Nursing Medication Administration Research Articles

A Multidisciplinary Approach to Increase Dysphagia Compliance in Stroke Patients.

BACKGROUND: The objective was to optimize conditions that increase dysphagia compliance after stroke-a measure recognized by The Joint Commission in designating institutions as primary or comprehensive stroke centers and by the American Heart Association that promotes stroke treatment adherence and bestows achievement and quality awards. Failure to meet stroke measures, including medication documentation, may produce poor patient outcomes that directly affect consumer confidence and choice of treatment facility. Stroke patient care requires multidisciplinary team collaboration to manage multiple factors; variations in practice create fallouts that need correction, the absence of which jeopardizes standards for maintaining stroke center designation. PURPOSE: Aims were to determine the nature of dysphagia fallouts in our quaternary academic teaching hospital, assess multidisciplinary workflows and barriers to success, and develop strategies to enhance dysphagia compliance. DESCRIPTION: We used a multidisciplinary approach using James Reason's Swiss cheese model to examine compliance. The clinical nurse specialist interviewed physicians, advanced practice providers, pharmacists, speech-language pathologists (SLPs), nurses, and informaticists to ascertain discipline-specific success barriers, targeting top issues for each discipline to develop solutions. Unit educators unified their dysphagia reduction strategies; physicians, pharmacists, and informaticists collaborated to clarify standardized medication route orders and to increase electronic health record swallow screen visibility to multidisciplinary users; and SLPs adjusted workflow and documentation. EVALUATION: Outcomes included reinforcing correct nursing charting, pharmacy oral-to-feeding tube conversion order revision, optimization of delivery and awareness of medication routes, electronic health record system enhancements, and SLPs aligning documentation with nursing medication administration. The multidisciplinary approach proved successful and increased dysphagia compliance by 9.6% (P = .001). These outcomes contributed to a successful The Joint Commission survey, redesignation as a comprehensive stroke center, and American Heart Association Gold Plus achievement award.

Assessing the Suitability of Interruption Intervention Strategies in Nursing Medication Administration: A Delphi Study

Purpose: This study explored the suitability of interventions for medication interruption and intervention preferences.Methods: Two rounds of Delphi surveys were conducted with 18 expert panels comprising staff (or charge) nurses, nursing managers, and Quality Improvement (QI) team nurses working in a tertiary general hospital. For 47 situations involving the location of interruption, medication step, and source of interruption, the suitability of three interventions (no-interruption zone, medication safety vest, and education) was evaluated using a 5-point scale.Results: A total of 51 interventions for each situation were found appropriate by satisfying the degree of convergence and consensus. Patients or caregivers, peer nurses, doctors, telephones, and call bells were sources of interruption and were identified as appropriate for the application of interventions. 'Responding to requests and inquiries' by patients or caregivers showed high overall suitability. The nurses' preferred color for the intervention design (no-interruption zone, medication safety vest) is blue text on a yellow background. The priority groups for education related to medication interruptions were patients or caregivers, nurses, and non-nursing staff, in that order.Conclusion: Effective implementation of tailored intervention strategies that consider the specific characteristics of medication interruptions is crucial for mitigating interruptions and enhancing patient safety. Comprehensive educational programs aimed at reducing medication interruptions by improving awareness are necessary. Moreover, future research should evaluate these strategies in clinical settings to ensure their effectiveness in enhancing patient safety.

Association of external interruptions with increased medication administration duration and self-interruptions: A direct observational study: Empirical research quantitative.

To examine task duration and frequency of self-interruptions among study participants during externally interrupted compared with externally uninterrupted simulated medication administration. Interruptions are prevalent during nursing medication administration and can lead to inefficient, delayed, omitted and unsafe patient care. Interrupted nursing tasks are shown to take longer to complete compared to uninterrupted tasks; however, studies seldom indicate if the time spent in the interruption was included or excluded in the reported task duration. It is unknown if the time spent in the interruption leads to longer task completion times or if other factors, such as the time needed to re-engage in the primary task and/or self-interruptions, are involved. Little is known about associations between external interruptions and self-interruptions during nursing tasks. Self-interruptions are caused by an individual's own decision to stop an activity to attend to something else. Cross-sectional within-subjects design. This two-site study investigated task duration and frequencies of self-interruptions during externally interrupted and externally uninterrupted simulated medication administration. Data on medication administration duration, external interruption duration and self-interruptions were collected via direct observation from November 2019-February 2020. The time spent in the external interruption was deducted from the medication administration duration. Thirty-five participants were included in the study. The externally interrupted task had a significantly longer duration and significantly more frequent self-interruptions within-subjects compared to the externally uninterrupted task. Self-interruptions were most often due to forgotten supplies. The findings suggest that the time needed to re-engage with an externally interrupted task and/or self-interruptions may lead to longer task completion times. Researchers are encouraged to investigate mediators of interruptions that lead to longer task completion times and errors. Findings can be used to develop and implement interruption management strategies that aim to improve the safety and quality of patient care. Equator guidelines were followed using the STROBE reporting method. No patient or public involvement in this study. Educators and researchers can use the study findings to guide teaching methods and direct future studies. By gaining a better understanding of the mediators of interruptions that create longer task completion times and increase the risk for errors, tailored interruption management strategies that aim to improve the safety and quality of healthcare can be developed and implemented.

