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Medical procedures are sensitive processes bearing many unintended and avoidable errors. One such error is poor medication management which may lead to medication shortage for patients, further worsening their state. As a preventable error, medication shortage can be addressed following effective documentation of the acquisition, delivery, and availability of drugs in the hospital. The failure mode effect analysis (FMEA) revealed that lack of medication on the floor could pose a serious challenge for patients needing immediate medication on the said floor. Patients are likely to incur out-of-pocket costs, increased drug errors, complaints, and adverse outcomes if they realize a drug shortage on the floor. In critical cases where patients urgently need medication, the outcome may be severe, leading to mortality. There need to be mitigations in the stocking, following communication between the nurse and the pharmacist to ensure that every floor has sufficient medication stock.
The analysis only presented an overview of the challenge that needs to be solved. Still, it would be irrelevant if the team working on this solution were not experienced enough to provide possible mitigations. The severity of the challenge illustrates the need to develop effective corrective actions for emulation, not only on one floor but the entire hospital. According to Jain (2017), medication management is a complicated process characterized by risks and errors that might be life-threatening. This means that a lack of adequate medication implies that patient outcomes are negatively affected. An important individual to consider in such a case is the primary caregiver and the complexity of their work. Therefore, safeguards employed to address medication shortages should not introduce new errors that make their work complicated. The goal of the analysis is to develop a redesigned process that will effectively reduce healthcare risks and improve medication safety (Anjalee et al., 2021). The team tasked with reviewing any proposed mitigation should ensure that they have little to no unintended negative consequences.
The medication administration workflow illustrated that the floor experiences a drug shortage that requires another procedure for restocking. This process can be time-consuming and expensive for both the hospital and the patient. Therefore, the review team implemented several measures to prevent this from happening based on the workflow:
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There should be medication carts for bigger units that allow the medication to be stored closer to patients to reduce distractions.
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Medication references should be accessible at the administration point. Pharmacy contacts need to be placed in the administration point inscribed in bold and bright text to promote effective communication and reduce time consumption.
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In case of shortages, the review team proposed that floor stock medication be arranged in smaller units to ensure that every floor has a reliable supply.
The proposed measures are meant to improve medication administration while introducing no significant change to the traditional practices in the facility. Moreover, they are not expensive to implement as they only require improvement in communication and training. Instead, the changes address the issue that could have caused healthcare risks previously overshadowed in the facility. This means that the FMEA analysis was successful and useful in developing new ideas and increasing the skills of all involved parties. Instead of waiting for a situation to deteriorate, healthcare professionals who employ these measures would manage their processes and provide better care with increased positive outcomes in patients. The analysis also shows that the healthcare system is not a predetermined institution, but professionals can control its effectiveness by implementing new ideas to analyze, control, and enhance procedures.
References
Anjalee, J. A. L., Rutter, V., & Samaranayake, N. R. (2021). Application of failure mode and effect analysis (FMEA) to improve medication safety: A systematic review. Postgraduate Medical Journal, 97(1145), 168-174. Web.
Jain, K. (2017). Use of failure mode effect analysis (FMEA) to improve medication management process. International Journal of Health Care Quality Assurance, 30(2), 175-186. Web.
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