title: Establishing a Telephone Medication Order Policy and Protocol for a Small Private Hospital in Jamaica.
abstract: OBJECTIVE
  To institutionalize an evidence-based policy/protocol adapted from the Agency for Healthcare Research and Quality (AHRQ) national medication standards for managing telephone medication orders (TMO) and to determine the impact of the policy/protocol on the number of telephone medication errors (TME) on two medical units of a small private hospital in Jamaica.
  
  
  METHODS
  Kotter's Eight-step Change Model was used to facilitate organizational change among nurses and physicians by teaching and implementing the TMO policy/protocol adapted from AHRQ standards and collecting pre-policy and post-policy frequency of TMEs. A convenience sample of 80 nurses and physicians participated in training about the policy/protocol, took post-instructional tests and participated in the implementation of the policy/protocol. Chart audits over six weeks monitored adherence to the policy/protocol. The annual monthly mean of TMEs for the prior year was compared with the number of TMEs just prior to implementation of policy/protocol and at the end of the first six weeks of implementation.
  
  
  RESULTS
  One hundred per cent of the convenience sample of 80 nurses and doctors passed the post-instructional test; the workforce adhered fully to the protocol during six weeks of implementation, and there was a 100% reduction in TMEs between the prior year and six weeks after policy/protocol implementation.
  
  
  CONCLUSIONS
  Kotter's eight-step framework of organizational change was a successful strategy in institutionalizing and sustaining adherence to the TMO policy/protocol, reducing the number of TMEs and positively influencing the organizational culture.
authors.affiliation: Duke University, Durham, North Carolina, USA, E-mail: mo_julia@yahoo.com.
authors.forename: M
authors.initials: M
authors.lastname: Grant-Coke
authors.affiliation: Duke University, Durham, North Carolina, USA.
authors.forename: D L
authors.initials: DL
authors.lastname: Powell
authors.affiliation: Nursing Council of Jamaica, Jamaica.
authors.forename: J
authors.initials: J
authors.lastname: Lyttle
authors.affiliation: University of Technology, Caribbean School of Nursing, Jamaica.
authors.forename: H
authors.initials: H
authors.lastname: Hewitt
keywords: Medication errors; medication guidelines; organizational change; telephone medication order