Hospitals in pursuit of excellence

"Time Out" for Meds Safety

Front-line nurses led the way in a medication safety initiative at Stanford Hospital & Clinics, Stanford, Calif. This initiative?Medication Pass Time Out?targeted reducing distractions and interruptions and, ultimately, medication administration errors. An eight-member implementation team, supported by senior executives, used the Plan-Do-Check-Act cycle to evaluate process and monitor interventions in a pilot unit. The team worked with unit nurses to draft a policy that "builds a protected hour with no interruptions early in a shift for a nurse to exclusively focus on reconciling medication orders, administering medication, checking labels and charting medication administration," says Elisa Nguyen, patient care manager, Patient Care Services. Another pilot unit tested the process and revised it several times. Six months after implementation, the pilot unit improved their medication administration process without interruption from 81 percent to 99 percent and medication administration error rate from 98 percent to 100 percent. Medication Pass Time Out has been rolled out to other hospital units. This work was part of a larger initiative to improve patient outcomes throughout Bay Area hospitals. To learn more, contact Nguyen at enguyen@stanfordmed.org.