title: Using lean to improve medication administration safety: in search of the "perfect dose".
abstract: BACKGROUND
  At Virginia Mason Medical Center (Seattle), the Collaborative Alliance for Nursing Outcomes (CALNOC) Medication Administration Accuracy Quality Study was used in combination with Lean quality improvement efforts to address medication administration safety.
  
  
  METHODS
  Lean interventions were targeted at improving the medication room layout, applying visual controls, and implementing nursing standard work. The interventions were designed to prevent medication administration errors through improving six safe practices: (1) comparing medication with medication administration record, (2) labeling medication, (3) checking two forms of patient identification, (4) explaining medication to patient, (5) charting medication immediately, and (6) protecting the process from distractions/interruptions.
  
  
  RESULTS
  Trained nurse auditors observed 9,244 doses for 2,139 patients. Following the intervention, the number of safe-practice violations decreased from 83 violations/100 doses at baseline (January 2010-March 2010) to 42 violations/100 doses at final follow-up (July 2011-September 2011), resulting in an absolute risk reduction of 42 violations/100 doses (95% confidence interval [CI]: 35-48), p < .001). The number of medication administration errors decreased from 10.3 errors/100 doses at baseline to 2.8 errors/100 doses at final follow-up (absolute risk reduction: 7 violations/100 doses [95% CI: 5-10, p < .001]). The "perfect dose" score, reflecting compliance with all six safe practices and absence of any of the eight medication administration errors, improved from 37 in compliance/100 doses at baseline to 68 in compliance/100 doses at the final follow-up.
  
  
  CONCLUSIONS
  Lean process improvements coupled with direct observation can contribute to substantial decreases in errors in nursing medication administration.
authors.affiliation: Hospital Quality and Safety, Virginia Mason Medical Center, Seattle, USA. Joan.Ching@vmmc.org
authors.forename: Joan M
authors.initials: JM
authors.lastname: Ching
authors.forename: Christina
authors.initials: C
authors.lastname: Long
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Williams
authors.forename: C Craig
authors.initials: CC
authors.lastname: Blackmore
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D017598:Efficiency, Organizational / Q000592:standards*; D005260:Female; D006302:Health Services Research; D006801:Humans; D016014:Linear Models; D008297:Male; D008508:Medication Errors / Q000517:prevention & control*; D008510:Medication Systems, Hospital / Q000458:organization & administration*; D024802:Nurse's Role; D019982:Organizational Case Studies; D017064:Process Assessment, Health Care; D011785:Quality Assurance, Health Care; D017751:Safety Management / Q000458:organization & administration*; D014481:United States; D014768:Virginia