Final Output PDF

In Partial Fulfillment of the Requirements in
Post Graduate Nurse Training Batch 13
Continuous Quality Improvement Study on:

Delayed Administration of Standing Order Medications at the
Mere Marie Anne Ward of Notre Dame de Chartres Hospital
Researchers:
Abanilla, Kuchen R., RN
Costales, April Anne B., RN
Garcia, Recyl B., RN
Mappala, Charisse S., RN
Tabbang, Celine Dione M., RN
-Team Black Mamba-
TABLE OF CONTENTS
TITLE
PAGE
ABSTRACT..2
INTRODUCTION...3
I. PROBLEM IDENTIFICATION
A. List of Problems.4
B. Problem vs Cause...4
C. Controllability5
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 Analysis24
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
Delayed Administration of Standing Order Medications at the Mere Marie Anne Ward of NDCH
|1|Page
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.
|2|Page
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 patients health care
experience, safety, and healing. One responsibility given to nurses is administering medications to patients
following 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 nurses 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 staffnurses 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 patients 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.
|3|Page
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. Nurses 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 ward
Problem
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. Nurses Cap as a Source of Nosocomial Infection
Cause
9. Increased Incidence of Hospital Readmission
Problem
10. Refusal of Patients to Medicines
Problem
|4|Page
C. Controllability of Problems
Controllable, Uncontrollable,
or Interface
List of Problems
Delayed Administration of Standing Order Medications at Mere
Marie 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
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 30minute rule of medication administration.
Through observation, there is low compliance of

nurses to the handwashing protocol. Last February
22, 2016, one nurse did handwashing thrice for the
entire shift while another did handwashing twice
for the entire shift.
No data collected
|5|Page
E. Classifications of Problems According to Significance

List of Problems
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 were
delayed.
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

Patients
No data collected
Significant
Go
F. Prioritization (Nominal Group

A B C D E F
List of Problems
Delayed Administration of Standing Order Medications at Mere
Marie Anne Ward
Total
18
3
3
2
3
3
2
3
2
3
2
3
3
17
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
|6|Page
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 the
30 minute rule of medication administration.
|7|Page
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
No
Paracetamol 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
No
10:00 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
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
Yes
Colvan Syrup 1.2 ml
1:40 PM
Yes
2:00 PM
2:10 PM
No
Mupirocin Ointment
2:40 PM
Yes
3:00 PM
Ketorolac 60 mg IV
3:40 PM
Yes
4:00 PM
4:00 PM
No
4:15 PM
No
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
No
Colvan 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
|8|Page
8:00 PM
10:00 PM
Simvastatin 40 mg
Diphenhydramine 50 mg
Mupirocin Ointment
Cefuroxime 750 mg IV
8:20 PM
8:30 PM
8:40 PM
8:41 PM
10:00 PM
10:39 PM
No
No
Yes
Yes
No
Yes
|9|Page
II. UNDERSTANDING THE PRESENT SYSTEM

A. Problem Flow Chart Activity
Person in charge
Flow Chart
Responsibilities
Start
Charge Nurses and Staff
Nurses
30-60 min
Endorsement
The nurse endorses all the patients,

activities and medications (Charge to
Charge and Charge to Staff)
3-5 min.
Nurse on Duty
The nurse charges the medications on

the HMIS.
Charging of
medications
5-10 min.
Nurse on duty, Nurse

auxiliary, pharmacists
Claiming of
medications and
supplies
3-5 min.
Nurse on duty
Preparation of
medication
1-2 min.
Nurse on Duty
Validation of the drug
The person in charge goes to the

pharmacy claims and checks the
supplies and medication received.
The nurse prepares the drugs

according to the route of
administration.
The nurse applies the 10 Rs of

medication administration and
checks the doctors orders.
1-15 min.
Nurse on Duty
Administration of
Medication
The nurse proceeds to the patients

room, explains the medication and
administers it to the right route.
1-3 min.
Nurse on Duty
Waste Management
The nurse applies the 7S of NDCH
1-2 min.
Documentation
Nurse on Duty
End
The nurse records the time and date

of administration at the medication
sheet.
| 10 | P a g e
B. Key Task
Key Task
Standard Performance
Measurement
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
orders
Target
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 orders
25/45
X
100%
=
55.55%
100%
X100
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
| 11 | P a g e
Unable to read
doctors order
III. ANALYSIS OF THE PROBLEM

