Medication Timeless

The article “Medication Timeliness” – Timely Medication Administration Guidelines for Nurses: Fewer
Wrong-Time Errors?” highlights the problems and inherent safety risks associated with the unrealistic
30 minute rule for the majority of non-critical medications. One quote from the article truly brings the
issue to the forefront of the clinical practice arena.
Healthcare has changed since “right time” was first defined many years ago. Hospitalized patients are
sicker, more medications are prescribed to each patient, and the formulary has expanded
dramatically. The medication administration process (from physician order to patient administration)
has grown in complexity with the addition of computerized physician order entry, medication
barcoding, automated dispensing cabinets, electronic medical records, and time-consuming patient
identification procedures. The 30-minute rule was outdated and impractical even before it
became “law.”
Answer the questions that follow in paragraph format using the readings for context and citations.

Part one
1. Think about the information from the power point, article and the readings about errors and
answer the question: Can you see the patient safety risks related to continuing to try and follow
the 30 minute rule?
Use and cite at least one concept or content from the article

Part two: Using this short scenario, answer the questions in 2-3 paragraphs
At an acute care hospital, a change in the process of medication administration is occurring because
the unit is piloting use of a bar coding system for medication administration.
One month after the barcoding system was initiated, the nursing unit receives information from the
Performance Improvement Department identifying that a significant decrease in the timeliness of
administration of antibiotics has been noted. The nurse manager has written several reprimands for
the staff involved. Using concepts from the chapters and required articles, answer the following
questions.
1. Is this nurse manager taking an appropriate approach to this problem? Address the concept of
“Blame or a Culture of Safety”.
2. During this same time, the nurse educator and the students notice that additional patient ID bands
have been placed on the side rails of the beds. The instructor explains that this is a form of a
“work around”, allowing the staff to scan the patient’s ID band more easily for the bar coding
system. What are the inherent risks associated with work arounds and this one in particular?

Answer:

Continuing to adhere strictly to the 30-minute rule for medication administration poses significant patient safety risks in the current healthcare environment. The article “Medication Timeliness” emphasizes how healthcare has evolved over the years, with patients becoming sicker, medication regimens becoming more complex, and technological advancements introducing new layers of complexity to the medication administration process. The 30-minute rule, which was originally established many years ago, fails to account for these changes and may lead to increased errors and patient harm.

One concept from the article that illustrates the patient safety risks of the 30-minute rule is the increasing complexity of the medication administration process. With the implementation of computerized physician order entry, medication barcoding, and electronic medical records, nurses must navigate multiple steps and technological interfaces to administer medications accurately and safely. The rigid adherence to the 30-minute rule may result in rushed or compromised medication administration practices, as nurses may prioritize meeting the arbitrary time limit over thorough verification and double-checking procedures.

Furthermore, the article suggests that the 30-minute rule was outdated and impractical even before it became a regulatory requirement. This highlights the disconnect between regulatory guidelines and the realities of clinical practice, where nurses must balance adherence to regulations with their commitment to patient safety. In light of these considerations, it is evident that continuing to enforce the 30-minute rule poses significant patient safety risks and may contribute to medication errors and adverse events.

Part Two:

The nurse manager’s approach to addressing the decrease in the timeliness of antibiotic administration may not be appropriate, especially if it focuses solely on reprimanding staff members. This approach reflects a culture of blame rather than a culture of safety. Instead of identifying and addressing systemic issues that may be contributing to the decrease in timeliness, such as workflow inefficiencies or barriers to using the barcoding system effectively, the nurse manager’s response places blame on individual staff members. A culture of safety encourages open communication, teamwork, and shared accountability for patient outcomes. Therefore, a more appropriate approach would involve conducting a root cause analysis to identify underlying factors contributing to the decrease in timeliness and implementing system-wide improvements to address these issues.

The use of additional patient ID bands on the side rails of beds as a workaround for scanning patient ID bands more easily poses inherent risks to patient safety. Workarounds are temporary solutions to overcome system deficiencies or inefficiencies but can introduce new risks or vulnerabilities. In this case, placing additional ID bands on the side rails may lead to confusion or errors if nurses mistakenly scan the wrong ID band or overlook the primary ID band worn by the patient. Furthermore, relying on workarounds may undermine the effectiveness of the barcoding system and detract from efforts to address underlying system issues. Therefore, it is essential to address the root causes of workflow challenges and implement sustainable solutions rather than relying on temporary workarounds that may compromise patient safety.

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