Title : Improving care and reducing medication errors in a pulmonary hypertension Unit
Abstract:
Purpose: Pulmonary hypertension (PH) is a "heterogeneous clinical disease characterized foremost by an abnormal increase in pulmonary artery pressure"(Johnson et al., 2023, p. 529). Treatment of PH includes lifelong intravenous prostacyclin administration. Nurses play a critical role in safe prostacyclin administration, as these medications pose a significant risk of causing patient harm like hypotension, syncope and even death if used in error. This project aims to improve nurses' confidence in administering PH intravenous medications (prostacyclin) and reduce medication calculation errors.
Description: ?Confidence is integral in reducing errors while safely administering high-risk medications. Data collected from event reports in this unit from April to July 2023 revealed that 40.5% of all medication events were associated with PH medication administration errors. Surveys assessed nurses' confidence levels regarding administering PH medications before and after a training program. Pre- and post-surveys used a five-point Likert scale to measure the distribution of confidence levels ranging from "No Confidence" to "High Confidence." A pre-intervention survey was conducted in August 2023 in a sample of 25 registered nurses (RNs) with less than two years of experience with PH care to identify a gap in confidence level, which showed that only 35% of nurses having "Confidence" and "High Confidence" in administering PH medications. Gap analysis and 1:1 interviews of nursing staff in the unit revealed vital educational opportunities. The nurses caring for the PH patients in the designated unit undergo specialized training before caring for this population. The high-risk nature of the medication and the inadequate experience of the nursing and pharmacy staff in handling PH medications could exacerbate a lack of confidence and compromise the quality of PH care. The team developed a comprehensive and interactive training program, including a didactic course with PowerPoint presentations and hands-on training. Attendees received instruction via case scenarios and simulation for medication pump programming, pump setup, and medication calculation. The team incorporated a detailed checklist outlining the PH medication administration steps into the class and toolkit, ensuring that no step is missed. Small group staff training was conducted from September to November 2023, providing ample time for each nurse to fully grasp the training materials and techniques.
Outcome: ?Preliminary data collection revealed medication calculation errors and a lack of confidence in PH medication administration. After the intervention, the data comparison of medication event reports from the pre (April-July 2023) and post (November 2023-January 2024) intervention period showed a 93.33% decline in PH-related medication errors. Post-intervention survey data ending in January showed the participants improving their rating in the “Confidence” and “High Confidence” to 65%. A multimodal educational approach led to practice changes that improved nurses' confidence in PH medication administration and reduced medication calculation errors. The team will continue to provide PH refresher courses monthly for new and current staff, audit medication events, improve processes, and conduct surveys every six months to measure nurses' confidence levels.
Audience Take Away:
- The importance of PH medications
- Nurses role in safe administration of Prostacyclin
- Improve nursing confidence in administering PH intravenous medications (prostacyclin)
- Prevent patient harm by reducing medication calculation errors.