A. Balloon Tree
Drug is not yet available
Drug is not
available at
pharmacy list
Charging limit/
account close
Too much
workload (toxic)
Gossiping of
nurses
Scarcity of supply
such as syringe,
soluset
NOD is unable to
claim medications
at pharmacy
Stock is not
available at the
nurses station
Unable to
update
kardex and
medication
card
Doctors rounds
Interruptions during
medication
preparation
Shifting of
medication
Skipped to
carry out
doctors order
Patient undergo
surgery
UDDS policy is not

observed
Lack of
knowledge
by nurse
Sleeping,
Eating/NPO
Unable to
carry out
doctors
orders
Delay In medication
administration of standing
orders at the MMA wards
Refuses
to take
any drug
Patient
condition
Taste of the
medication
Slow
medication
preparation
NOD is lazy
Lack of time
for nurses on
duty
NOD is not
knowledgeable
about drug
preparation
Lack of drug
information
Lack of staff
Legends:
Lack of
strategies
Main problem
Delay in carrying
out orders
Key task
Root cause
| 12 | P a g e
Method
B. Fish Bone Diagram (Ishikawa)

Man
UDDS not followed
Uneven nurse over

patient quantity
# of stock being ordered

on system
Lack of staff
Unable to carry out

doctors orders
Interuptions during
meds preparation
Unable to recognize the

medication needed to correctly
administer on the said shift
Gossiping of nurses
Not available at the

pharmacy
Specific instruction
&schedule time
Patient undergo
procedure
Scarcity of
supply
NOD not knowledgeable

about drug preparation
Delay in carrying out
doctors order
Illegible writing
Unfamiliar &lack of
information about the
drug
A need of verification of
doctors order
Material
Environment
Patient
condition
No specific APs
work flow
Unexpected
doctors rounds
Environment
| 13 | P a g e
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
Gossiping of Nurses
12
Charging of Medications at the HMIS System
14
Slow Medication Preparation
13
Slow IV Push Administration
13
Number of Patients
14
Patients Condition
10
Validation of Probable cause

Root cause
Unavailable
Unit Stock of
the
Medication
Gossiping
during
Endorsements
Charging of
Medicines
Using the
HMIS System
Validation
method
Findings
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.
Observation 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.
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.
Controllability
Conclusions
controllable
True cause
controllable
True cause
controllable
True cause
| 14 | P a g e
Slow
Medication
Preparation
Slow IV Push
Administration
Number of
Patients
Patients
Condition
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.
Observation and
Questionnaire

that it is necessary to give some IV
medications in Slow IV push for the
safety of the patient.
Observation and
Questionnaire
Observation and
Questionnaire
D. Pareto table and chart

Causes
Frequency

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.
that the patients condition will affect
the time rendered for their medications
because of their different care
demands prior to giving their
medication.
controllable
True cause
uncontrollable
Not true
cause
uncontrollable
Not true
cause
uncontrollable
Not true
cause
Cumulative
Frequency
Percentage
Cumulative
Percentage
0%
0%
0%
7.14%
7.14%
7.14%
14.28%
7.14%
21.42%%
28.58%
50%
14
50%
100%
LEGEND:
A. Slow IV Push Administration
B. Patients 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
| 15 | P a g e
Root Causes of Delayed Administration of Standing Order

Medications
8
120%
100%
6
80%
5
4
60%
40%
2
20%
1
0
0%
A
Frequency
Cumulative Percentage
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. Patients 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
| 16 | P a g e
IV. SELECTION OF BEST ALTERNATIVE SOLUTION

A. Prioritization Matrix
True Causes
Alternative Solution
Slow IV Push
Administration
Patients
Condition
Number of
Patients
If a medication is
required to be
administered via
slow push, the nurse
should administer
the medications first
or if possible
administer via
soluset.
If a patients
condition requires
delay in medication
administration the
nurse should check
every 5 minutes if
the patient is ready
to take the drug.
If the unit has a lot of
patients the nurse
should start
preparing
medications 30
minutes before the
scheduled time.
Controllability
Controllable
Controllable
Controllable
Advantage
Disadvantage
Criteria
A B C D
4 4 4 4
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.
Frequent checking
will minimize delay in
medications
especially that some
patients tend to
forget to update
nurses about their
present condition.
If the nurse prepares
ahead of time the
nurse would be able
to minimize delays
especially with a
great number of
patients.
Total
16
Go
Constant following
up of 1 patient can
cause delay to
medication
administration to
other patients.
14
Go
Due to high
workload nurses
would tend to
forget to prepare
medications 30
minutes before
administration.
14
Go
Decision
| 17 | P a g e
Gossiping of
Nurses
Slow
Medication
Preparation
Charging of
Medications
Using the HMIS
Unavailable
Unit Stock of
the Medication
The nurses should

