B. Potential Problem Analysis
True Cause Best Solution Potential
Problem
Most Likely
Cause
Preventive Action Contingent Action Person
Responsible
Target
Slow IV Push
Administration
Administering
via soluset if
possible
As patient
advocate the
nurse might
not use a
soluset to
avoid charges
Costly for
patients
Reinforce nurses to
use the flowchart
provided for
“Administration of
Standing Order
Medications”
Posting of
Flowchart on
“Administration of
Standing Order
Medications”,
enforcing strict
compliance
Kuchen,
Recyl,
April,
Charrise,
Celine
March
2016
Patient’s
Condition
Checking
patient every 5
minutes
Nurses might
forget to check
the patient
every now and
then
Lack of time
due to high
workload
Reinforce nurses to
use the flowchart
provided for
“Administration of
Standing Order
Medications”
Posting of
Flowchart on
“Administration of
Standing Order
Medications”,
enforcing strict
compliance
Kuchen,
Recyl,
April,
Charrise,
Celine
March
2016
Number of
Patients
Preparing
medication 30
minutes before
scheduled time
The nurses
might not be
able to
immediately
prepare
medications
Lack of time
due to high
workload
Reinforce nurses to
use the flowchart
provided for
“Administration of
Standing Order
Medications”
Posting of
Flowchart on
“Administration of
Standing Order
Medications”,
enforcing strict
compliance
Kuchen,
Recyl,
April,
Charrise,
Celine
March
2016
Gossiping of
Nurses
Focusing on the
medications,
discussion on
medication
administration
Non-
compliance of
nurses
It has become a
daily habit for
nurses
Reinforce that focus
should be solely on
the medication
preparation and
administration
Posting of
Flowchart on
“Administration of
Standing Order
Medications”,
enforcing strict
compliance
Kuchen,
Recyl,
April,
Charrise,
Celine
March
2016
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C. Monitoring Plan
Data to be
Collected
Data Source
and Collection
How will Data
be Collected
Who Will
Collect the
Data
When will Data
be Collected
Tools for Data
Presentation
Total Number
of Drugs that
are
Administered
within the 30
Minute Rule
Direct
Observation at
the MMA
Ward
Direct
Observation
and
Documentation
Kuchen,Recyl,
April,
Charrise,
Celine
March 1- 16,
2016
Pie Graph
Total Number
of Drugs that
are
Administered
More than the
30 Minute Rule
Direct
Observation at
the MMA
Ward
Direct
Observation
and
Documentation
Kuchen,
Recyl,
April,Charrise,
Celine
March 1- 16,
2016
Pie Graph
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VI. EVALUATION OF RESULTS
A. Revised Flowchart
FLOWCHART ON STANDING ORDER MEDICATION ADMINISTRATION
Person
ResponsibleFlowchart Description
Nurse on
Duty
Nurse on
Duty,
pharmacist
Nurse on
Duty
Nurse On
Duty
Nurse on
Duty,
Pharmacist
Nurse on
Duty
Nurse on
Duty
Nurse on
Duty
Nurse on
Duty
Nurse on
Duty
1a. The outgoing nursecharges medication
needed for the next shift.
2a. Following the proper
distribution of drugs.
3a. Outgoing shift claims
medication from
pharmacy.
4a. Endorsement of
patient and there
medication availability
5a. The nurse prepares
for necessary materials
e.g. (solu-set, syringes,
etc.) and verifies the
medication for expiration
date and Right dose.
6a. Before administration
the nurse observes RightPatient, Right time, Right
route, Right approach,
Right education
6b. The nurse administer
medication.
7a. The nurse observes
for cleanliness and
proper disposal.
8a. The nurse observesfor Right documentation.
Start
Outgoing shift
charges medication
Follow UDDS
Outgoing shift
claims medication
Endorsement
Preparation and
validation of
medicationYes No
Large Number
of patientSlow IV push
Yes No
Administer 30
minutes prior Regulartime
Use Sulo-Set Push
Administration
Patient Requires DelayYes No
Give MedicationCheck every 5 minutes
FOCUS ON
PREPARATION
AND
ADMINISTRATION!
7s
Documentation
End
1
2
3
4
5
6
7
8
1-2 min.
5-10 min.
15-30 min.
1-3 min.
1-3 min.
1 min.
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Database on Administration of Standing Order Medications at MMA Ward
(March 2-16, 2016/ 7-3 shift, 3-11 Shift)
Time Schedule Drug Time Given Delayed?