463 Understanding the role of nurses in deprescribing medicines for older people: A systematic review

Abstract Introduction It is predicted that by 2035, two-thirds of people aged over 65 in the UK will be living with multiple health conditions requiring a life-long intake of multiple medicines (1). Recent reports suggest that over 8.4 million people take 5+ medicines, and 3.8 million take 8+ medicines (2). Polypharmacy, the concurrent intake of multiple medicines (5+) by one person is not problematic if the multiple medicines are prescribed appropriately to achieve clear therapeutic objectives and minimise harm. However, problematic polypharmacy arises if the risks of medicines exceed their benefits due to drug interactions and adverse drug reactions. Deprescribing is a personalised medicine optimisation intervention to ensure the safe and effective withdrawal of medicines that are no longer appropriate, beneficial or wanted. Several studies explored the role of pharmacists and doctors in deprescribing medicines for older people, and the benefits to patients and the health care system. However, literature on the nurses’ role in this process remains scarce, despite their frequent contact with older people. Aim To review the relevant studies to identify the role nurses play in deprescribing for older people. Methods This is a systematic review of qualitative and quantitative studies, published in Embase, CINHAL, Google Scholar, British Nursing Database and PubMed, between 2012 and 2022. A manual search of reference lists of included studies was also conducted. We used key words such as nurse, nurse prescriber, deprescribing and medication optimisation to search for studies reporting on the role of nurses in deprescribing medicines for older people >65 years of age, in all healthcare settings. The quality of studies was appraised using the Critical Appraisal Skills Programme (CASP) tool. Thematic analysis was used to identify recurrent themes or concepts from the included studies, and these were then synthesised to answer the research question. Results Twelve studies met the inclusion criteria, 11 of which were of qualitative design. All of the included studies were of moderate to high quality. Five critical roles of nurses in deprescribing were identified including: (i) Assessors; (ii) Co-ordinators; (iii) Facilitators, (iv) Communicators; and (v) Educators. Deprescribing requires multidisciplinary collaboration with clear communication between healthcare providers, and nurses are key players through their management of patients and physically effecting prescribing and deprescribing. They also have a role in assessing patients for deprescribing opportunity, coordinating multidisciplinary healthcare professional support, communicating with patients, relatives and other healthcare professionals, and educating nurses and other healthcare professionals on the importance of deprescribing as a discipline. Despite this, deprescribing is not yet integrated into nurse medication administration, prescribing, and initial or continued professional development. Conclusion Evidence on the role of nurses in deprescribing for the older people is limited. However, the studies included in this systematic review highlight the crucial role nurses play in all stages of the process. Further exploration is required to understand the role of the nurse in deprescribing and how their initial and continued professional development can be optimised to support it.

Improving Nursing Medication Administration Practice in Inpatient Units: A Quality Improvement Project

Background: Nurses play a unique and crucial role in medication administration. In hospital units, the medication administration process is frequently viewed as a series of sequential steps, beginning with prescribing, then dispensing, and finally administering to the patient. Local problem: Data from 2020 indicated improper nursing medication administration practices in the hospital's inpatient units, despite adherence to medication safety standards and policies, so the current project was created to improve nursing medication administration compliance. Methods: A quality improvement project was conducted using the Standards for Quality Improvement Reporting Excellence Revised Publication Guidelines (SQUIRE 2.0). Common quality improvement tools were used, including the fishbone diagram, Focus PDCA, and the General Medication Administration (GMA) instrument. Interventions: Staff audit interviews and observations, as well as engaging and educating processes, were conducted weekly. A final medication administration compliance assessment was performed on the staff. Results: The present project found high medication administration compliance and an excessive enhancement of awareness among nurses related to medication administration. Conclusion: This quality improvement project summarizes the steps of using quality improvement tools to find and treat improper medication administration practices. As is obvious, there has been improvement in nursing compliance.

