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Case Studies provide real stories of current efforts, including programs being initiated, practices being implemented, and outcomes being targeted and/or achieved. Case studies are presented as both an opportunity for learning from others as well as a spark for further ideas on how we work to improve the patient experience. If you have a case study to share please contact us.
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Duke Raleigh Hospital
Duke Raleigh Hospital Improves Patient Satisfaction with Bedside Barcode Scanning
What was the challenge, opportunity or issue faced?
One of the challenges we faced was to increase patient confidence and safety of the medication administration process. Our nurses were using paper medication records and correcting them by hand. Adopting the best practice of using an electronic medication administration record and barcode scanning was a challenge and created a great deal of anxiety for them. Another challenge we faced was to make sure patients knew we were taking thoughtful and active steps toward making them safer. Patients frequently exhibit concern about receiving the correct medications. They have heard statistics about hospital medication errors. Adding to patients’ concerns is that the medications they receive are often a different brand and look different from the ones they take at home. Increasing their sense of safety was important.
What did they do to address it?
Once the decision was made to implement bedside barcode scanning, frontline nursing staff was recruited to participate in making decisions all along the way. Because of their involvement throughout the process, they were true "Super Users”. At implementation the nurses were provided one-on-one support for the first few days of implementation. The nurses were encouraged to say to the patient, "I'm a little slower with your medications today, because we are implementing a new process which will make you safer."
What were the outcomes?
The nurses adapted more quickly than they anticipated. Early resisters soon were saying they would never willingly give medications without scanning again. As our CNO rounded on patients, they were pleased to be "scanned like bread" and thought it was a great safety tool. The most astonishing result was recognizing the volume of potential medication errors ("near misses”) we avoided by using the barcode scanners. The "near miss” report showed that every time a "wrong medication” warning was triggered, the nurse did not give the medication. Our overall inpatient satisfaction results, as measured by Press Ganey, have steadily increased since implementing bedside medication verification; success on all accounts.
In July of 2011 we trained all of our staff in the RELATE™ patient centered care communication model. This model focuses on using key words that not only help patients to feel safe and secure, but also helps them understand the steps we are taking to do so. The RELATE™ model was a perfect complement to our efforts to improve patients’ perceptions of safety about medications.
Continued efforts toward improving patients’ perceptions about the medications they received involved implementing medication side effect pop-ups on the information system screen during the medication verification process. The pharmacy department started with the top 100 drugs, creating a pop-up screen which lists the top 3 side effects associated with each drug. Staff uses effective key words to emphasize the top side effects when giving the medications. Early feedback from staff is that they really appreciate this new feature, and the pharmacy is now adding more drugs to the list. Feedback from patients has also been very positive.
We are currently piloting a new interactive medication review sheet that will be given to patients at discharge. The review sheet is designed to emphasize RELATE™ and the Teach Back method when reviewing new medications and their side effects. The most recent Press Ganey HCAHPS report shows Duke Raleigh Hospital is in the 78th percentile for the Communication about Medications domain. We anticipate that the new pop-up feature and interactive review sheet will continue to improve patients’ perceptions of safety and communication about the medications they receive at Duke Raleigh Hospital.
About Duke Raleigh Hospital
World-class care is close to you at Duke Raleigh Hospital. Conveniently located on Wake Forest Road, Duke Raleigh Hospital has been an important part of the world-renowned Duke University Health System since 1998. Duke Raleigh has 186-beds and a comprehensive array of services including a cancer center, orthopaedic and spine center, cardiovascular and wellness services, neurosciences, pulmonary and cardiac rehabilitation, wound healing center, diabetes center, outpatient imaging center, intensive care and progressive care units, pain clinic, same day surgery, emergency department and community outreach and education programs. Duke Raleigh Hospital is a recipient of Magnet designation for nursing excellence and recognized as the first hospital in the state with the North Carolina Nurses Association Hallmarks of Healthy Workplaces distinction.