8:00 AM Celecoxib 200 mg 1 tab 8:02 AM NO
Diamicron 80 mg 1 tab 8:04 AM NO
Felodipine 10 mg 1 tab 8:15 AM NO
Omacor 1 g 1 tab 8:07 AM NO
Carvedilol 6.25 mg 1 tab 8:30 AM NO
Restime 40 mg 1 tab 8:15 AM NO
Cefizime 100mg/ 5 ml 3.5 ml 8:20 AM NO
Hydrocortisone 100mg/ ml IV 8:16 AM NO
Losartan 50 mg 1 tab 8:00 AM NO
Zykast 1 tab 8:27 AM NO
Tramadol + Paracetamol 500 mg 1 tab 8:35 AM YES
Fenofibrate 40mg 1 tab 8:29 AM NO
Ambroxol 75 mg 1 tab 8:19 AM NOMetoprolol 25 mg 8:16 AM NO
Co amoxiclav 625mg/ tab 1 tab 8:09 AM NO
Loraped syrup 120mg/ ml 5 ml 8:12 AM NO
KCL (k-lyte) 1 tab 8:15 AM NO
Sinupret 1 tab 8:20 AM NO
Co- Aleva 1 tab 8:34 AM YES
Combizar 100mg/25mg 1 tab 8:40 AM YES
Provasc 5 mg 1 tab 8:13 AM NO
Diltiazem 60 mg 1 tab 8:19 AM NO
Montra 30 mg 1 tab 8:00 AM NO
Ticagrelor 90 mg 1 tab 8:13 AM NO
Trimetazidine 35 mg 1 tab 8:20 AM NO
Celecoxib 200 mg 1 tab 8:15 AM NO
Diamicron 80 mg 1 tab 8:25 AM NO
Felodipine 10 mg 1 tab 8:45 AM YES
Hydrocortisone 100mg/ ml IV 8:03 AM NO
Losartan 50 mg 1 tab 8:15 AM NO
Co amoxiclav 625mg/ tab 1 tab 8:09 AM NO
Trimetazidine 35 mg 1 tab 8:27 AM NO
Celecoxib 200 mg 1 tab 8:17 AM NO
Hydrocortisone 100mg/ ml IV 8:29 AM NO
Restime 40 mg 1 tab 8: 17 AM NO
Cefizime 100mg/ 5 ml 3.5 ml 8:12 AM NO
Hydrocortisone 100mg/ ml IV 8:16 AM NO
Losartan 50 mg 1 tab 8:30 AM NO
Montra 30 mg 1 tab 8:16 AM NO
Ticagrelor 90 mg 1 tab 8:20 AM NO
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1:00 PM Clopidogrel 75 mg 1 tab 1:03 PM NO
Tramadol + Paracetamol 500 mg 1 tab 1:10 PM NO
Carnicor 330 mg 1 tab 1:13 PM NO
Eldicet 50 mg 1 tab 1:38 PM YES
Metronidazole 500 mg 1 tab 1:40 PM YES
Diltiazem 60 mg 1 tab 1:18 PM NOArixtra 2.5 mg SQ 1:23 PM NO
Cilostazol 100 mg 1 tab 1:15 PM NO
Clopidogrel 75 mg 1 tab 1:09 PM NO
Tramadol + Paracetamol 500 mg 1 tab 1:06 PM NO
Carnicor 330 mg 1 tab 1:05 PM NO
Eldicet 50 mg 1 tab 1:17 PM NO
Metronidazole 500 mg 1 tab 1:26 PM NO
Diltiazem 60 mg 1 tab 1:39 PM YES
Arixtra 2.5 mg SQ 1:04 PM NO
Cilostazol 100 mg 1 tab 1:18 PM NOEldicet 50 mg 1 tab 1:20 PM NO
Metronidazole 500 mg 1 tab 1:15 PM NO
Diltiazem 60 mg 1 tab 1:30 PM NO
Arixtra 2.5 mg SQ 1:15 PM NO
Cilostazol 100 mg 1 tab 1:21 PM NO
Diltiazem 60 mg 1 tab 1:06 PM NO
Arixtra 2.5 mg SQ 1:17 PM NO
Zinc Sulfate Syrup 1 ml 1:19 PM NO
Colvan Syrup 5 ml 1:25 PM NO
Zinc Sulfate Syrup 1 ml 1:30 PM NO
Tramadol + Paracetamol 500 mg 1 tab 1: 37 PM YES
Carnicor 330 mg 1 tab 1:02 PM NO
Eldicet 50 mg 1 tab 1:15 PM NO
Metronidazole 500 mg 1 tab 1:20 PM NO
Diltiazem 60 mg 1 tab 1:07 PM NO
Arixtra 2.5 mg SQ 1:18 PM NO
Cilostazol 100 mg 1 tab 1:35 PM YES
2:00 PM Cefuroxime 250 mg IV 2:00 PM NO
Furosemide 20 mg/ ml 2:03 PM NO
Ceftriaxone 2g IV 2:30 PM NO
Metronidazole 500mg/100 ml 2:15 PM NOPulmodual 2.5ml 2:18 PM NO
Cefuroxime 250 mg IV 2:28 PM NO
Furosemide 20 mg/ ml 2:02 PM NO
