Theses and Dissertations at Montana State University (MSU)
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Item Implementation of a multidose naloxone protocol in a rural volunteer emergency medical service: a safety-diven quality improvement project(Montana State University - Bozeman, College of Nursing, 2024) Overstreet, Riesa Rachael; Chairperson, Graduate Committee: Stacy Stellflug; This is a manuscript style paper that includes co-authored chapters.Background: Opiate overdose (OOD) deaths are increasing in Montana. Emergency medical technicians (EMTs) are the primary prehospital providers in rural areas and the first contact for many OOD patients. In the last ten years, many states have added naloxone administration to the EMT scope. Now, EMTs administer a third of the naloxone given nationally. Local problem: A rural volunteer EMS experienced patient contact times longer than the duration of naloxone's action. State protocols allowed EMTs to administer one dose of intranasal naloxone. Methods: The Iowa Model--Revised guided the quality improvement (QI) project, which aimed to provide standardized, evidence-based interventions to improve the identification and treatment of patients with OOD, expedite their arrival at definitive care, and ultimately improve patient survival. Interventions: The project team created an evidence-based multidose OOD protocol for the volunteer EMS based on the EMT, scope of practice, and the practice environment. Naloxone and protocol training, badge cards, and substance use identification training supported the protocol implementation. Results: Overall, EMTs reported protocol use for patients with any signs and symptoms of OOD 71% of the time, increasing throughout the implementation period. Fifty percent of patients with evidence-based OOD signs and symptoms received naloxone. Conclusion: The QI project demonstrated that volunteer EMTs could apply the protocol to identify and treat patients with evidence-based signs and symptoms of OOD with similar accuracy to EMS providers nationally. Interdisciplinary partnerships in resource-limited rural settings can support QI efforts and increase the representation of rural populations in the literature.Item Bar code medication administration workarounds : a learning experience(Montana State University - Bozeman, College of Nursing, 2015) Gullett, Lynda Marie; Chairperson, Graduate Committee: Linda TormaThe Institute of Medicine (IOM) created a report "To Err is Human: Building a Safer Health System" in 1999, bringing to light the scope of Adverse Drug Events (ADE). Ranked one of the most common types of medical error, medication administration errors harm at least 1.5 million people every year, while only 2% of ADEs are caught before reaching the patient. Thirty-eight percent of ADEs occurred during medication administration by nurses that could have been prevented. Bar Code Medication Administration (BCMA) is considered the gold standard, adding an additional layer of security, ensuring quality and safety during the process of medication administration. A microsystem assessment was conducted and the perception of BCMA by the nurses was a process that "worked well", however many workarounds occurred during BCMA, which increased the risk for ADEs. The purpose of this project was to improve awareness of BCMA workarounds amongst the nursing staff on the medical floor. The global aim of this project was to engage the direct care nursing staff in a root cause analysis (RCA) to identify reasons why workarounds occur on the unit during BCMA. The specific aims were to improve overall nursing compliance rates for medication and patient scanning by at least 1% and overall knowledge of BCMA policy and procedures by 20%. Background and rationales for BCMA, agency policy and procedures governing the process, and flowcharts depicting the workarounds observed during the assessment were reviewed prior to engaging the staff in a root cause analysis. The RCA focused on finding out the cause(s) of the observed workarounds. The results included meeting the specific aims with a 31% increase in overall nursing knowledge of the policy and procedures for BCMA, as well as having greater than 1% increase in scanning compliance. Feedback from the RCA resulted in a new awareness from nursing staff in how thinking in a problem solving fashion forces them to evaluate how and why they manage their workflow in the manner in which they do.Item Interruptions and distractions of nurses during medication administration on a medical surgical unit(Montana State University - Bozeman, College of Nursing, 2013) Wines, Darin Ralph; Chairperson, Graduate Committee: Sandra KuntzMedication error is one of the most common preventable problems in the United States medical system today (IOM, 2006). In 2006 the Institute of Medicine recommended there should be "research effort aimed at learning more about preventing medication errors" (p. 3). One way to achieve this goal is to better understand what contributes to medication errors during administration. Many medication administration errors are a direct result of "imperfections in the work system, work assignation, staff understanding and the working conditions" (Buchini & Quattrin, 2012, p. 327). Research shows identification of interruptions or distractions can reduce medication administration errors. Understanding interruptions and distractions create a body of knowledge for policy for future quality improvement. The purpose of this project was to identify interruption trends during medication administration among nursing personnel on one medical-surgical unit in a hospital in Montana. In order to better understand the process surrounding medication administration as well as timing and possible distractions or interruptions, a descriptive observational design was used. Twenty-two nurses on a medical surgical unit were observed during 74 medication passes. Distractions and interruptions during the process were recorded at eight different time periods. Findings of this study did not indicate one single variable was significantly responsible for distractions or interruptions. Rather, the data identified a model which helped explain over 73% the time it took to complete medication administration. Distractions and interruptions of; face-to-face, medication issues, other, equipment, and pagers all contributed. The only variable not contributing to the time equation was noise experienced by the nurse during the medication process. Creating policy to address the variables that interfere with medication administration could decrease interruptions and distractions. The ultimate goal was to create a standard medication administration process for enhanced efficiency, quality and patient safety.