avoid any kind of
interruption during
drug preparation and
administration.
The nurses must be
well trained and
skilled to prepare
medications that
would be
administered within
the shift.
The UDDS policy or
system should be
implemented with
strict compliance.
The outgoing nurses
should have charged
the patients
medication for the
incoming shift.
Controllable
Controllable
Controllable
Controllable
If unnecessary
conversations are
minimized delay of
administration of
medications would
be prevented.
The process of
medication
preparation done is
more efficient thus
decreasing time
needed to do so.
This habit is hard to

break thus
implementation
would be difficult.
14
Go
Being well trained

and skilled to do a
certain task requires
experience and
rigorous training.
16
Go
The UDDS policy was

created in order to
correctly prepare and
charge medication
before each shift.
This help the nurses
focus on the
preparation and
administration of
medications instead
of worrying to charge
the medications
needed.
This policy is
4
implemented mostly
by the pharmacy
department.
16
Go
Sometimes nurses
are busy and lack
time at the end of
the shift because of
the various tasks
required of them.
16
Go
Criteria:
Legend Rating:
A Effectiveness of Solution
B Probability of Success
C Ease of Implementation
D Reasonable Cost
4 - Excellent
3 - Satisfactory
2 - Good
1 Poor
| 18 | P a g e
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 Patients Condition

Plan
To formulate a flowchart regarding standing order medication administration. If the patients

condition requires delay in medication administration the nurse should check every 5 minutes to
update the patients 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.
This would be checked through direct observation in compliance of the 5 minute rule.
Act
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.
Do
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.
Act

| 19 | P a g e
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 Rs of medication administration.
Do
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

Plan
avoid any unnecessary interruptions in medication preparation and administration. Also,
discussion on the 10 Rs of medication administration.
Do
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

Plan
be knowledgeable on the Unit Dose Drug Distribution System
Do
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.
| 20 | P a g e
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.
Do
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.
| 21 | P a g e
V. SOLUTION IMPLEMENTATION
A. Action Plan and Gantt Chart
Solution
What
-Flowcharts on
Administration of
Standing Oder
Medications will be
posted on the
medication
1. Printing and
preparation area of
posting of
the MMA ward
Administration
where it will
of Standing
readable and
Order
accessible.
Medication
-Flowchart of
flowchart at
Administration of
MMA Ward
Standing Order
Medication will
facilitate timely
administration of
standing order
medication
2. Staff
Interview and
Daily Direct
Observation
Staff interview was

initially done and
then daily direct
observation was
done to see the
compliance of nurses
to the 30 minute rule
of medication
administration
Who
Kuchen,
Recyl,
April,
Charrise,
Celine
Kuchen,
Recyl,
April,
Charrise,
Celine
Where
MMA Ward of
Notre Dame de
Chartres
Hospital
MMA Ward of
Notre Dame de
Chartres
Hospital
When
March 1, 2016
to
March 16, 2016
March 1, 2016
to
March 16, 2016
Whom
How
How Much
Nurses on Duty,
Members
Posting of
Administration of
Standing Order
Medications will
be posted at the
medication
preparation area of
MMA Ward where
it will be readable
and accesible
50 Pesos
Nurses on Duty,
Members
Interview was done

to collect initial
data from the
nurse of the MMA
ward then daily
direct observation
was done by the
members who
were assigned to
the unit
10 Pesos
| 22 | P a g e
Gantt Chart
Activity
Person
in
Charge
Identification of Probable Problems
All
Members
Data Collection
All
Members
Evaluation of Data Collected
All
Members
Revisions are Done
All
Members
Planning for Implementation
All
Members
Formulation of Flowchart
All
Members
Implementation at MMA Ward
All
Members
Evaluation of Results
All
Members
Formulation of Final Output
All
Members
Date
Feb
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
Projected
Date
Actual
Date
Projected
Date
Actual
Date
Projected
Date
Actual
Date
Projected
Date
Actual
Date
Projected
Date
Actual
Date
Projected
Date
Actual
Date
Projected
Date
Actual
Date
Projected
Date
Actual
Date
Projected
Date
Actual
Date
| 23 | P a g e
Mar
17
B. Potential Problem Analysis