Ceftriaxone 2g IV 2:14 PM NO
Metronidazole 500mg/100 ml 2:25 PM NO
Pulmodual 2.5ml 2:28 PM NO
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Cefuroxime 250 mg IV 2:05 PM NO
Furosemide 20 mg/ ml 2:18 PM NO
Ceftriaxone 2g IV 2:19 PM NO
Metronidazole 500mg/100 ml 2:03 PM NO
Pulmodual 2.5ml 2:14 PM NO
Ceftriaxone 2g IV 2:19 PM NOMetronidazole 500mg/100 ml 2:30 PM NO
Pulmodual 2.5ml 2:19 PM NO
Metronidazole 500mg/100 ml 2:05 PM NO
Pulmodual 2.5ml 2:10 PM NO
Ketorolac IV 2:31 PM YES
Paracetamol 300 mg 1 amp 2:20 PM NO
Paracetamol 300 mg 1 amp 2:26 PM NO
4:00 PM Paracetamol 300 mg 1 amp 4:00 PM NO
Ketorolac IV 4:15 PM NO
Ceftriaxone 1g 4:17 PM NOCefuroxime 750 mg 4:30 PM NO
Ketorolac IV 4:35 PM YES
Ceftriaxone 1g 4:14 PM NO
Cefuroxime 750 mg 4:19 PM NO
Ketorolac IV 4:09 PM NO
Ceftriaxone 1g 4:15 PM NO
Cefuroxime 750 mg 4:20 PM NO
Ceftriaxone 1g 4:21 PM NO
Cefuroxime 750 mg 4:18 PM NO
Ceftriaxone 1g 4:18 PM NO
Ceftriaxone 1g 4:25 PM NO
Cefuroxime 750 mg 4:30 PM NO
Cefuroxime 750 mg 4:00 PM NO
5:30 PM Ranitidine 1 tab 5:35 PM NO
6:00 PM Diamicron 80 mg 1 tab 6:09 PM NO
Omacor 1g 1 tab 6:07 PM NO
Carvedilol 6.25 mg 1 tab 6:17 PM NO
Restime 40 mg 1 tab 6:25 PM NO
Cefuroxime 100 mg/5ml 3.5 ml 6:28 PM NO
Tramadol + Paracetamol 500 mg 1 tab 6:13 PM NO
Ketorolac 30 mg/ ml 6:20 PM NOAmbroxol 75 mg 1 tab 6:17 PM NO
Co Amoxiclav 625 mg /tab 6:27 PM NO
Loraped Syrup 100mg/ml 5ml 6:20 PM NO
KCL (k Lyte) 1 tab 6:17 PM NO
Co-Aleva 1 tab 6:25 PM NO
Carnicor 330 mg 1 tab 6:35 PM YES
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Eldicet 50 mg 6:40 PM YES
Metronidazole 500 mg/ tab 6:25 PM NO
Diltiazem 60 mg 1 tab 6:17 PM NO
Ticagrelor 90 mg 1 tab 6:20 PM NO
Trimetazidine 35 mg 1 tab 6:22 PM NO
Ibuprofen 200 mg 1 cap 6:15 PM NODiamicron 80 mg 1 tab 6:26 PM NO
Omacor 1g 1 tab 6:30 PM NO
Carvedilol 6.25 mg 1 tab 6:25 PM NO
Restime 40 mg 1 tab 6:28 PM NO
Cefuroxime 100 mg/5ml 3.5 ml 6:15 PM NO
Tramadol + Paracetamol 500 mg 1 tab 6:09 PM NO
Ketorolac 30 mg/ ml 6:12 PM NO
Ambroxol 75 mg 1 tab 6:15 PM NO
Co Amoxiclav 625 mg /tab 6:20 PM NO
Loraped Syrup 100mg/ml 5ml 6:17 PM NOKCL (k Lyte) 1 tab 6:19 PM NO
Co-Aleva 1 tab 6:20 PM NO
Carnicor 330 mg 1 tab 6:17 PM NO
Eldicet 50 mg 6:37 PM NO
Metronidazole 500 mg/ tab 6:40 PM YES
Diltiazem 60 mg 1 tab 6:12 PM NO
Ticagrelor 90 mg 1 tab 6:23 PM NO
Trimetazidine 35 mg 1 tab 6:28 PM NO
Eldicet 50 mg 6:00 PM NO
Metronidazole 500 mg/ tab 6:17 PM NO
Diltiazem 60 mg 1 tab 6:28 PM NO
Ticagrelor 90 mg 1 tab 6:30 PM NO
Trimetazidine 35 mg 1 tab 6:17 PM NO
Co Amoxiclav 625 mg /tab 6:20 PM NO
Loraped Syrup 100mg/ml 5ml 6:23 PM NO
KCL (k Lyte) 1 tab 6:27 PM NO
Co-Aleva 1 tab 6:18 PM NO
Carnicor 330 mg 1 tab 6:20 PM NO
Carvedilol 6.25 mg 1 tab 6:30 PM NO
Restime 40 mg 1 tab 6:18 PM NO