Development of a Behavioral Change Strategy to Improve the Safety of Nursing Medication Administration.

Development of a Behavioral Change Strategy to Improve the Safety of Nursing Medication Administration.

316 Improving Electronic Prescribing of Mechanical VTE Prophylaxis in General Surgery Patients

Abstract Aim Mechanical VTE prophylaxis forms part of NICE guidance in general surgical patients. Locally, thromboembolic deterrent (TED) stockings are used but not available as a prescription item on the electronic system. They are often prescribed verbally or via noted plans but do not appear on the medication administration record. Importantly, multiple incidents of patient harm through pressure damage have been seen due to poorly checked TEDs. Our aim was to audit and improve safe mechanical VTE prophylaxis prescribing. Method At each cycle, we retrospectively collected data from two weeks of admissions. Data relating to VTE assessment completion, VTE score, TEDs in use, TEDs prescription and LMWH prescription was collected. Our initial intervention consisted of departmental education regarding a work around enabling TEDs to be prescribed as a freehand extra-formulary item. This was reaudited at 12 months. Results All patients in both cycles had VTE assessments completed. TED stocking use increased significantly from 5.1% to 26.4% and prescription of TEDs, when used, increased from 0% to 61.1%. However, documentation regarding daily checks was non-existent. Conclusions Our QIP showed a significant improvement in TEDs use and prescription. However, the intervention is difficult and time consuming. Subsequently from this project, a TEDs stocking item is in the final approval phase for integration into the online prescribing system and will come with associated safety checks built into the nursing medication administration system. Once this is live, we will complete a third cycle to assess uptake and again at 6 months to assess for lasting change.

TH7.12 Improving electronic prescribing of mechanical VTE prophylaxis in general surgery patients

Abstract Aims Mechanical VTE prophylaxis forms part of NICE guidance in general surgical patients. Locally, thromboembolic deterrent (TED) stockings are used but not available as a prescription item on the electronic system. They are often prescribed verbally or via noted plans but do not appear on the medication administration record. Importantly, multiple incidents of patient harm through pressure damage have been seen due to poorly checked TEDs. Our aim was to audit and improve safe mechanical VTE prophylaxis prescribing. Methods At each cycle, we retrospectively collected data from two weeks of admissions. Data relating to VTE assessment completion, VTE score, TEDs in use, TEDs prescription and LMWH prescription was collected. Our initial intervention consisted of departmental education regarding a work around enabling TEDs to be prescribed as a freehand extra-formulary item. This was reaudited at 12 months. Results All patients in both cycles had VTE assessments completed. TED stocking use increased significantly from 5.1% to 26.4% and prescription of TEDs, when used, increased from 0% to 61.1%. However, documentation regarding daily checks was non-existent. Conclusions Our QIP showed a significant improvement in TEDs use and prescription. However, the intervention is difficult and time consuming. Subsequently from this project, a TEDs stocking item is in the final approval phase for integration into the online prescribing system and will come with associated safety checks built into the nursing medication administration system. Once this is live, we will complete a third cycle to assess uptake and again at 6 months to assess for lasting change.

Agent-based Modeling Simulation of Nurse Medication Administration Errors.

CIN: Computers, Informatics, Nursing: April 2021 - Volume 39 - Issue 4 - p 229 doi: 10.1097/01.NCN.0000741992.26395.d4

Agent-Based Modeling Simulation of Nurse Medication Administration Errors.

It has been 20 years since the National Academy of Medicine released its report, "To Err Is Human," which shocked the healthcare community on the pervasiveness of medical error. While errors in medication administration are a significant contributor to medical error, research seeking to understand the complex systems nature and occurrence of medication administration error is limited. Computer modeling is increasingly being used in the healthcare industry to assess the impact of changes made to healthcare processes. The objective of the study is to evaluate the use of agent-based modeling, a type of computer modeling that allows the simulation of virtual individuals and their behavior, to simulate nurse performance in the medication administration process. The model explores the effect of Just-in-Time information, as an intervention, on the occurrence of medication error. The model demonstrated significant utility in understanding the interplay of the system elements of the nurse medication administration process. Therefore this approach, using systems-level computer simulation such as agent-based models, can help administrators understand the effects of changes to the medication administration process as they work to reduce errors and increase performance.