True Cause
Best Solution
Potential
Problem
Most Likely
Cause
Preventive Action
Contingent Action
Posting of
Flowchart on
Administration of
Standing Order
Medications,
enforcing strict
compliance
Posting of
Flowchart on
Administration of
Standing Order
Medications,
enforcing strict
compliance
Posting of
Flowchart on
Administration of
Standing Order
Medications,
enforcing strict
compliance
Posting of
Flowchart on
Administration of
Standing Order
Medications,
enforcing strict
compliance
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
Administration of
Standing Order
Medications
Patients
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
Administration of
Standing Order
Medications
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
Administration of
Standing Order
Medications
Gossiping of
Nurses
Focusing on the
medications,
discussion on
medication
administration
Noncompliance of
nurses
It has become a
daily habit for
nurses
Reinforce that focus

should be solely on
the medication
preparation and
administration
Person
Responsible
Target
Kuchen,
Recyl,
April,
Charrise,
Celine
March
2016
Kuchen,
Recyl,
April,
Charrise,
Celine
March
2016
Kuchen,
Recyl,
April,
Charrise,
Celine
March
2016
Kuchen,
Recyl,
April,
Charrise,
Celine
March
2016
| 24 | P a g e
Slow
Medication
Preparation
Reinforcement
of skills and
discussion
regarding
medication
preparation.
Charging of
Medications
Strict
Non
implementation compliance
of the UDDS
policy
Pharmacy is
included
Unavailable
Unit Stock of
the Medication
Charging of
outgoing shift
for the
incoming shift
Endorsement
should include
availability of
due
medications
It is difficult to
implement
Non
compliance
Lack of time of
nurses due to
high workload
Reinforce nurses to
increase knowledge
on medication
administration.
Lack of time
due to high
workload
Reinforce nurses to
use the flowchart
provided for
Administration of
Standing Order
Medications,
partnership with
the pharmacy
department
Nurse is not
knowledgeable
of the UDDS
policy
Partly a
responsibility
of pharmacists
Lack of time
due to high
workload
Reinforce nurses to
use the flowchart
provided for
Administration of
Standing Order
Medications which
includes charging of
medications for the
next shift.
Posting of
Flowchart on
Administration of
Standing Order
Medications,
enforcing strict
compliance
Posting of
Flowchart on
Administration of
Standing Order
Medications,
enforcing strict
compliance
Kuchen,
Recyl,
April,
Charrise,
Celine
March
2016
Kuchen,
Recyl,
April,
Charrise,
Celine
March
2016
Posting of
Flowchart on
Administration of
Standing Order
Medications,
enforcing strict
compliance
Kuchen,
Recyl,
April,
Charrise,
Celine
March
2016
| 25 | P a g e
C. Monitoring Plan
Data Source
and Collection
How will Data

be Collected
Who Will
Collect the
Data
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
Data to be
Collected
When will Data

be Collected
Tools for Data

Presentation
| 26 | P a g e
VI. EVALUATION OF RESULTS

A. Revised Flowchart
FLOWCHART ON STANDING ORDER MEDICATION ADMINISTRATION
Person
Flowchart
Description
Responsible
1a. The outgoing nurse
Start
charges medication
Nurse on
needed for the next shift.
1-2 min.
1
Duty
Outgoing shift
2a. Following the proper
charges medication
distribution of drugs.
Nurse on
2
Duty,
3a. Outgoing shift claims
Follow
UDDS
pharmacist
medication from
FOCUS ON
pharmacy.
5-10
min.
3
PREPARATION
Nurse on
Outgoing shift
AND
Duty
4a. Endorsement of
claims medication
ADMINISTRATION!
patient and there
Nurse On
medication availability
4
Duty
Endorsement
5a. The nurse prepares
15-30 min.
5
Nurse on
for necessary materials
Large Number
Duty,
e.g. (solu-set, syringes,
Slow IV push
Preparation and
of
patient
Pharmacist
etc.) and verifies the
validation of
medication for expiration
medication
Yes No
Yes No
date and Right dose.
Nurse on
Duty
6a. Before administration
Use Sulo-Set
Push
Administer 30
Regular
the nurse observes Right
minutes prior
time
Patient, Right time, Right
route, Right approach,
Nurse on
Right education
Duty
6b. The nurse administer
1-3 min.
6
medication.
Administration
Nurse on
No
Yes
Patient Requires Delay
Duty
7a. The nurse observes
for cleanliness and
Nurse on
proper disposal.
Check every 5 minutes
Give Medication
1-3
min.
7
Duty
7s
8a. The nurse observes
Nurse on
for Right documentation.
1 min.
8
Duty
Documentation
End
| 27 | P a g e
Database on Administration of Standing Order Medications at MMA Ward