Cefuroxime 100 mg/5ml 3.5 ml 6:24 PM NOTramadol + Paracetamol 500 mg 1 tab 6:15 PM NO
Fluimucil 1 sachet 6:21 PM NO
Hidrasec 1 sachet 6:15 PM NO
Hidrasec 1 sachet 6:23 PM NO
Ibuprofen 200 mg 1 cap 6:30 PM NO
8:00 PM Metformin 500 mg 8:00 PM NO
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Simvastatin 80 mg 8:13 PM NO
Lactulose 30 ml 8:17 PM NO
Betahistene 24 mg 8:30 PM NO
Metformin 500 mg 8:41 PM YES
Simvastatin 80 mg 8:35 PM YES
Metformin 500 mg 8:09 PM NOSimvastatin 80 mg 8:12 PM NO
Metformin 500 mg 8:15 PM NO
Simvastatin 80 mg 8:23 PM NO
Lactulose 30 ml 8:30 PM NO
Betahistene 24 mg 8:15 PM NO
Metformin 500 mg 8:20 PM NO
Simvastatin 80 mg 8:15 PM NO
Xanor 1 tab 8:10 PM NO
Diphenhydramine 8:15 PM NO
Diphenhydramine 8:41 PM YESDiphenhydramine 8:35PM YES
Simvastatin 80 mg 8:00 PM NO
Lactulose 30 ml 8:05 PM NO
10:00 PM Cefuroxime 750 mg 10:00 PM NO
Cefuroxime 750 mg 10:20 PM NO
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B. Comparative of Pre and Post Implementation Phase
Pre-Implementation phase shows that 44.44% of the standing order medications were given
beyond the 30 minute rule of medication administration and after the implementation phase 9.87% of
the medications were given beyond 30 minutes. Comparison of data shows decrease of 34.57%
Initially, a total of 45 standing order medications were included form the MMA Ward and 44.44%
of the said medications were given beyond the 30 minutes rule of medication administration while during
the implementation phase, the group gathered 233 standing order medications at the MMA ward from
March 2 to March 16, 2016 with 9.87% given beyond 30 minutes.
A significant decrease of 34.57% shows that solutions such as posting of proposed flowchart,
discussion on techniques of medication administration and charging of medications by the outgoing shift
for the due medications of the incoming shift are effective in preventing delays in administration of
standing order medications.
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
40.00%
45.00%
Pre-Implementation Post-Implementation
Standing Order Medications Administered beyond the 30 Minute Rule
Post-Implimentation
Pre-Implementation
44.44%
9.87%
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SOLUTION A:
POSTING OF PROPOSED FLOWCHART AT MARE MARIE ANNE WARD
Figure 1: Compliance to 30 minute rule of standing medication administration
Figure 1 shows the compliance of nurses to 30 minute rule in administering standing orders. On
pre implementation phase the result is, 55.56% is being given on time or within 30 minutes, and 44.44% is
given exceeding the 30 minute rule. As for the post-implementation phase the result for the standing
medication exceeding 30 minutes decreased from 44.44% to 9.87%, and the medication given within 30
minutes increased from 55.56% to 90.13%.