The Essential Steps of Medication Administration Practices Project medication administration improvement practices among acute inpatients in a tertiary hospital

The current project aimed to conduct an audit of nursing medication administration practices, to implement evidence-based best practice recommendations and assess the effectiveness of these changes in maximizing medication administration safety and reducing the risks of adverse incidents across 10 wards/units in a large tertiary hospital.Medications are the most common treatment used in healthcare. Because they are so commonly used, medications are associated with a higher incidence of errors and adverse events than other healthcare interventions. Nurses are primarily involved in the administration of medications to patients and this duty is an important aspect of professional practice. The Australian Commission on Safety and Quality in Healthcare has recognized medication safety as a National Standard, thus reinforcing its importance.The project used the JBI's Practical Application of Clinical Evidence System and Getting Research into Practice audit tool for promoting change in healthcare practice. A baseline audit of 200 observations of medication administration was conducted and measured against eight best practice recommendations, followed by the implementation of targeted strategies and follow-up audits.The baseline audit revealed deficits between current practice and best practice in three of the eight criteria. Identification of barriers for implementation of medication administration best practice criteria were made by the project team and reflective practice and ward/unit led strategies were implemented. There were improved or sustained outcomes across all best practice criteria in the follow-up audits.The findings showed how audit may be used to promote best practice in healthcare and that reflective practice and front-line led strategies can have a positive impact on clinical practice. Some of the measured criteria did not reach 100%, leaving room for improvement; however, by the end of the project attitudes towards medication administration had been 'transformed' from a passive, routine 'must do' task, to an active process with a focus on safety and patient/carer engagement. Future audits are planned to ensure sustainability.

A Meta-Analysis of the Effects of Intervention on the Prevention of Medication Administration Errors in Nurses

Background/Objectives: Medication errors are one of the most common medical incidents occurring in hospitals and are the major health events. This study aims to perform a meta-analysis of the effects of intervention on the avoidance errors in nurses and to provide basic data for evidence-based nursing practice.Method/Statistical Analysis: CINAHL, PubMed, EMBASE, Ovid, the Cochrane Library and relevant articles published in January 1975 and in February 2018 were searched. Randomized controlled trial and non-randomized controlled trials were included. Risk of Bias and Risk of Bias Assessment tool for Non-randomized Studies were used to evaluate quality of the selected studies. The random effects model was used considering various characteristics of the selected studies to calculate average effect size.Findings: A total of 3538 studies were retrieved from five electronic databases, thirty studies of which were included in this study: five were randomized controlled trials and eight were non-randomized controlled trials. Interventions were medical devices and education intervention. Medical devices intervention was useful to directly reduce nurse medication administration errors (OR=0.64, 95% CI: 0.45 to 0.93. p=.020), and simulation education was effective in improving nurse medication knowledge (SMD=1.06, 95% CI: 0.07 to 2.05, p=.036).Improvements/Applications: The results of this study can be widely used as the bias for the selection of useful moderations to increase safety of patients at nursing sites.

A Meta-Analysis of the Effects of Intervention on the Prevention of Medication Administration Errors in Nurses

Background/Objectives: Medication errors are one of the most common medical incidents occurring in hospitals and are the major health events. This study aims to perform a meta-analysis of the effects of intervention on the avoidance errors in nurses and to provide basic data for evidence-based nursing practice.Method/Statistical Analysis: CINAHL, PubMed, EMBASE, Ovid, the Cochrane Library and relevant articles published in January 1975 and in February 2018 were searched. Randomized controlled trial and non-randomized controlled trials were included. Risk of Bias and Risk of Bias Assessment tool for Non-randomized Studies were used to evaluate quality of the selected studies. The random effects model was used considering various characteristics of the selected studies to calculate average effect size.Findings: A total of 3538 studies were retrieved from five electronic databases, thirty studies of which were included in this study: five were randomized controlled trials and eight were non-randomized controlled trials. Interventions were medical devices and education intervention. Medical devices intervention was useful to directly reduce nurse medication administration errors (OR=0.64, 95% CI: 0.45 to 0.93. p=.020), and simulation education was effective in improving nurse medication knowledge (SMD=1.06, 95% CI: 0.07 to 2.05, p=.036).Improvements/Applications: The results of this study can be widely used as the bias for the selection of useful moderations to increase safety of patients at nursing sites.