(March 2-16, 2016/ 7-3 shift, 3-11 Shift)
Time Schedule
8:00 AM
Drug
Celecoxib 200 mg 1 tab
Diamicron 80 mg 1 tab
Felodipine 10 mg 1 tab
Omacor 1 g 1 tab
Carvedilol 6.25 mg 1 tab
Restime 40 mg 1 tab
Cefizime 100mg/ 5 ml 3.5 ml
Hydrocortisone 100mg/ ml IV
Losartan 50 mg 1 tab
Zykast 1 tab
Tramadol + Paracetamol 500 mg 1 tab
Fenofibrate 40mg 1 tab
Ambroxol 75 mg 1 tab
Metoprolol 25 mg
Co amoxiclav 625mg/ tab 1 tab
Loraped syrup 120mg/ ml 5 ml
KCL (k-lyte) 1 tab
Sinupret 1 tab
Co- Aleva 1 tab
Combizar 100mg/25mg 1 tab
Provasc 5 mg 1 tab
Diltiazem 60 mg 1 tab
Montra 30 mg 1 tab
Ticagrelor 90 mg 1 tab
Trimetazidine 35 mg 1 tab
Felodipine 10 mg 1 tab
Restime 40 mg 1 tab
Cefizime 100mg/ 5 ml 3.5 ml
Montra 30 mg 1 tab
Time Given
8:02 AM
8:04 AM
8:15 AM
8:07 AM
8:30 AM
8:15 AM
8:20 AM
8:16 AM
8:00 AM
8:27 AM
8:35 AM
8:29 AM
8:19 AM
8:16 AM
8:09 AM
8:12 AM
8:15 AM
8:20 AM
8:34 AM
8:40 AM
8:13 AM
8:19 AM
8:00 AM
8:13 AM
8:20 AM
8:15 AM
8:25 AM
8:45 AM
8:03 AM
8:15 AM
8:09 AM
8:27 AM
8:17 AM
8:29 AM
8: 17 AM
8:12 AM
8:16 AM
8:30 AM
8:16 AM
8:20 AM
Delayed?
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
YES
NO
NO
NO
NO
NO
NO
NO
YES
YES
NO
NO
NO
NO
NO
NO
NO
YES
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
| 28 | P a g e
9:00 AM
10:00 AM
12:00 PM
Restime 40 mg 1 tab
Ketorolac IV
Ketorolac IV
Ketorolac IV
Ketorolac IV
Furosemide 20 mg/ ml
Ceftriaxone 2g
Pulmodual 2.5 ml
Ceftriaxone 2g
Pulmodual 2.5 ml
Ceftriaxone 2g
Pulmodual 2.5 ml
Ceftriaxone 2g
Pulmodual 2.5 ml
Ceftriaxone 2g
Metronidazole 500 mg IV
Clindamycin IV
Ketorolac 30mg/ ml
Ibuprofen 200 mg 1 cap
Ketorolac 30mg/ ml
Ketorolac 30mg/ ml
Ketorolac 30mg/ ml
8:18 AM
8:26 AM
8:30 AM
8:09 AM
8:25 AM
8:19 AM
8:09 AM
8:10 AM
9:00 AM
9:03 AM
9:33 AM
9:03 AM
10:09 AM
10:06 AM
10:17 AM
10:35 AM
10:06 AM
10:07 AM
10:10 AM
10:15 AM
10:24 AM
10:15 AM
10:07 AM
10:19 AM
10:35 AM
10:15 AM
10:06 AM
10:21 AM
10:19 AM
10:23 AM
12:30 PM
12:05 PM
12:36 PM
12:15 PM
12:20 PM
12:22 PM
12:40 PM
12:01 PM
12:12 PM
12:28 PM
12:20 PM
12:07 PM
12:13 PM
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
YES
NO
NO
NO
NO
YES
NO
NO
NO
NO
NO
NO
NO
NO
YES
NO
NO
NO
NO
NO
NO
NO
YES
NO
NO
NO
YES
NO
NO
NO
NO
NO
NO
| 29 | P a g e
1:00 PM
2:00 PM
Clopidogrel 75 mg 1 tab
Carnicor 330 mg 1 tab
Eldicet 50 mg 1 tab
Metronidazole 500 mg 1 tab
Arixtra 2.5 mg SQ
Cilostazol 100 mg 1 tab
Clopidogrel 75 mg 1 tab
Eldicet 50 mg 1 tab
Arixtra 2.5 mg SQ
Eldicet 50 mg 1 tab
Arixtra 2.5 mg SQ
Arixtra 2.5 mg SQ
Zinc Sulfate Syrup 1 ml
Colvan Syrup 5 ml
Zinc Sulfate Syrup 1 ml
Eldicet 50 mg 1 tab
Arixtra 2.5 mg SQ
Ceftriaxone 2g IV
Metronidazole 500mg/100 ml
Pulmodual 2.5ml
Ceftriaxone 2g IV
Pulmodual 2.5ml
1:03 PM
1:10 PM
1:13 PM
1:38 PM
1:40 PM
1:18 PM
1:23 PM
1:15 PM
1:09 PM
1:06 PM
1:05 PM
1:17 PM
1:26 PM
1:39 PM
1:04 PM
1:18 PM
1:20 PM
1:15 PM
1:30 PM
1:15 PM
1:21 PM
1:06 PM
1:17 PM
1:19 PM
1:25 PM
1:30 PM
1: 37 PM
1:02 PM
1:15 PM
1:20 PM
