Running head: POLICY ACTION PLAN 1

Policy Action Plan

Lauren N. Smith

Delaware Technical Community College

NUR 420: Nursing Policy

In acute care settings, an electronic software system is used to dispense and administer

medications to patients. The current workflow incorporates many moving parts. First, the doctor

or qualified medical professional identifies an intervention that requires a medication and orders

the medication through the electronic software system in the patient’s electronic medical record.

Second, the nurse accesses the medication from a list under a patient’s name in an electronic

medication dispensing machine. Lastly, the nurse uses the patient’s electronic chart in the same

software system that it was ordered from to review, scan, and administer the medication.

There are regulations in place to prevent these types of prescribing and

administration errors from happening. “The Institute for Safe Medication Practices recommends

the following safeguards: use both brand and generic names on prescriptions, include the

indication for the medication, change computer medication selection screens so that look-alike

drug names are not listed consecutively, and alter the font or capitalization of look-alike product

names to highlight the differences in drug names” (Quist et al., 2017, pp. 507).

The problem with the current workflow presents problems. Firstly, the doctor has the

opportunity to make an error when ordering a medication because they have a list of thousands

of brand and generic names to choose from. Secondly, the electronic medical record that the

nurse accesses does not have a fail-safe to prevent a medication from being scanned that is not

appropriate for the patient. The system simply recognizes that the medication being scanned

matches the order from the prescriber.

Nursing informatics plays an important role in the prescribing and administration of

medication in the acute care setting. By syncing orders with the patient medical record we can

“…combine bar code medication administration technology at the point of care with real

time medication surveillance of therapeutic goal attainment, enhanced adverse drug-event

alerts, and adverse event-surveillance information. In other words, if bar code data could be

used to do more than identify the patient and report medication administration doses, the

additional synchronization of information would broaden the scope of the medication-

administration patient safety zone. This would give nurses more efficient access to

information which the nurse actually uses when administering medications. Additional

information, triggered by the bar code, might help the nurse to identify and evaluate the

appropriateness of the drug dose and route, given the drug's specific therapeutic goal and

respond to an enhanced, real-time medication contraindication/drug interaction check with the

EHR, by linking the drug on the same screen with the most recent, clinically relevant

laboratory values” (Lavin, 2015, pp. 6). A properly designed informatics system for safe

medication administration “…can include knowledge support, pop up alerts, and order

recommendations to guide providers in the provision of care as safely and as completely as

possible” (Melton, 2017, pp. 5). In erring on the side of caution with human error, “alerts

raise awareness of a potential issue or other available functionalities and can be more

effective at catching potential issues than clinicians” (Melton, 2017, pp. 5).

Trending of medications accompanied by relevant corresponding lab values can help

avoid medication errors. For example, “…insulin administration in the eMAR should be

trended with the most recent plasma glucose and serum potassium levels in a single view, so

as to keep busy nurses from having to retrieve the labs from another flow sheet in the EHR”

(Lavin, 2015, pp. 6). Other quality improvements include “improving user friendliness (screen

size, font size, adequate LED lighting for use in darkened rooms) of handheld devices used to

bar code scan medications, and built in efficient and timely access to laboratory results for
POLICY ACTION PLAN 4

all medication providers (physicians, advanced practice registered nurses, pharmacists, and

other direct care nurses (Lavin, 2015, pp. 6).

In order to implement policy change I would contact a few key stakeholders who have

influence over policy change. Firstly I would contact Megan Williams RN, APRN, the

president of the Board of Nursing in Delaware. She could provide me with insight on how

policies are implemented, the steps that I would need to take in order to present policy change

to the Board of Nursing, and whether or not the specific policy has the potential for

implementation. Secondly, I would contact Julia George, MSN, RN, FRE, the president of the

Board of Directors for the National Council of State Board of Nursing. She would be able to

guide me in the step that needed to be take in order to effect policy change nationwide. The

steps for nationwide policy change or much more involved than at the state level. Lastly, I

would contact Carolyn Harmon, DNP, RN-BC, the President of the board of directors of

American Nursing Informatics Association. She would have the greatest insight as to where

nursing informatics is missing its mark in patient safety when administering medications.

Since the advancement of informatics technology from paper to electronic

charting and medical records, there have been no further proposals for advancement and there

are no pending laws surrounding the topic. However, I have made a workflow map that

depicts the current workflow (figure 1) and an updated workflow that shows wher e a policy

change would take effect (figure 2). I would like to change the current process by eliminating

the element error completely. In order to do this, it would require creating a system within the

software that recognized patient data in order to decipher whether or not a medication is

appropriate. The workflow map to depict policy change is shown in figure 2. This would include

monitoring of vital signs, patient history, assessments that have been charted in the electronic
POLICY ACTION PLAN 5

medical record, previous medications given, lab values, and imaging results. For example, if a

patient’s lab values resulted a high potassium level, and the patient needed to be intubated, the

software system should be able to identify that the patient should receive rocuronium instead of

succinylcholine for paralyzation due to succinylcholine’s side effect of increase acidosis.

Figure 1

Patient requires emergency care

Doctor
makes the
decision to
order
medication

Nurse dispenses the medication from

Medication
appropriateness
is reviewed by
the nurse

The medication is scanned against

Figure 2

Patient requires emergency care

New software Doctor

Nurse dispenses the medication from

Medication
appropriateness
is reviewed by
the nurse

New software
will use existing
patient data in
The medication is scanned against the electronic
the patient’s electronic chart chart to monitor
appropriateness
of the
medication
Medication
administered
POLICY ACTION PLAN 7

What I hope to achieve with this process is a drastic decrease in the amount of medication

errors on a nationwide scale. In the next 90 days I plan to reach out to the three aforementioned

presidents with guidelines for the new workflow I have come up with. I hope to accomplish a

safer, more effective work environment for patients, physicians, physicians assistance, and

nurses.
POLICY ACTION PLAN 8

References

Lavin, M., Harper, E., Barr, N. (2015). Health information technology, patient safety, and

professional nursing care documentation in acute care settings. Online Journal of

Issues in Nursing, 20(2), 6-6. doi: 10.3912/OJIN.Vol20No02PPT03

Melton, B. (2017). Systematic review of medical informatics-supported medication decision

making. Biomedical Informatics Insights, 9, 1-7. doi: 10.1177/1178222617697975

Quist, A., Hickman, T., Amato, M., Volk, L., Salazar, A., Robertson, A., Wright, A, Bates, D.,

Phansalkar, S., Lambert, B., Schiff, G., (2017). Analysis of variations in the display of

drug names in computerized prescriber order entry systems. American Journal of Health

System Pharmacy, 74(7), p. 499-509. doi: 10.2146/ajhp151051.