Essay: Plan to increase staff compliance in using BCMA

Executive Summary
Recently, a 350-bed urban hospital spent millions of dollars initiating the usage of the Bar Code Medication Administration systems in efforts to decrease the number of medication errors, improve documentation, and help to reduce the amount of money spent in replenishing supplies. Even though the amount of “rights for medication” has increased overtime, the use of BMCA serves to protect patients against medication errors by verifying the original “five” rights (Alexander, Frith, Hoy 2015). Unfortunately, it has been brought to my attention as charge nurse of a 25- bed medical-surgical unit that not all of the staff was onboard with this new innovation. Therefore, putting at risk the health of the patient’s through creating shortcuts when using the BCMA system. Due to this noncompliance presented from the staff, a plan has been established in an effort to increase the staff’s compliance. The goal of this plan is to increase compliance in the unit to at least 95% within the next year.
Plan
Using the theory of innovation and the transformational leadership style, management will initiate a plan that will help make this new change a process that is easier to accept and improve the unprofessional attitudes demonstrated by some of the staff. The plan will also aid towards cultivating a positive environment that can make any staff member feel welcomed into. With the leadership of a transformational leader one of the goals is to build an environment where staff can come together to voice all opinions without receiving any judgmental repercussions. This will be ensured by centering on open-communication, mutual respect, and accountability. When accountability is not given to those who are non-compliant, staff members who are in fact obeying the new rules may see it as an opportunity to also break the rules. To have this plan be effective, leaders of the team will make sure to practice an open-door policy so that they can be reached whenever necessary. Also, it is imperative to make sure that everyone is on the same page and therefore, staff meetings will be held every week for the first month and every month thereafter. The goals of this plan will be shared among everyone in the unit and implemented through evidence-based nursing interventions. Building a multidisciplinary team with management, the pharmacy department, and IT, will aid in getting everyone to be involved with the change therefore decreasing the chances of having misunderstandings throughout the process.
The staff members who comply and agree with the use of BCMA will be recognized with their photo making it to the “Nurse Innovator Wall”. Typically, recognition and appreciation are sought in a dynamic field like nursing, especially when nurses are able to adjust accordingly. The complying staff members will be helpful in making the manager aware of all noncompliance occurring on the medical surgical unit. Resisters will be able to approach the nurse innovators and managers at any time during the twelve-hour shifts. Those who continue to resist will be asked to speak with the manager an in effort to figure out what’s the root of the issue and how to combat it. There will be daily rounds performed by the manager, weekly staff meetings for the first month and monthly after that, and informational flyers available around the unit to remind staff of the importance and purpose of utilizing BCMA properly.
Throughout this plan, interviews will be held with every staff member to evaluate the progress being made. Other tools that will assist with the evaluation are data reports and random check-offs every shift. These measures will assist in tracking the trend of compliance. As an incentive, free lunch meals will be provided monthly for the staff members who are meeting and executing the expected standards. Lastly, at the end of the twelve months the manager will sit one-on-one with each staff member of the unit to review individualized data reports that depict the percentage of compliance with the usage of the BCMA system. These reports will serve to determine whether or not the individual qualifies for a monetary incentive such as an annual raise.
Bar-Coded Medication Administration
Today, healthcare providers must identify the patient using two patient identifiers, such as their name and date of birth. To add on to that safety, despite the number of medication rights changing, the original five still remain: the right patient, right medication, right dose, right route, and right time (Alexander, Frith, Hoy, 2015). While these rights serve as a protective barrier to keep the patient safe from medication errors, the use of BCMA helps comply with these rights by alerting the nurse of any discrepancies. In a study performed by Macias (2018) and colleagues it was found that when paying attention to errors that the BCMA has influence over, the incidence was reduced by 85%. Errors such as wrong medication, administration omission, wrong dose, and wrong order of administration.
