Developing and Implementing Medication Administration Protocol in a Residential Treatment Facility

Background:In the United States, medication errors are responsible for thousands of deaths every year in the pediatric population. Residential treatment facilities hire unlicensed medical staff to administer medications with minimal training and supervision from a licensed medical provider. The state of Utah does not mandate or regulate the amount of training hours required for medication administration in residential treatment facilities. Providing more training for medication administration and medication safety could help to decrease medication errors. The purpose of this quality improvement project is to implement a pediatric medication administration evidence-based practice protocol to improve the knowledge and safety of medication administration for staff at a residential treatment facility.Method:In this quality improvement project, a pre-education survey was used to assess staff member's knowledge of medication administration and medication safety and observe for medication errors for one medication pass in each of the four homes. A training on medication administration and the medication safety toolkit was conducted for staff members using the results from the pre-education survey. The post-education survey was implemented one month after medication training to assess for feasibility, usability, and satisfaction. Additionally, three months following the training, another medication observation was completed in each of the four homes for one medication pass to compare pre- and post-medication errors.Results:In this study, 13 of the 16 staff members (n=13, 81%) who administer medications completed the pre-survey one month before medication education training, and a total of 11 staff members (n=11, 69%) completed the post-survey one month after medication education training. Results from the pre-education survey showed that 69% (n=9) felt well trained to administer medications, and 62% (n=8) had made a medication error. The most common themes from the pre-education survey were "Less Distractions" and "More Training with Med Pass & Medications." Post-education survey results showed that 82% (n=9) of participants found the medication training useful, and 82% (n=9) felt the medication safety toolkit was easy to use. In the post medication error observation, there was a 19% increase in washing hands (3/16) and a 19% increase in hand sanitizer use (3/16). There was a 25% (4/16) medication error rate in the pre-medication error observation and a decrease with no medication errors (0/16) during the post medication error observation. The change in the medication error rate in the post-medication error observation was the only significant change when compared to the pre-medication error observation results.Conclusions:The medication administration training and medication safety toolkit was well received from the participants that completed the survey. Further quality improvement studies need to be conducted to determine if an increase in medication administration training and an increase in compliance monitoring would lead to better outcomes.