1:07 PM
1:18 PM
1:35 PM
2:00 PM
2:03 PM
2:30 PM
2:15 PM
2:18 PM
2:28 PM
2:02 PM
2:14 PM
2:25 PM
2:28 PM
NO
NO
NO
YES
YES
NO
NO
NO
NO
NO
NO
NO
NO
YES
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
YES
NO
NO
NO
NO
NO
YES
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
| 30 | P a g e
4:00 PM
5:30 PM
6:00 PM
Ceftriaxone 2g IV
Pulmodual 2.5ml
Ceftriaxone 2g IV
Pulmodual 2.5ml
Pulmodual 2.5ml
Ketorolac IV
Paracetamol 300 mg 1 amp
Ketorolac IV
Ceftriaxone 1g
Cefuroxime 750 mg
Ketorolac IV
Ceftriaxone 1g
Cefuroxime 750 mg
Ketorolac IV
Ceftriaxone 1g
Cefuroxime 750 mg
Ceftriaxone 1g
Cefuroxime 750 mg
Ceftriaxone 1g
Ceftriaxone 1g
Cefuroxime 750 mg
Cefuroxime 750 mg
Ranitidine 1 tab
Omacor 1g 1 tab
Restime 40 mg 1 tab
Cefuroxime 100 mg/5ml 3.5 ml
Ketorolac 30 mg/ ml
Co Amoxiclav 625 mg /tab
Loraped Syrup 100mg/ml 5ml
KCL (k Lyte) 1 tab
Co-Aleva 1 tab
2:05 PM
2:18 PM
2:19 PM
2:03 PM
2:14 PM
2:19 PM
2:30 PM
2:19 PM
2:05 PM
2:10 PM
2:31 PM
2:20 PM
2:26 PM
4:00 PM
4:15 PM
4:17 PM
4:30 PM
4:35 PM
4:14 PM
4:19 PM
4:09 PM
4:15 PM
4:20 PM
4:21 PM
4:18 PM
4:18 PM
4:25 PM
4:30 PM
4:00 PM
5:35 PM
6:09 PM
6:07 PM
6:17 PM
6:25 PM
6:28 PM
6:13 PM
6:20 PM
6:17 PM
6:27 PM
6:20 PM
6:17 PM
6:25 PM
6:35 PM
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
YES
NO
NO
NO
NO
NO
NO
YES
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
YES
| 31 | P a g e
8:00 PM
Eldicet 50 mg
Metronidazole 500 mg/ tab
Omacor 1g 1 tab
Restime 40 mg 1 tab
Ketorolac 30 mg/ ml
KCL (k Lyte) 1 tab
Co-Aleva 1 tab
Eldicet 50 mg
Eldicet 50 mg
KCL (k Lyte) 1 tab
Co-Aleva 1 tab
Restime 40 mg 1 tab
Fluimucil 1 sachet
Hidrasec 1 sachet
Hidrasec 1 sachet
Metformin 500 mg
6:40 PM
6:25 PM
6:17 PM
6:20 PM
6:22 PM
6:15 PM
6:26 PM
6:30 PM
6:25 PM
6:28 PM
6:15 PM
6:09 PM
6:12 PM
6:15 PM
6:20 PM
6:17 PM
6:19 PM
6:20 PM
6:17 PM
6:37 PM
6:40 PM
6:12 PM
6:23 PM
6:28 PM
6:00 PM
6:17 PM
6:28 PM
6:30 PM
6:17 PM
6:20 PM
6:23 PM
6:27 PM
6:18 PM
6:20 PM
6:30 PM
6:18 PM
6:24 PM
6:15 PM
6:21 PM
6:15 PM
6:23 PM
6:30 PM
8:00 PM
YES
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
YES
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
| 32 | P a g e
10:00 PM
Simvastatin 80 mg
Lactulose 30 ml
Betahistene 24 mg
Metformin 500 mg
Simvastatin 80 mg
Metformin 500 mg
Simvastatin 80 mg
Metformin 500 mg
Simvastatin 80 mg
Lactulose 30 ml
Betahistene 24 mg
Metformin 500 mg
Simvastatin 80 mg
Xanor 1 tab
Diphenhydramine
Diphenhydramine
Diphenhydramine
Simvastatin 80 mg
Lactulose 30 ml
Cefuroxime 750 mg
Cefuroxime 750 mg
8:13 PM
8:17 PM
8:30 PM
8:41 PM
8:35 PM
8:09 PM
8:12 PM
8:15 PM
8:23 PM
8:30 PM
8:15 PM
8:20 PM
8:15 PM
8:10 PM
8:15 PM
8:41 PM
8:35PM
8:00 PM
8:05 PM
10:00 PM
10:20 PM
NO
NO
NO
YES
YES
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
YES
YES
NO
NO
NO
NO
| 33 | P a g e
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%
Standing Order Medications Administered beyond the 30 Minute Rule

