The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

MISSED AEROSOLIZED MEDICATION DOSES– PROCESS OF DEVELOPING A BENCHMARK FOR MISSED MEDICATION DOSES

Donna Clayton, Darnetta Clinkscale, Russ Wilner; Respiratory Care Services, Barnes-Jewish Hospital, St. Louis, MO

OBJECTIVE: Develop a common nomenclature for “missed medication doses”, then determine the occurrence benchmark rate within a University Hospital Consortium (UHC) group. BACKGROUND: The Joint Commission (TJC) standards require assurance of adequate staffing to safely treat patients. Missed medication doses can be a proxy for assessing adequate staffing. CMS requires Pharmacy Services to oversee medication administration to assure safe patient care. Upon review of internal missed medication data, BJH’s Medication Usage Safety Committee stated missed medication doses were unacceptable. The Committee requested we compare our performance to a professional benchmark. Insufficient published data was available. In 2008, a brief phone survey showed inconsistencies in definition, data collection, and reporting of missed doses. After review of CMS guidelines and the AARC recommendation regarding the definition of a missed dose, BJH opted to use the standard of 60 minutes. BJH categorized missed doses into operational (within RCS control, i.e., staffing, medication unavailable) and non-operational (beyond RCS control, i.e., patient unavailable, patient refusal). To develop a more robust benchmark, BJH administered an internet survey of UHC hospitals, using operational and non-operational definitions. 33 hospitals responded; 58% had an average bed size of 200-600. METHOD: RCS used CliniVision to determine baseline missed dose rates. Documented missed doses were calculated as a percent of total treatments administered to determine a miss rate. We reinstructed staff on proper documentation for missed doses, based on the newly-created definitions for operational and non-operational missed doses. RESULTS: Data from the UHC survey is presented in the image below. CONCLUSION: BJH performed similar to peers, with rates of 1.1% (operational) and 4.5% (non-operational). Many departments (44%) perform concurrent therapy, leading to a lower missed dose rate. As a profession, and to meet CMS and TJC requirements, departments must challenge themselves to achieve “zero” missed doses. Sponsored Research - None

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