A 36-month demonstration program at the University of California San Francisco (UCSF) reported this week an 87.7% reduction in medication administration errors – increasing medication administration accuracy to 98% at six Bay Area hospitals. An expanded cohort of 54 units in 9 hospitals showed similar results over the course of 13 months, from September 2008 to October 2009.
According to the study, the increase in accuracy can be linked directly to better adherence to six “best practice” procedures for medication administration identified by CalNOC (the California Nursing Outcomes Coalition). Participating hospitals showed an 80.5% improvement in adherence to CALNOC best practices. Combined improvement – for administration accuracy and adherence to best practices – was 81.4% for the study group. These results confirm earlier results announced at the program’s 18-month halfway point in February 2008.
“These results prove beyond any doubt that front-line clinicians are instrumental to improving the quality, safety and efficiency of American healthcare,” said Ed O’Neil, Director of UCSF’s Center for the Health Professions. “Front-line clinical workers have to be seen as a management resource, not a cost center. These are experienced essential personnel, who can identify problems, drive change, and deliver results.”
The clinical improvement model was developed and supervised by the Integrated Nurse Leadership Program (INLP), one of the core research and professional development programs of UCSF’s Center for the Health Professions.
“Achieving higher quality with lower costs requires investing in people, not just technology and facilities,” said INLP Director, Julie Kliger. “Policymakers and healthcare institutions need to recognize front-line clinicians as a tremendous but under-utilized resource that can make a huge difference in patient care. They have the greatest understanding of recurrent quality issues, so they are best equipped to lead improvement initiatives. And our research shows that they can deliver impressive results, when equipped with the right skills, authority, and executive support.”
The preliminary data were released today at an INLP graduation ceremony honoring 284 clinical participants from nine hospitals. The final data results [Kaiser Permanente Fremont, Kaiser Permanente Hayward, San Francisco General Hospital, Sequoia Hospital, St. Rose Hospital, and Stanford Medical Center] will be published next month in the December 2009 issue of The Joint Commission Journal on Quality and Patient Safety. The INLP’s 36-month program ran from September 2006 to September 2009 and trained front-line clinicians (primarily nurses) to take a leadership role in developing new clinical protocols, reporting tools and metrics, and administrative procedures – all focused on medication administration safety and accuracy.
At every institution in the study group, the initiatives led by INLP participants resulted in quantifiable improvements in care. Study results also indicate similar, significant improvements in accuracy when INLP procedures were extended from a single pilot unit into other medical units within the same institution. (Data Fact Sheet link.)
“The evidence tells us that the INLP improvement model can be applied across a broad spectrum of clinical issues and settings,” said Kliger. “We would even argue that the only way to achieve sustainable improvements in our healthcare system, in general, is to give a leadership role to clinicians on the front lines.”