44.44%
45.00%
40.00%
35.00%
30.00%
Post-Implimentation
25.00%
9.87%
20.00%
Pre-Implementation
15.00%
10.00%
5.00%
0.00%
Pre-Implementation
Post-Implementation
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.
| 34 | P a g e
SOLUTION A:
POSTING OF PROPOSED FLOWCHART AT MARE MARIE ANNE WARD
9.87%
90.13%
Post-Implementation
Within 30 minutes
Exceeding 30 minutes
44.44%
55.56%
Pre-implementation
0%
20%
40%
60%
80%
100%
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%.
| 35 | P a g e
SOLUTION B:
CHARGING OF OUTGOING SHIFT FOR THE INCOMING SHIFT
95%
5%
Post-Implementation
Charged
Not Charged
65%
35%
Pre-Implementation
0%
20%
40%
60%
80%
100%
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.
| 36 | P a g e
C. Conclusion
Key Task
Standard
Performance
Measurement
PreImplementation
PostImplementation
20
210
Target
Total # of
The nurse
administer
the standing
order
medication
within 30
minutes
Standing Order
The nurse
should give all
standing order
Medication
given within 30
minutes
medication
X100
within 30
minutes
Total # of
__
45
44.44%
__
90.13%
100%
233
Standing Order
Medications
D. Benefits of the Study

