FINAL OUTPUT.pdf

8/17/2019 FINAL OUTPUT.pdf

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Delayed Administration of Standing Order Medications at the Mere Marie Anne Ward of NDCH | 1 | P a g e

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


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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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.


Charging of

Medicines

Using the

HMIS System

Observation and

Questionnaire


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.



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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.


Slow IV Push

Administration

Observation and

Questionnaire


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


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.


cause

Patient’s

Condition

Observation and

Questionnaire


that the patient’s condition will affect

the time rendered for their medications

because of their different care

demands prior to giving their

medication.


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.


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.


would include the 30 minute rule which would imply nurses to start preparing and administering

medications 30 minutes before the scheduled time.


This would be check through direct observation of nurses if they are complying to the 30 minute

rule as said in the flowchart.



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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.


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.


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


avoid any unnecessary interruptions in medication preparation and administration. Also,

discussion on the 10 R’s of medication administration.


would enforce nurses to focus on medication preparation. Also, the group would conduct

discussion on medication preparation techniques.


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


be knowledgeable on the Unit Dose Drug Distribution System


would include charging of medications using the HMIS, the UDDS policy should be strictly

followed by the 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.


22/43


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.


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.


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.


23/43


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


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


24/43


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


25/43


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


Standing Order

Medications”

Posting of

Flowchart on


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


Standing Order

Medications”

Posting of

Flowchart on


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


Standing Order

Medications”

Posting of

Flowchart on


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


Standing Order

Medications”,

enforcing strict

compliance

Kuchen,

Recyl,

April,

Charrise,

Celine

March

2016


26/43


27/43


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


28/43


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.


29/43


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



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


Restime 40 mg 1 tab 8: 17 AM NO

Cefizime 100mg/ 5 ml 3.5 ml 8:12 AM NO



Montra 30 mg 1 tab 8:16 AM NO

Ticagrelor 90 mg 1 tab 8:20 AM NO


30/43


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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



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


Diltiazem 60 mg 1 tab 1:30 PM NO


Cilostazol 100 mg 1 tab 1:21 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


Eldicet 50 mg 1 tab 1:15 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



Metronidazole 500mg/100 ml 2:25 PM NO

Pulmodual 2.5ml 2:28 PM NO


32/43


Cefuroxime 250 mg IV 2:05 PM NO





Ceftriaxone 2g IV 2:19 PM NOMetronidazole 500mg/100 ml 2:30 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









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


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


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



Cefuroxime 100 mg/5ml 3.5 ml 6:15 PM NO


Ketorolac 30 mg/ ml 6:12 PM NO

Ambroxol 75 mg 1 tab 6:15 PM NO


Loraped Syrup 100mg/ml 5ml 6:17 PM NOKCL (k Lyte) 1 tab 6:19 PM NO



Eldicet 50 mg 6:37 PM NO

Metronidazole 500 mg/ tab 6:40 PM YES




Eldicet 50 mg 6:00 PM NO

Metronidazole 500 mg/ tab 6:17 PM NO





Loraped Syrup 100mg/ml 5ml 6:23 PM NO

KCL (k Lyte) 1 tab 6:27 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



Betahistene 24 mg 8:15 PM NO

Metformin 500 mg 8:20 PM NO


Xanor 1 tab 8:10 PM NO

Diphenhydramine 8:15 PM NO

Diphenhydramine 8:41 PM YESDiphenhydramine 8:35PM YES



10:00 PM Cefuroxime 750 mg 10:00 PM NO



35/43


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%


36/43


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%


37/43


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%


38/43


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


39/43


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


40/43


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


41/43


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


Venue


different units

Power point

presentation of CQI

training and other


CQI course outline


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


Venue

Power point

presentation about

Pareto diagram


42/43



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


Venue


different units

Power point

presentation of CQI

training and other


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.


43/43

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.

FINAL OUTPUT.pdf

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