Implementing changes in clinical settings is important because they can often improve the quality of care and promote the mission and vision of healthcare facilities. In the pediatric intensive care unit, adverse drug effects are a common problem because 12.2 percent of the population in the unit is affected by adverse drug effects that have a high mortality rate (Silva et al., 2013). According to a study by Silva et al. (2013), use of multiple drugs and low patient age are the main factors that cause adverse drug effects in pediatric intensive care units.
Commonly used drugs in intensive care units, such as the routinely administered inotropes and antibiotics, are often hazardous to young patients, and each additional drug increases the change for adverse effects by 1.7 percent (Silva et al., 2013). Possible drug-related issues that can impact the occurrence of adverse drug effects include toxicity, dosage, time of administration, and duration of use, but drugs are also sometimes administered to resolve issues caused by other drugs, so better diagnostic methods are required (Silva et al., 2013).
With those findings in mind, it is possible to suggest that controlling drug treatments is a high priority for pediatric intensive care units. The implementation of a bar-coded medication administration (BCMA) system is a change that would lower adverse drug effects because it would introduce an organized central system for drug administration that would allow nurses to monitor several factors, including time of administration, dosage, and duration of use, of drug therapy on each patient individually (Schifalacqua, Costello & Denman, 2009).
The proposed change to solve the issue of adverse drug effects would align the intensive care unit with its goals and mission because the mission of intensive care is to deliver optimal care based on empirical evidence from scientific research. The vision of intensive care is to provide optimal care for patients in critical condition and maximizing positive outcomes, so the change is in alignment with the vision. The goals of leaders in the intensive care unit are related to improving multidisciplinary interventions and constant quality improvement in care delivery, so the change would be in alignment with the unit’s goals as well.
Kurt Lewin’s three-phase change model would be used to implement the BCMA system. That model would be selected because it addresses all fundamental aspects of change, so it can be applied across different settings equally. In the first phase, it is important to induce a need for change among the staff to facilitate its implementation (Marquis & Huston, 2012). However, presenting the need to change in this scenario would be simple because guilt or concern for the well-being of patients can be elicited. In addition, workload in healthcare facilities for nurses was reduced after implementing the BCMA system (Schifalacqua et al., 2009), so it will probably be easy to motivate the staff to accept the change.
In the second phase, identifying obstacles and finding solutions would be used to develop a plan of action for implementing the change. For example, obstacles can be cultural or individual. Promoting a culture based on open communication and trustworthiness is important, so the first step in implementing the change is to create policy should include penalties only for employees who violate legal regulations because the staff members might reject a system used for tracking and punishing their errors.
Individual obstacles may be the lack of capacity or capability, which are both equally important for facilitating change (Bevan, 2010). The second step would be to build confidence among staff members who want to engage in a new learning experience and give them the opportunity to learn the skills required for operating the BCMA system by attending educational courses. Once the employees develop the capacity and capability, the third step would be to implement the hardware and software required to operate the system.
Finally, the third stage is when the change becomes a constant. However, because further improvements should be made, it is important to engage in multidisciplinary learning encounters and frequently measuring results and adapting protocols accordingly. The fourth step would be to promote collaboration between nurses and pharmacist because it would be possible to maximize the positive outcomes enabled by the new system. The fifth step would be to measure results and look for potential improvements in the system.
Although changes are difficult to implement in larger organizations because they take time to become constant and lot of strategic planning, implementing a BCMA system in a pediatric intensive care unit is a change that will result in a positive outcome. Because using multiple medications in a single treatment without proper oversight can be a risk factor for adverse effects, the staff should be motivated to implement an improved and reliable system in practice that will most likely reduce error margins, which are responsible for high morbidity and mortality rates in the pediatric intensive care unit.
References
Bevan, H. (2010). How can we build skills to transform the healthcare system? Journal of Research in Nursing, 15(2), 139-148.
Marquis, B. L., & Huston, C. J. (2012). Leadership roles and management functions in nursing: Theory and application (Laureate Education, Inc., custom ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.
Schifalacqua, M., Costello, C., & Denman, W. (2009). Roadmap for planned change, part 2: Bar-coded medication administration. Nurse Leader, 7(2), 32-35.
Silva, D. C., Araujo, O. R., Arduini, R. G., Alonso, C. F., Shibata, A. R., & Troster, E. J. (2013). Adverse drug events in a paediatric intensive care unit: A prospective cohort. BMJ open, 3(2).
