Redesigning From Work-as-Imagined to Work-as-Done: A Systems Safety Approach to Bedside Medication Storage.
Purpose: This quality improvement study aimed to address challenges in medication storage and accessibility in an acute pediatric care setting. By examining current processes, improvement opportunities were identified to enhance medication availability and reduce errors by introducing new locked med...
| Publicado en: | Journal of Patient Safety Vol. 22; no. 4; pp. 334 - 340 |
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| Autores principales: | , , , , , , |
| Formato: | pictorial research Journal Article |
| Publicado: |
Lippincott Williams & Wilkins
Jul2026
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=194635845&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 194635845 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 15498417 1WYD jtl: Journal of Patient Safety issn: 15498417 maglogo: N pubinfo: dt: Jul2026 vid: 22 iid: 4 pid: 433 pub: Lippincott Williams & Wilkins place: Baltimore, Maryland artinfo: ui: 194635845 194635845 194635845 10.1097/PTS.0000000000001472 194635845 ppf: 334 ppct: 6 formats: tig: atl: Redesigning From Work-as-Imagined to Work-as-Done: A Systems Safety Approach to Bedside Medication Storage. aug: au: Kuntz, Kerri Nare, Matthew T. Assee, April Pabst, Damon Dierking, Sarah McDonnell, Jennifer Fouquet, Sarah affil: Quality, Safety, and Human Factors, Children's Mercy, Missouri sug: subj: Patient Bedside Drug Storage Methods Medication Systems Medication Errors Prevention and Control Safety Quality Improvement Pediatric Care Acute Care Health Services Accessibility Pediatric Nursing Human Female Adult Hospitals Multidisciplinary Care Team Descriptive Statistics Simulations Teaching Methods Workload Confidence Scales Workflow Time and Motion Studies Program Evaluation Task Performance and Analysis Ergonomics Knowledge Convenience Sample Male Summated Rating Scaling Adult: 19-44 years Female Male ab: Purpose: This quality improvement study aimed to address challenges in medication storage and accessibility in an acute pediatric care setting. By examining current processes, improvement opportunities were identified to enhance medication availability and reduce errors by introducing new locked medication storage boxes for multiuse, patient-specific medications. Methods: This quality improvement study was conducted in a 38-bed medical-surgical unit at a large Midwestern pediatric hospital. The study consisted of 3 phases: preintervention, simulation, and postintervention. Preintervention included near miss frequency counts, bedside medication audits, time observation audits, and a knowledge survey. The simulation phase involved in-situ simulations over 2 shifts with ten nurses (n=10), measuring success rates, task completion times, workload, and task difficulty and confidence ratings. Postintervention activities repeated the initial measures collected during the preintervention phase. Results: Participants showed a higher task success rate (94.6%) for the work-as-imagined procedure compared with a work-as-done (60%) and intervention (89%) processes. Overall, the intervention process decreased perceived workload according to the unweighted NASA-Task Load Index (NASA-TLX) scores and decreased task time compared with the work-as-imagined storage process. Confidence in task completion was highest for work-as-imagined, with a slight decrease in difficulty for the intervention or work-as-done. Conclusions: This study underscores the importance of identifying and addressing gaps between organizational policies or standard operating procedures and actual practices while engaging frontline staff. The implementation of new medication lockboxes significantly improved the medication storage process, demonstrating the effectiveness of quality improvements methods in enhancing both safety and efficiency. These findings highlight the value of a collaborative, systems-based approach in driving meaningful improvements in health care settings, ultimately contributing to better patient outcomes and operational efficiency. pubtype: Academic Journal doctype: pictorial research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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