Guideline Approval
Contents
Email approval
Policy and procedure update email
Committee approval
1. SBAR
Email approval
This is the actual email that signifies the approval of the guideline and the location of the guideline on the HUB.
Contents
Email approval
Policy and procedure update email
Committee approval
1. SBAR
Email approval
This is the actual email that signifies the approval of the guideline and the location of the guideline on the HUB.
Date: 2/5/13
To: James Schadler
Guideline Name: Medical/Surgical Inpatients: Independent Double Check of Medications
On behalf of the Nursing Practice Guideline Subcommittee, we thank you for submitting your guideline for review. We are pleased to announce that your guideline has been approved.
Your guideline will be available for search on the HUB under the Policy/Procedure/Guideline link. Please inform your staff where to find this document.
All guidelines must be reviewed and revised as needed to reflect the most current evidence at least once every three years.
Thank you for your submission and we wish you the best.
Sincerely,
Nursing Practice Guideline Subcommittee
To: James Schadler
Guideline Name: Medical/Surgical Inpatients: Independent Double Check of Medications
On behalf of the Nursing Practice Guideline Subcommittee, we thank you for submitting your guideline for review. We are pleased to announce that your guideline has been approved.
Your guideline will be available for search on the HUB under the Policy/Procedure/Guideline link. Please inform your staff where to find this document.
All guidelines must be reviewed and revised as needed to reflect the most current evidence at least once every three years.
Thank you for your submission and we wish you the best.
Sincerely,
Nursing Practice Guideline Subcommittee
Policy and procedure update email
Below is another email that displays all the policies that were created, revised, reviewed, and deleted in January of 2013. The Independent Double Check of Medications is included in this document.
Below is another email that displays all the policies that were created, revised, reviewed, and deleted in January of 2013. The Independent Double Check of Medications is included in this document.
Committee approval
Updating a nursing practice guideline is a very challenging task and a long journey. Updating the original policy that was conceived in the intensive care areas and adapting the document to the medical and surgical areas of the hospital took nearly two months. The next step in the process was to seek the approval of medical/surgical managers and educators. In October of 2012, I attended the monthly luncheon for managers and educators to obtain their approval. The entire guideline was approved pending the removal of requiring an independent double check of insulin rate changes. One of the educators thought that performing this check on a hourly basis would be too difficult to perform. I cited all the variables involved with insulin rate changes, the research and several of the hospital's documented medication errors. A heated debate ensued that concluded upon removal of an independent double check on insulin rate changes. The Pulmonary Unit continues to perform independent double checks on insulin rate changes and documents this action because there are too many variables to consider and the published research indicates that the margin for error increases significantly as the variables increase.
The final step for guideline approval is the Nursing Practice Guideline Subcommittee. A SBAR document was created for the subcommittee. A SBAR document is a clear and concise communication tool that stands for situation, background, assessment, and recommendation. Below is that document that was utilized in the subcommittee meeting that was held in January of 2013.
1. SBAR
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Situation:
Independent double checks of high risk medications are performed
inconsistently and infrequently charted appropriately in the Medical/Surgical
areas based on observations, interviews, and chart audits, despite the most
current policy and procedure in place, that were created by the ICU areas.
Background:
This variance is derived from an uncertainty of which medications require an
independent double check and which specific components of these
medications require an independent double check, such as: new bag, new cassette, bolus, rate change, dose change, setting change, and care handoff. Scanning a medication verifies the actual medication components but does not verify the actual settings of the infusion pump. These values must be manually entered into the EPIC charting system.
Assessment:
Numerous PSNs have been documented on medication errors of these high
risk medications over the past 2 years, including over 200 PSNs on Heparin
alone. The literature indicates a significant reduction in medication errors when an independent double check of the medication is performed and an identical conclusion is reached by two healthcare personnel that are involved in medication management. This ensures that the values manually entered in the electronic Medication Administration Record matches the information displayed on the infusion pump. The Nursing Practice Guideline clarifies when and how independent double checks are performed and how to appropriately chart them.
Recommendation:
The Medical/Surgical Educators, Managers, and Director have approved this guideline that is specific to Medical/Surgical inpatient areas. I am here today, to seek your approval of the Medical/Surgical Nursing Practice Guideline. Extensive education will be provided with a survey to evaluate the current level of knowledge to determine the focus points of education and a post-survey to quantify the amount of learning that has taken place. This will determine if further education is required. Thank you, for your time.
---------------------------------------------------------------------------------------------------------------------
The Nursing Practice Guideline was approved for use.
Updating a nursing practice guideline is a very challenging task and a long journey. Updating the original policy that was conceived in the intensive care areas and adapting the document to the medical and surgical areas of the hospital took nearly two months. The next step in the process was to seek the approval of medical/surgical managers and educators. In October of 2012, I attended the monthly luncheon for managers and educators to obtain their approval. The entire guideline was approved pending the removal of requiring an independent double check of insulin rate changes. One of the educators thought that performing this check on a hourly basis would be too difficult to perform. I cited all the variables involved with insulin rate changes, the research and several of the hospital's documented medication errors. A heated debate ensued that concluded upon removal of an independent double check on insulin rate changes. The Pulmonary Unit continues to perform independent double checks on insulin rate changes and documents this action because there are too many variables to consider and the published research indicates that the margin for error increases significantly as the variables increase.
The final step for guideline approval is the Nursing Practice Guideline Subcommittee. A SBAR document was created for the subcommittee. A SBAR document is a clear and concise communication tool that stands for situation, background, assessment, and recommendation. Below is that document that was utilized in the subcommittee meeting that was held in January of 2013.
1. SBAR
---------------------------------------------------------------------------------------------------------------------
Situation:
Independent double checks of high risk medications are performed
inconsistently and infrequently charted appropriately in the Medical/Surgical
areas based on observations, interviews, and chart audits, despite the most
current policy and procedure in place, that were created by the ICU areas.
Background:
This variance is derived from an uncertainty of which medications require an
independent double check and which specific components of these
medications require an independent double check, such as: new bag, new cassette, bolus, rate change, dose change, setting change, and care handoff. Scanning a medication verifies the actual medication components but does not verify the actual settings of the infusion pump. These values must be manually entered into the EPIC charting system.
Assessment:
Numerous PSNs have been documented on medication errors of these high
risk medications over the past 2 years, including over 200 PSNs on Heparin
alone. The literature indicates a significant reduction in medication errors when an independent double check of the medication is performed and an identical conclusion is reached by two healthcare personnel that are involved in medication management. This ensures that the values manually entered in the electronic Medication Administration Record matches the information displayed on the infusion pump. The Nursing Practice Guideline clarifies when and how independent double checks are performed and how to appropriately chart them.
Recommendation:
The Medical/Surgical Educators, Managers, and Director have approved this guideline that is specific to Medical/Surgical inpatient areas. I am here today, to seek your approval of the Medical/Surgical Nursing Practice Guideline. Extensive education will be provided with a survey to evaluate the current level of knowledge to determine the focus points of education and a post-survey to quantify the amount of learning that has taken place. This will determine if further education is required. Thank you, for your time.
---------------------------------------------------------------------------------------------------------------------
The Nursing Practice Guideline was approved for use.