Where’s my med? Improving patient-specific medication storage for emergency department boarders

Abstract

BackgroundThere have been an increased number of patients boarding in the emergency department (ED) who often experience delays in receiving nonurgent medications not typically stocked in the ED automated dispensing cabinets (ADC). ObjectivesTo describe a quality improvement project designed to decrease the amount of time it takes nursing staff to obtain patient-specific medications for patients boarding in the ED at a community hospital. Practice descriptionPrior to this quality improvement project, standard practice was for pharmacy staff to send all medications to the ED based on inpatient cart fill lists, resulting in a 24-hour supply being sent at 1 time. Medications that were not immediately due were often misplaced by ED staff as there was no standard location to store them. Practice innovationA separate location for each examination room in the ED was created in 1 central ADC to store patient-specific medications. Pharmacy staff were instructed to load medications directly into the ADC for expected long-term behavioral health boarders. Nursing staff were instructed to place future doses in the newly created locations and were educated on how to locate medications utilizing the electronic medication administration record. Evaluation methodsED nursing staff timed how long it took them to obtain medications for 40 boarding patients before and after implementation of the quality improvement initiatives. ResultsThe postimprovement intervention decreased the amount of time it took to obtain medications for forty ED boarding patients by 66%, from an average of 37.7 minutes at baseline to 12.9 minutes postintervention. This was a statistically significant improvement via an unpaired t-test (P < 0.0001 with a 95% CI from 15.3 to 34.47). This was rechecked after 1 year and the improvement was sustained. ConclusionA multidisciplinary team-based quality improvement initiative was successful in reducing the time it took to obtain medications for ED boarding patients.