“MedsTime”: Integrating patients and families in medication safety

Shannon Feehan sfeehan@stanfordchildrens.org
Simon Mawer smawer@theriskauthority.com

Abstract

Medication errors are costly and frequently result in harm in hospitalized children. To address this, frontline nurses, patients, and families on a medical surgical floor at Stanford Children’s Hospital used human centered design (“Design Thinking”) to develop a novel program for improving medication safety. Inspired by frontline needs and experiences, the diverse team created and implemented a solution which engages patients and families in medication safety while reducing interruptions to nurses’ workflow. In the process, we observed medication administration and interviewed patients, families, and nurses, then downloaded and synthesized what we learned. We hosted a kickoff workshop with nurses, brainstormed different ideas, and built a rapid prototypes to bring the ideas to life. With patient and family input and feedback, what resulted was the 'MedsTime’ program, consisting of two solutions: MedSafety, a communication tool that invites participation and facilitates conversations with patients and families about medication safety–including the five rights; and MedPref, a tool that invites families to share significant information and preferences so nurses can better plan for and administer medications. These solutions support autonomy and encourage patients and families to play an active role and partner in the medication administration process. Results of the pilot test on the unit showed a 55% decrease in medication interruptions, and a 40% increase in patients' having some understanding of the importance of medication safety measures. 100% of nurses involved in the pilot study indicated that the tools somewhat or greatly improved their workflow, and said they are more likely to be involved in future improvement work as a result of this project. In the pilot study, we highlighted that patients and families can meaningfully improve patient safety when invited to engage as active participants in improvement work, and established the program’s potential to reduce medication error. In our expanded implementation across multiple units, we are measuring changes in nurse workflow, interruptions during medication administration, patient and family participation and satisfaction with medication administration, and nurse satisfaction with this this approach to improvement work through surveys and observations. In this presentation, we will describe our journey using Design Thinking to develop a patient and family-centered solution for a serious safety issue, discuss how Design Thinking can support efforts to improve care and engage staff, patients and families, and provoke discussion on how to integrate high reliability and quality improvement approaches to facilitate change in the hospital setting.  
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