0% 20% 40% 60% 80% 100%
Pre-implementation
Post-Implementation
Within 30 minutes
Exceeding 30 minutes
9.87% 90.13%
44.44%55.56%
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SOLUTION B:
CHARGING OF OUTGOING SHIFT FOR THE INCOMING SHIFT
Figure2: Compliance of charging standing medications for the next shift
Figure 2 shows the compliance of outgoing nurses charging and claiming of medications from the
pharmacy for the incoming shift, initially there are 65% of standing medications that are charged for the
next shift and 35% of standing medications were not charged. After implementation and strict compliance
of charging and claiming there is 5% of cases that standing medication were not charged and claimed and
95% that it is charged and claimed in the pharmacy ready to be endorsed to the next shift.
0% 20% 40% 60% 80% 100%
Pre-Implementation
Post-Implementation
Charged
Not Charged
95%
65% 35%
5%
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C. Conclusion
Key TaskStandard
PerformanceMeasurement
Pre-
Implementation
Post-
ImplementationTarget
The nurse
administer
the standing
order
medication
within 30
minutes
The nurse
should give all
standing order
medication
within 30
minutes
Total # of
Standing Order
Medication
given within 30
minutes
Total # of
Standing Order
Medications
X10020
__
45
44.44%
210
__
233
90.13% 100%
D. Benefits of the Study
Patient: Appropriate protocols will be done for the improvement of the hospital’s medication
administration procedure. This includes minimizing the delays of medication administration
which provides patients timely and appropriate interventions, providing holistic quality health
care for all patients.
Through timely medication administration and health education, patients will be able to
understand the importance of taking their medications on time and thus creating a cooperative
relationship between the patients and the healthcare team.
Health care team: With the help of the standardized flowchart of administration of standing
order medications and charging protocols, nurses on duty will have a better guide to help them
during the preparation and administration of medications thus providing patients safe and
quality health care services.
Nurses on duty will understand the importance of strict compliance to the standardized
flowchart on administering standing order medications for not more than 30 minutes which also
allows them to improve their attitude and let them embody the mission and vision of the
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institution which is to give compassionate and quality health care services. Moreover, imposing
a standardized protocol will enhance the knowledge and skills of the nurses to avoid potential
problems which can have a direct effect on the safety of the patients.
Health care institution: The standardized flowchart and charging protocols will become useful in
in the medication administration procedure contributing to the hospitals established image of
providing holistic quality healthcare services and to add to that a center of excellence.
Compliance of nurses on duty on the timely administration of standing order medications
will reflect the institutions ideals on improving the standards of their health care services at par
with global standards.
Furthermore, the study can be a basis for future researches that aims to improve the
standards on timely administration of standing orders which can contribute to the continuity of
providing quality health care allowing the institution to be at trend on the changes in all aspect
of the health care services.
VII. STANDARDIZATION
WHAT WHEN WHERE WHO WHY HOW
What to
standardize
Effective
date
What
area
Person
ResponsibleObjective Compliance
Standardize
flowchart on
administerin
g standing
order
medication
on or within
30 minutes
timeframe
March
2016
In
patient
unit of
MMA -
ward
April
Charisse
Celine
Kuchen
Recyl
To establish a
guideline at the
in-patient unit
of MMA ward
as to when a
medication
may bereasonably
expected to be
delivered to
the patient
care.
Including medication
availability upon endorsement
Charging of medications by the
outgoing shift for the due
medications of the incoming
shift
Open communication between
the nursing service the
pharmacy department
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0
0.5
1
1.5
22.5
3
Problem Identification
Understanding the present
system
Analysis of Root Causes
Selection of Best
Alternative Soultion
Solution Implementation
Evaluation of ResultsStandardization
Self Evaluation and
Planning
Brainstorming
Pareto Diagram
Ishikawa Diagram
Before
After
VIII. SELF EVALUATION AND FUTURE PLANS
A. Radar Chart
This graph show the level of knowledge and competency of the researchers regarding the different
steps in conducting CQI before and after the implementation of the study that was conducted.
