Implementation of a Nurse-Initiated Protocol to Improve Enteral Medication Administration Documentation in Stroke Patients.

John C Drennan, Tiffany O Sheehan, Tracie Schroeder, J Tyler Haller
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Abstract

Abstract: BACKGROUND: Medication documentation falls under the "7 rights" of medication administration, but strategies to prevent medication administration documentation errors (MADEs) related to route of administration are underreported in the literature. This study aimed to report the outcomes of a nurse-initiated protocol designed to prevent MADEs and align both actual and documented medication administration routes in hospitalized stroke patients with feeding tubes (FTs). METHODS: This was a retrospective descriptive study conducted at a Comprehensive Stroke Center and large academic medical center in the Western United States. Adults admitted with the diagnosis of stroke between February 2022 and August 2023, who had an FT on arrival, or placed during admission, and received at least 1 enteral medication ordered for by mouth (PO) administration, were included. The protocol allowed nurses to place a communication order to a pharmacist via the electronic health record, requesting all enteral medications ordered for PO administration be changed to FT administration. RESULTS: There were 481 patients included with a median age of 68 years (interquartile range, 58-76 years). The nurse-initiated protocol was used in 170 patients (35.3%), with 99 patients (58.2%) having all enteral medication orders converted completely by a pharmacist. Of the 170 patients in which the protocol was initiated, 145 (85.3%) had all scheduled enteral medication orders converted. For the 71 patients who did not have all enteral medication orders converted completely, the median number of potential MADEs was 2 (1-4.5). CONCLUSION: A nurse-initiated protocol designed to prevent MADEs and improve the accuracy of actual and documented route of medication administration for patients hospitalized for stroke with FTs had modest use. The nurse-initiated protocol in this study is the first of its kind and may help guide further research on preventing and reducing MADEs.

实施由护士发起的协议,改进脑卒中患者的肠内给药记录。
摘要:背景:用药记录属于用药 "七项权利 "的范畴,但文献中关于预防与给药途径相关的用药记录错误(MADEs)的策略报道不足。本研究旨在报告一项由护士发起的规程的结果,该规程旨在预防 MADE,并使带输液管(FT)的住院脑卒中患者的实际给药途径与记录给药途径保持一致。方法:这是一项在美国西部综合卒中中心和大型学术医疗中心进行的回顾性描述性研究。研究对象包括 2022 年 2 月至 2023 年 8 月期间诊断为脑卒中的成人,他们在到达时或入院时已安装 FT,并接受了至少一种口服 (PO) 肠内给药。该方案允许护士通过电子病历向药剂师下达医嘱,要求将所有口服肠内药物改为FT给药。结果:共纳入 481 名患者,中位年龄为 68 岁(四分位间范围为 58-76 岁)。170名患者(35.3%)使用了护士发起的方案,99名患者(58.2%)的所有肠内用药医嘱完全由药剂师转换。在启动该方案的 170 名患者中,145 名患者(85.3%)转换了所有预定的肠内用药医嘱。在未完全转换所有肠内用药医嘱的 71 名患者中,潜在 MADE 的中位数为 2(1-4.5)。结论:由护士发起的旨在预防 MADE 并提高脑卒中住院 FTs 患者实际用药和记录用药途径准确性的方案使用效果一般。本研究中由护士发起的方案是首个此类方案,有助于指导预防和减少 MADE 的进一步研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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