title: Spreading a medication administration intervention organizationwide in six hospitals.
abstract: BACKGROUND
  Six hospitals from the San Francisco Bay Area participated in a 12-month quality improvement project conducted by the Integrated Nurse Leadership Program (INLP). A quality improvement intervention that focused on improving medication administration accuracy was spread from two pilot units to all inpatient units in the hospitals.
  
  
  METHODS
  INLP developed a 12-month curriculum, presented in a combination of off-site training sessions and hospital-based training and consultant-led meetings, to teach clinicians the key skills needed to drive organizationwide change. Each hospital established a nurse-led project team, as well as unit teams to address six safety processes designed to improve medication administration accuracy: compare medication to the medication administration record; keep medication labeled throughout; check two patient identifications; explain drug to patient (if applicable); chart immediately after administration; and protect process from distractions and interruptions.
  
  
  RESULTS
  From baseline until one year after project completion, the six hospitals improved their medication accuracy rates, on average, from 83.4% to 98.0% in the spread units. The spread units also improved safety processes overall from 83.1% to 97.2%. During the same time, the initial pilot units also continued to improve accuracy from 94.0% to 96.8% and safety processes overall from 95.3% to 97.2%.
  
  
  CONCLUSIONS
  With thoughtful planning, engaging those doing the work early and focusing on the "human side of change" along with technical knowledge of improvement methodologies, organizations can spread initiatives enterprisewide. This program required significant training of frontline workers in problem-solving skills, leading change, team management, data tracking, and communication.
authors.affiliation: Integrated Nurse Leadership Program, Center for the Health Professions, University of California, San Francisco, USA. julie@thealtosgroup.com
authors.forename: Julie
authors.initials: J
authors.lastname: Kliger
authors.forename: Sara
authors.initials: S
authors.lastname: Singer
authors.forename: Frank
authors.initials: F
authors.lastname: Hoffman
authors.forename: Edward
authors.initials: E
authors.lastname: O'Neil
mesh_terms: D003625:Data Collection / Q000379:methods; D004282:Documentation / Q000379:methods; D006801:Humans; D007318:Inservice Training / Q000458:organization & administration*; D008510:Medication Systems, Hospital / Q000458:organization & administration*; D009741:Nursing Staff, Hospital / Q000458:organization & administration*; D010355:Patient Identification Systems; D016730:Program Development; D058996:Quality Improvement / Q000458:organization & administration*; D017751:Safety Management / Q000458:organization & administration*