The Problem
It has been discovered that some members of this medical-surgical unit have been non-compliant with the addition of the BCMA system. Some of the barriers that have implicated resistance to this change have been presented as the system causing a lack of convenience and being a time-consuming practice. Some staff members have voiced their opinions and carried an unprofessional attitude to express them. One highly experienced and strong staff nurse even stated that she would rather resign than use the BCMA system. Nurses have reported that due to the additional safety checks that are required, the process of medication administration is delayed. Due to the resistance to change, the risk of medication errors and patient harm has increased with staff creating short-cuts such as, pre-scanning medications or documenting that the medications have been administered when, in fact, they have not. Some have also been overriding the barcode warning assuming it’s some kind of a glitch within the system.
Change Model
Adding a new process or protocol to the unit can be defined as a new innovation. It can depict growth and creativity (Hernandez et al., 2013). In the field of nursing it is essential that leaders address the problem identified by encouraging innovation. (Huber, 2018). Rogers’(2003) innovation-decision process consists of five stages: First, knowledge of an innovation’s existence and functions; Second, persuasion to form an attitude toward the innovation; Third, decision to adopt or reject; Fourth, implementation of the new idea; Fifth, confirmation to reinforce or reverse the innovation decision. Implementing Roger’s innovation theory, allows the problem at hand be addressed, introduce a solution, and evaluate the results. It’s expected that every staff member adapts differently to the innovation.
Changing Unit Culture and Attitudes Through Leadership
To achieve full participation from the staff, transformational leadership will be available at all times. A transformational leader motivates others and focuses on team growth and development. Transformational leadership has been studied with regards to successful change management and is the leadership that works best during circumstances of growth, change, and crisis. (Huber, 2018). Also, used to alter culture when needed in an organization.
Strategies for Identifying Supporters and Resisters
To successfully create change, those who adapt swiftly and execute exemplary behavior regarding the innovation will be used to influence and motivate the resisters to accept the change. Fear of the unknown can cause some to hold on to their old procedures and protocols. Having nurses demonstrate how the change is successfully being implemented will serve as paragons for the resisters. While providing support and how-to steps with regards to the innovation, supporters will have access to insight with the resisters and communicate the information back to the manager in an effort to successfully resolve the problem.
Strategies for Reducing Resistance
Some strategies that will be used by managers to reduce resistance are offering support during stressful moments, lending an ear, promoting solutions, keeping everyone involved and informed, and encouraging participation (Huber, 2018).
Strategies to Increase Support
Nurse managers and leaders are an important role when creating an environment that fosters and encourages innovation. Nurse leaders must create environments and opportunities for staff innovation; communicate expectations concerning time commitments and acceptable levels of risk; and allow for failures without blame. Creating opportunity for innovation involves acceptance of risk and the unknown, and fostering creativity and intellectual stimulation (Boston-Fleischhauer, 2016). Joseph and Huber (2016) also emphasized this point, noting that an effective leader will create an environment that will support new mindsets.
Team Building
To successfully build a team and maintain the interdisciplinary approach, all members will be included in outgoing emails, staff meetings, and informed about the incentives presented earlier.
Feedback and communication
A judgment-free environment is necessary to foster a trustworthy environment in which all the staff can openly communicate without fear of being lashed out at. Everyone should be able to express their opinions and concerns freely. Feedback regarding the new implementation will be available during one-to-one sessions or via emails. To help encourage staff members to speak up, a suggestion box will be placed in the employee’s lounge room. This will help employees submit suggestions or concerns anonymously.
Evaluating Effectiveness
Evaluating the trend of compliance will fall on the shoulders of the managers, as well as the leaders who are in agreement with this change. Random interviews and medication administration check-offs will be made throughout the shift. During staff meetings, results will be shared as a whole unit rather than per individual. This will help everyone not feel bombarded and continues to send the message that this is a team-effort process.
Maintaining the Changes
To maintain the changes made, individuals’ compliance will continue to be assessed. If found that compliance is decreasing, interventions (e.g., one-on-one conferences) will take place to purge the obstacles at hand. Also, as mentioned previously, staff will become aware and reminded about the monetary incentive and free meals offered if compliance with the use of BCMA steadily increases.