Exploring an extended role for pharmacy assistants on inpatient wards in UK hospitals: using mixed methods to develop the role of medicines assistants

ObjectivesThis project explored the deployment of pharmacy assistants to inpatient wards in a new role as ‘medicines assistants’ (MA).MethodsWard-based MAs were introduced to six wards across two UK hospitals to...

Characteristics of interruptions during medication administration: An integrative review of direct observational studies.

To synthesise and summarise data gathered by direct observation of the characteristics of interruptions in the context of nursing medication administration (MA) in hospital settings. Interruptions are prevalent during the MA process performed by nurses in hospital settings and have been found to be associated with an increase in frequency and severity of nursing MA errors. In addition, interruptions decrease task efficiency, leading to longer MA completion times. Integrative review. The electronic databases Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, PsycARTICLES and Google Scholar were searched using the terms "interruptions" AND "medication administration" AND "direct observation." Nine articles met the inclusion criteria. Interruptions are likely to occur at least once during nursing MA processes in hospital settings. This finding applies to medication administered to one patient, termed a medication pass, and medication administered to multiple patients, termed a medication round. Interruptions are most commonly caused by another nurse or staff member or are self-initiated, and last approximately 1min in length. A raised awareness among staff of the most common sources of interruptions may encourage changes that lead to a decrease in the occurrence of interruptions. In addition, nurse leaders can apply an understanding of the common characteristics of interruptions to guide research, policies and educational methods aimed at interruption management strategies. The findings from this review can be used to guide the identification and development of targeted interventions and strategies that would have the most substantial impact to reduce and manage interruptions during MA. Interruption management strategies have the potential to lead to a decrease in medication errors and an increase in task efficiency.

Medication administration evaluation tool design: An expert panel review

BackgroundTools currently available to evaluate nurse medication administration practices have limitations and are either not validated or have poor reliability. AimTo identify criteria and content for inclusion in a tool to evaluate medication administration by nurses in the clinical setting, using an expert panel. MethodsA peer review process using an expert multidisciplinary panel rated the relevance of the content on three tools; Medication Administration Safety Assessment Tool, Medication with Respect Tool and Clinical Skills Assessment Tool, using a four-point rating scale. Expert opinion was provided on relevance of content, rating scales and frequency of nurse evaluation. The level of agreement was analysed by item content validity index, mean item content validity index, mean expert proportion, scale content validity index with universal agreement, probability of chance agreement and a modified kappa rating. Qualitative themes were also reviewed. FindingsThe item and scale content validity index and the kappa index both rated the Medication Administration Safety Assessment Tool and Clinical Skills Assessment Tool as excellent. For the Medication with Respect Tool less than half of the item content validity index ratings rated as good and the kappa index rated as excellent, therefore the scale content validity did not achieve a good rating. ConclusionsThe expert panel review identified items of high level of agreement for relevance and determined that content needed to be clear, concise, observable, generic and practical to be useful for all nurses. Self-evaluation, feedback and a developmental plan were also key criteria.

Novel approach to vancomycin level monitoring: Impact of a multidisciplinary monitoring system on timing of vancomycin levels

A novel approach to vancomycin level monitoring is described. Vancomycin trough orders were added to the medication ordering system of a large teaching hospital and were generated when vancomycin was ordered. Pharmacists adjusted the order time so that the level was drawn appropriately. After pharmacist validation, the trough order appeared within the nursing medication list, and nurses were required to document when the level was drawn. Outcomes were evaluated before (retrospective group) and after (prospective group) implementation of this initiative. Among all patients for whom a vancomycin level was drawn, 24.0% of patients in the retrospective group had their first vancomycin level drawn within 2 hours of true trough, compared with 87.2% of patients in the prospective group (p < 0.0001). Among all patients receiving vancomycin, significantly more patients in the prospective group had a level drawn within 2 hours of the true trough compared with the retrospective group (71.9% versus 20.6%, p < 0.0001). Further, significantly more patients in the prospective group had a vancomycin level ordered compared with the retrospective group (100.0% versus 90.8%, p < 0.0001). The mean ± S.D. time from true trough that vancomycin levels were drawn was much longer in the retrospective group (184.9 ± 84.8 minutes versus 58.3 ± 60.7 minutes in the prospective group, p < 0.0001). A novel multidisciplinary approach to vancomycin trough monitoring involving automatic generation of trough orders, pharmacist validation of trough orders, and inclusion of trough orders in the nursing medication administration record was successful in significantly improving timing of vancomycin trough levels.

