Optimization of Medication Workflows to Improve Timely Medication Administration on a Pediatric Hospital Unit: A Quality Improvement Project

OBJECTIVE Medication workflows are important to improve patient safety and provide timely lifesaving medical care. When operating efficiently, they can also decrease medication and labor waste. The objective of this quality improvement project is to compare missing dose request rates before and after improvements in medication workflows, specifically, decreases in medication and labor waste and the financial implications of these improvements. METHODS The study evaluated the rate of medication missing dose requests on a 24-bed medical surgical unit in a standalone pediatric hospital from May 2022 to October 2022. Medication workflows were evaluated by pharmacy and nursing team members, and interventions were identified and implemented with the Model for Improvement methodology. Outcomes of missing dose requests per 100 medication doses dispensed were tracked weekly, as were staff time and costs of medications. RESULTS The missing dose requests per 100 medication doses dispensed decreased from 3.8 to 1.03 during the 6-month initiative. This improvement estimated that 988 missing medication doses were prevented, leading to an estimated $61,038.64 in waste savings. The average cost of the medication and materials (excluding labor) to replace a single missing dose of medication was $61.78. The median cost was $54.71 (IQR, 11.91–4,213.11). Pharmacist, pharmacy technician, and nurse time saved per missing dose were estimated to be 6, 14, and 17 minutes, respectively. CONCLUSION Multimodal improvements in inpatient medication workflow reduce missed medication errors and improve cost and labor efficiencies.