Medication Error Minimization Scheme (MEMS) in an adult tertiary intensive care unit (ICU) 2009-2011.
BACKGROUND
The Medication Error Minimisation Scheme (MEMS) is a locally based ongoing multidisciplinary, multifaceted quality improvement (QI) project within an Australian adult tertiary level Intensive Care Unit (ICU). The project commenced in 2009. Its primary aim is to enhance medication safety within this ICU by utilising existing resources. The aim of this paper is to provide a descriptive account of the various activities, interventions and results of this project within the first three years.


METHODS
The research design for this project was based upon Plan-Do-Study-Act (PDSA) cycles associated with QI projects. Medication error rates and audits of: intravenous infusions, incompatible intravenous medications and incorrect documentation of withheld medications were analyzed according to simple statistical techniques. Initial and follow up medication safety surveys were compared using basic statistical analysis. Focus groups exploring barriers and enablers of medication incident reporting were analyzed according to qualitative techniques associated with focus group discussions. Other interventions included: regular education sessions; discussions within other departmental meetings such as nursing staff meetings and Morbidity and Mortality meetings; and bedside discussions and demonstrations. Promotion of medication safety occurred within a number of forums; activities and findings were advertised and displayed; a recognizable Logo for MEMS was employed; and incentives were provided for staff.


RESULTS
Reported Medication Incidents (MIs) increased from 6.2 to 14.9 MIs per 1000 patient days. Audits and chart reviews confirmed that more MIs are uncovered by employing a variety of techniques in addition to incident reporting. Staff surveys provided a rich source of information regarding medication safety. Audits of intravenous infusions revealed a reduced error rate from 38/331 (11.5%) to 15/468 (3.2%). Chart review of incorrect documentation of omitted medications decreased from 105/347 (30.3%) to 104/486 (21.4%). Focus groups provided information that was able to be used in a number of hospital forums in order to explain the impact of existing systems upon ICU staff.


CONCLUSIONS
This ongoing QI project was able to achieve its targeted goals. The MI reporting rate was increased. This project demonstrated that measurable, "non-incident report" errors can be reduced by focusing upon and promoting medication safety in the ICU. These activities demonstrated a workplace that values medication safety, the discovery of shortfalls and the benefits of ongoing improvement.
Intensive Care Unit, St Vincent's Hospital, 390 Victoria St, Darlinghurst, NSW 2010, Australia. jbreeding@stvincents.com.au
Jeff
J
Breeding
Susie
S
Welch
Susan
S
Whittam
Hergen
H
Buscher
Fay
F
Burrows
Carmen
C
Frost
Maryke
M
Jonkman
Nicola
N
Mathews
Khai Shin
KS
Wong
Alison
A
Wong
D000328:Adult; D015400:Clinical Nursing Research; D004282:Documentation / Q000706:statistics & numerical data; D017144:Focus Groups; D006801:Humans; D007262:Infusions, Intravenous; D007362:Intensive Care Units / Q000592:standards*; D008485:Medical Audit; D008508:Medication Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D009937:Organizational Objectives; D058996:Quality Improvement / Q000458:organization & administration; D012107:Research Design