2460

OBJECTIVES/SPECIFIC AIMS: Ivor-Lewis esophagectomy (ILE) is an invasive surgical procedure with a high incidence of postoperative pneumonia. Antibiotic prophylaxis could reduce respiratory infections but increase Clostridium difficile and antibiotic resistance. Our institution reduced the duration of piperacillin-tazobactam prophylaxis following ILE from 4 to 1 day or less in January 2015. We evaluated short-term outcomes in ILE patients before and after this institutional change. METHODS/STUDY POPULATION: Retrospective cohort study of all ILE patients from 2012 to 2016. We confirmed antibiotic duration directly from nursing medication administration records. The primary outcomes of this study were rates of C. difficile and postoperative pneumonia. Secondary outcomes include other infection, length of hospital stay, and readmission within 30 days. We used logistic regression to analyze impact of days of antibiotics and χ2 or Fischer exact tests for categorical variables. RESULTS/ANTICIPATED RESULTS: Of 104 ILE patients, 40.4% (n=42) were after January 2015, 11.5% developed pneumonia and 5.8% developed C. difficile colitis. ILE patients received more days of antibiotics before the institutional change compared with after (6.1 vs. 2.9 d, p&lt;0.01). For a 1-day increase in antibiotic duration, the odds of acquiring C. difficile increased significantly by 1.2 (p=0.03). Before compared with after the institutional change, rates of C. difficile were 8.1% Versus 2.4% (p&gt;0.2), rates of pneumonia were 11.3% Versus 11.9% (p&gt;0.2), and length of stay was 10.9 Versus 10.5 days (p&gt;0.2), respectively. DISCUSSION/SIGNIFICANCE OF IMPACT: Institutional policy can have an impact on patient outcomes. Antibiotic stewardship is associated with reduced rates of inpatient C. difficile. Our study suggests reduced antibiotics are not associated with pneumonia, although larger studies are necessary to confirm this finding. Surgeons should consider the benefit of decreased rates of C. difficile before administering prolonged antibiotic prophylaxis following esophagectomies.

Assessment of the Nurse Medication Administration Workflow Process.

This paper presents findings of an observational study of the Registered Nurse (RN) Medication Administration Process (MAP) conducted on two comparable medical units in a large urban tertiary care medical center in Columbia, South Carolina. A total of 305 individual MAP observations were recorded over a 6-week period with an average of 5 MAP observations per RN participant for both clinical units. A key MAP variation was identified in terms of unbundled versus bundled MAP performance. In the unbundled workflow, an RN engages in the MAP by performing only MAP tasks during a care episode. In the bundled workflow, an RN completes medication administration along with other patient care responsibilities during the care episode. Using a discrete-event simulation model, this paper addresses the difference between unbundled and bundled workflow and their effects on simulated redesign interventions.

Use of failure mode, effect and criticality analysis to improve safety in the medication administration process.

To critically evaluate the causes of preventable adverse drug events during the nurse medication administration process in inpatient units with computerized prescription order entry and profiled automated dispensing cabinets in order to prioritize interventions that need to be implemented and to evaluate the impact of specific interventions on the criticality index. This is a failure mode, effects and criticality analysis (FMECA) study. A multidisciplinary consensus committee composed of pharmacists, nurses and doctors evaluated the process of administering medications in a hospital setting in Spain. By analysing the process, all failure modes were identified and criticality was determined by rating severity, frequency and likelihood of failure detection on a scale of 1 to 10, using adapted versions of already published scales. Safety strategies were identified and prioritized. Through consensus, the committee identified eight processes and 40 failure modes, of which 20 were classified as high risk. The sum of the criticality indices was 5254. For the potential high-risk failure modes, 21 different potential causes were found resulting in 24 recommendations. Thirteen recommendations were prioritized and developed over a 24-month period, reducing total criticality from 5254 to 3572 (a 32.0% reduction). The recommendations with a greater impact on criticality were the development of an electronic medication administration record (-582) and the standardization of intravenous drug compounding in the unit (-168). Other improvements, such as barcode medication administration technology (-1033), were scheduled for a longer period of time because of lower feasibility. FMECA is a useful approach that can improve the medication administration process.