Respiratory Care Protocols were initially developed to help manage the work flow of our department in delivering aerosol medications. Over the time period following the implementation and subsequent refinements of our protocols the hospital's Quality Improvement Department noted a significant decrease in medication errors. This study looks at the impact of our protocols on the medication error rate.
Raw data on medication errors was obtained from our Quality Improvement Department from 1/03 to 2/09. The medication errors assigned to the Respiratory Therapy (RT) Department included therapist unavailable, patient unavailable, medication unavailable and equipment unavailable. The RT medication error rate was compared to the non-RT error rate by control charts.
The following aerosol protocols were implemented: whole hospital conversion to Breath Actuated Nebulizers (BAN) and Levalbuterol q6h and q8h with q2h prn (7/2002); Levalbuterol q8h with q2h prn only and incorporating Tiotropium (10/2004); using 0.42 mg (1ml) dose Levalbuterol with the BAN (10/2005); and utilizing Arformoterol (12/2007). The initial RT medication error rate was 16.69 per 1,000 patient days. From 3/05 to 9/06 there was a sustained second-order change to 9.15 and from 9/06 to 2/09 there was another sustained second-order change to 5.76 (both p<0.001). There was no change in the non-RT error rate.
The hospital-wide reduction in medication errors was due to the improved performance in our RT department. Our Respiratory Care protocols aimed at reducing treatment times, treatment loads and variation in practice reduced medication errors. By decreasing the time needed to deliver aerosol therapy the Respiratory Therapist was more available and fewer treatments were missed.
Protocols can decrease medication errors by standardizing practice, minimizing variability and being implementation tools for guidelines. Patient safety is improved with fewer medication errors.
Russell Acevedo, No Financial Disclosure Information; No Product/Research Disclosure Information