Development of the System for the Administration of High-Alert Drugs for Patient Safety

Abstract

Objective: To develop the guideline for the administration and storage of high-alert drugs and monitor the adherence to the guideline. Method: The Drug System Development Committee of a provincial hospital developed the guideline for the administration and storage of high-alert drugs from literature review and brainstorming among its members. Subsequently, it organized training on knowledge and the guidelines on high-alert drugs emphasizing on the administration and storage for all of the 401 nurses within the hospital.  The measurement of knowledge relevant to high-alert drugs was conducted twice, one month after the training and six months later. Moreover, the administration and storage of high-alert drugs on all 18 wards was assessed twice, one month after the training and seven months later. After each assessment, feedback was provided to the wards on the practices not consistent to the guidelines. Results: Nurse’s knowledge measured after the training was 21 (out of 25). Seven months later, the knowledge significantly increased to 22.4 (P<0.05). The operation of this project did not increase the adherence of nurses on the guidelines for administration of high-alert drugs. However, it improved the adherence on the guidelines for storage of high-alert drugs with the score increasing from 11.1 in the first assessment to 13.3 (out of 16) in the second assessment. The overall score significantly increased from 78.7 in the first assessment to 84.2 (out of 100) in the second assessment. The number of patient wards with the overall score more than 90 increased from 0 in the first assessment to 6 in the second assessment. Error rate on administration of high-alert drugs decreased from 0.05-0.06 per 1000 hospital days before the project operation to 0.02 per 1000 hospital days at one year after the project operation. Conclusion: The operation to Improve the safe administration of high-alert drugs by providing relevant knowledge and guidelines to nurses, monitoring their practices on drug administration and storage of high-alert drugs and giving feedback on their practice could improve the knowledge among nurses, increase their adherence to the developed guideline and decrease errors in the administration of high-alert drugs.