In general, there was an increase in the level of knowledge in all criteria. Before the study begun
the Ishikawa and Pareto diagram had the lowest score of zero while brainstorming garnered the highest
with a score of 3. After the implementation, Ishikawa and Pareto diagram, problem identification,
understanding the present system and standardization garnered the lowest with a score of 2, on the other
hand brainstorming, self-evaluation, evaluation of results solution implementation, and analysis of root
cause obtained the highest score which is 3.
In comparison, before and after the implementation of the study, Pareto and Ishikawa diagram and
analysis of root cause had the greatest increase in the level of knowledge and competency.
Legend:
0- Not Heard About it.
1-
Can Do It With Supervision
2-
Can Do It Alone
3-
Can Teach Others
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B. Self-evaluation and Future Planning
Activities Person Responsible Schedule Resources Needed
1. Refresher programon Step 1 problem
identification
specifically the part of
identifying whether it’s
a Problem or a cause
PGNT coordinators:
Ma’am Gretchen C.
Rongo, RN/ ma’am
Izel Ilya Marzan, RN
Others:
Sir Aljan jay
Mendoza,RN
3rd week of February
Venue
Sample CQI studies of
different units
Power point
presentation of CQI
training and other
related tools such as
CQI course outline
2. Refresher program
and workshop on Step 3
Analysis of root cause
focusing on balloon tree
and Ishikawa diagram
PGNT coordinators:
Ma’am Gretchen C.
Rongo, RN/ ma’am
Izel Ilya Marzan, RN
Others:
Sir Aljan jay
Mendoza,RN
3rd week of February
Venue
Sample CQI studies of
different units
Power point
presentation of CQI
training and other
related tools such as
CQI course outline
3. Refresher program
on Step 3 Analysis of
root cause focusing on
Pareto Diagram and
interpretation
PGNT batch 13
Group 2 members:
Sir Kuchen
Abanillo,RN
Ma’am Recyl Garcia,
RN
Ma’am April Anne
Costales,RN
Ma’am Charisse
Mappala, RN
Ma’am Celine Dione
Tabbang
3rd week of February
Venue
Power point
presentation about
Pareto diagram
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Delayed Administration of Standing Order Medications at the Mere Marie Anne Ward of NDCH | 41 | P a g e
4. Refresher program
on Step 8, Self-
evaluation particularly
on the diagram on
knowledge on CQI
Methodology
PGNT batch 13
Group 2 members:
Sir Kuchen
Abanillo,RN
Ma’am Recyl Garcia,
RN
Ma’am April Anne
Costales,RN
Ma’am Charisse
Mappala, RN
Ma’am Celine Dione
Tabbang, RN
3rd week of February
Venue
Sample CQI studies of
different units
Power point
presentation of CQI
training and other
related tools such as
CQI course outline
C. Future plans
In accordance with the results of the study, the following recommendations are hereby presented.
1. To perform further studies regarding administration of Standing order Medications within or less than
30 minutes.
2. To amend self with the up to date protocols on the administration of Standing order medications by
attending and conducting seminars and workshops.
3. To inaugurate, advocate and sustain 100 percent compliance in administering Standing Order
Medications within 30 minutes.
4. To take part, utilize, propagate, and promote evidence based practice and contemplate that
Continuous quality improvement study is an important element in all aspects of the health care profession
such as nursing vocation that will uphold exceptional customer satisfaction and global competitiveness in
the future.
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References:
Agency, N. P. (2007). National Patient Safety Agency. Safety in Doses.
Agency, N. P. (2011). National Patient Safety Agency. Review of Medication Inceidents.
Council, N. a. (2010). Standards for Medicines Management. 24.
Dictionary, M. -W. (n.d.). Standing Order Definition. Retrieved from Merriam- Webster:
http://www.merriam-webster.com/dictionary/standing%20order
Green Cj, Du-Pre P, Elahi N, Dunckley P, McIntyre AS. Omission after admission: failure in
Prescribed medications being given to inpatients. Clin Med 2009; 9: 515-8
Practices, I. f. (2010, May 7). Quarter Watch. Monitoring FDA, Medwatch Reports.
Services, C. f. (2011). Centers for Medicare and Medical Services. Guidelines for Timely
Medication Administration.
Superable, C. M. (2011). Staff Nurses Perception of Medication Errors, Percieved Causes and
Reporting Behaviors.
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