Abstract 160: Nurse Driven Protocol For Medication Routes In Adult Patients With Pharmacy Assistance
Introduction/ Objective: Stroke patients are at high risk for swallowing complications which leads many patients to receive a temporary or permanent enteral feeding tube. Providers are required by regulatory guidelines to indicate in medication orders the specific route in which a medication will be administered. The data for our stroke patients from CY (calendar year) 2020 showed a 23% average of stroke patients had incorrectly documented medication routes. We designed a pilot study to assess the feasibility of a nurse driven protocol that involved nursing communication with pharmacy to change medication routes. This protocol was created to ensure safe and timely administration, correct medication dosage and formulation, and would meet standards of regulatory guidelines for medication orders.
Methods: All patients admitted to the neurosurgical ICU were included in the pilot from April 5th to May 3rd, 2021. In the pilot, nursing had the ability to enter a “substitute dosage form” through the existing medication request system in the electronic medical record (MedConnect). This MedConnect request alerted the Pharmacist to review all medications on the MAR and change the administration routes to the correct route as indicated by the nurse on the request. After review, the pharmacist would contact the provider for either an order discontinuation or a new order for medications identified as unable to be crushed or requiring a new order for appropriate formulation conversion.
Results: During the pilot study period a total of 102 patients were admitted to the neurosurgical ICU. Of these patients, 15% (15/102) had medications documented with the incorrect route by the nurse. Of those 15 patients, 73% (11/15) did not have a medication request completed by the nurse. The remaining patients (4/15) or 27% had a medication request completed by a nurse but pharmacy failed to intervene. Comparing this data to that of CY 2020, there was an 8% improvement in correct medication routes.
Conclusion: A nurse driven protocol for medication routes involving pharmacy is feasible and may be associated with a reduction of medication route errors. The plan is to expand this nurse driven protocol house-wide at our hospital.