Patient: Appropriate protocols will be done for the improvement of the hospitals 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
| 37 | P a g e
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
What to
standardize
WHEN
Effective
date
Standardize
flowchart on
administerin
g standing
order
medication
on or within
30 minutes
timeframe
March
2016
WHERE
What
area
In
patient
unit of
MMA ward
WHO
Person
Responsible
April
Charisse
Celine
Kuchen
Recyl
WHY
HOW
Objective
Compliance
To establish a
guideline at the
in-patient unit
of MMA ward
as to when a
medication
may be
reasonably
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
| 38 | P a g e
VIII. SELF EVALUATION AND FUTURE PLANS

A. Radar Chart
Problem Identification
3
Ishikawa Diagram
2.5
Understanding the present

system
2
1.5
Pareto Diagram
Analysis of Root Causes
1
0.5
0
Brainstorming
Self Evaluation and

Planning
Standardization
Selection of Best
Alternative Soultion
Solution Implementation
Evaluation of Results
Legend:
0- Not Heard About it.
Before
1- Can Do It With Supervision
After
2- Can Do It Alone
3- Can Teach Others
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.
| 39 | P a g e
B. Self-evaluation and Future Planning

Activities
1. Refresher program
on Step 1 problem
identification
specifically the part of
identifying whether its
a Problem or a cause
Person Responsible
Schedule
Venue
PGNT coordinators:
Maam Gretchen C.
Rongo, RN/ maam
Izel Ilya Marzan, RN
Sample CQI studies of

different units
3rd week of February
Others:
Sir Aljan jay
Mendoza,RN
Maam Gretchen C.
Rongo, RN/ maam
Izel Ilya Marzan, RN
Power point
presentation of CQI
training and other
related tools such as
CQI course outline
Venue
PGNT coordinators:
and workshop on Step 3
Analysis of root cause
focusing on balloon tree
and Ishikawa diagram
Resources Needed

different units
Others:
Sir Aljan jay
Mendoza,RN
Power point
presentation of CQI
training and other
CQI course outline
PGNT batch 13
Group 2 members:
Sir Kuchen
Abanillo,RN
on Step 3 Analysis of
root cause focusing on
Pareto Diagram and
interpretation
Maam Recyl Garcia,

RN
Maam April Anne
Costales,RN
Venue
rd
3 week of February
Power point
presentation about
Pareto diagram
Maam Charisse
Mappala, RN
Maam Celine Dione
Tabbang
| 40 | P a g e
PGNT batch 13
Group 2 members:
on Step 8, Selfevaluation particularly
on the diagram on
knowledge on CQI
Methodology
Venue
Sir Kuchen
Abanillo,RN
Maam Recyl Garcia,
RN
Maam April Anne
Costales,RN
Maam Charisse
Mappala, RN

different units
Power point
presentation of CQI
training and other
CQI course outline
Maam Celine Dione

Tabbang, RN
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.
| 41 | P a g e
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.
| 42 | P a g e

Final Output PDF

Hochgeladen von

Dokumentinformationen

Originalbeschreibung:

Originaltitel

Copyright

Verfügbare Formate

Dieses Dokument teilen

Dokument teilen oder einbetten

Freigabeoptionen

Stufen Sie dieses Dokument als nützlich ein?

Sind diese Inhalte unangemessen?

Copyright:

Verfügbare Formate

Final Output PDF

Hochgeladen von

Copyright:

Verfügbare Formate

In Partial Fulfillment of the Requirements in

Post Graduate Nurse Training Batch 13

Continuous Quality Improvement Study on:

I. PROBLEM IDENTIFICATION AND PRIORITIZATION

1. Delayed Administration of Standing Order Medications at Mere Marie

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. Nurses Cap as a Source of Nosocomial Infection

9. Increased Incidence of Hospital Readmission

10. Refusal of Patients to Medicines

Delay in Signing of Consent for Operation

Compliance of Nurses to Handwashing Protocol

Delay in Decision Making for Cesarean Section Candidates

Use of Amitemp Thermometer vs. Digital Thermometer

Risk for Falls in Pediatric Patients

Delayed Updating of HMIS for Newly Admitted Patients

Increased Incidence of Hospital Readmission

Refusal of Patients to Medicines

D. Verification of Existence of the Problem

Initial Data Collected

Delayed Administration of Standing Order

Last February 22-26, 2016, during the7-3 and 3-11

Compliance of Nurses to Handwashing Protocol

Through observation, there is low compliance of

Risk for Falls in Pediatric Patients

E. Classifications of Problems According to Significance

Initial Data Collected

Last February 22-26, 2016, 7-3 and 3-11

Through observation, there is low

Risk for Falls in Pediatric

F. Prioritization (Nominal Group

Delay - To impede the time on administering medication.

H. Scope and Limitation

II. UNDERSTANDING THE PRESENT SYSTEM

The nurse endorses all the patients,

The nurse charges the medications on

Nurse on duty, Nurse

Validation of the drug

The person in charge goes to the

The nurse prepares the drugs

The nurse applies the 10 Rs of

The nurse proceeds to the patients

The nurse applies the 7S of NDCH

The nurse records the time and date

The nurse administers

C. Verification of Key Task

The nurse administers

number of standing order

To formulate solutions in minimizing interruptions in medication administration

III. ANALYSIS OF THE PROBLEM

UDDS policy is not

B. Fish Bone Diagram (Ishikawa)

UDDS not followed

Uneven nurse over

# of stock being ordered

Unable to carry out

Unable to recognize the

Not available at the