CHAPTER I Introduction Nursing management is a curriculum that focuses on the development of nursing leadership and management skills essential

to the professional nurse. It includes ethico-moral aspects of health care and nursing practice, the nurses responsibilities for personal and professional growth. One strategy to use in enhancing leadership and management skills is through action research. This action research is designed to provide students concepts necessary to critically read and evaluate and experience problem-solving approach in meeting problems in nursing care. It deals with the research process and its application to the nursing care management of clients in varied settings. It includes concepts of research theories in nursing tools for research. While recent trends move nursing and health care out of the hospital and into the community, some areas of nursing remain predominately in the hospital setting. One of these areas is Labor and Delivery nursing. Registered nurses hold about 2.6 million positions in the United States, according to the Bureau of Labor Statistics. Most RNs, about 60 percent, are employed in hospitals. By hospital policy and compassionate rationalization, nurses and midwives aim to deliver the paramount understanding about rules and regulation in the delivery room on what every patient should know as well as with their significant others. They can update the patient and their significant others the situation the patient is undergoing, the needs they can give, the emotional and spiritual support and other necessary information that are essential and desirable. As nurses

and midwives they are still liable to practice with good ethics. Furthermore, it's a huge impact to the society on what they do, how much they know and why is their profession important. The delivery nurse is a registered nurse and holds the nursing license required by his state. The nurse usually holds a Bachelor of Science in Nursing and undergoes training to acquire obstetric skills in the delivery and nursery rooms. Delivery room nurses have the joy of being a part of bringing one new life after another into the world through the miracle of childbirth. A delivery room nurse works with adults and newborns and in high-pressure situations, such as high-risk pregnancies. Delivery nurses help relieve stresses new mothers-to-be might experience. Unlike other area or department in the hospital, the delivery room nurses and midwives give humane and excellent patient care that is entirely different. From welcoming the expecting mothers, establishing rapport, comforting them during labor, explaining to them the proper breathing, positioning and so on and so forth until delivery progresses and when the baby is out. Convenience and respect as an individual manages the bonding between the nurses, midwives and their patients. Through laughter's and tears the healthcare team and patients undertake. It is a one of a lifetime event that stresses out how humanity witnesses their weakness and strength during labor and delivery. Not even science can stop the process because it is a natural occurrence of life. A successful labor and delivery room nurse enjoys working with people and performs well in high-pressure situations. Labor and delivery room nurses are generally available to a woman at the beginning of her labor, and it is the nurses job to ensure that both a mother and her child get all of the support and medical care they need for a healthy delivery. Delivery room nurses are responsible for staying with the mother when labor begins and supporting the mother

through a healthy delivery. During labor, this nurse monitors the fetus and mother, counting contractions as they come. The delivery room nurse performs the first vaginal examination for the mother. During labor, the nurse might help the mother breathe her way through complicated contractions. The nurse administers IVs to the mother and preps her for a cesarean section if necessary. The nurse also takes care of the baby right after delivery. She takes the Apgar score of the newborn and records birth weight, applies identification bands to newborns and supplies the mother and baby with medications post-delivery. The delivery room nurse might also help the mother if she shows signs of postpartum depression. Labor and delivery registered nurses use professional judgment, critical thinking, and fast decision making skills. They care for women who are laboring, having complications of pregnancy or having recently delivered. They work closely with patients, families, and other health care professionals. Labor and delivery registered nurses provide care to women and their newborns during the antepartum, intrapartum, postpartum, and neonatal stages of this important life event. They assess each mother and baby and develop an individualized plan of care. Labor and delivery registered nurses collaborate with physicians and other health care providers to provide the best plan of care for each patient. They implement the plan of care by monitoring the mother and baby and by teaching patients about their care and topics related to womens health and newborn care. Labor and delivery nurses evaluate the effectiveness of the care plan and modify it as needed to meet the changing needs of the mother, newborn, and family. They also provide psychosocial and emotional support to patients and families.

Labor and delivery registered nurses assume many different roles, including: antepartum nurse who provides care to patients who have complications of pregnancy requiring hospitalization; labor and delivery nurse who provides care to patients in labor who have uncomplicated or complicated deliveries; circulating nurse who manages patient care in the operating room during a cesarean delivery; scrub nurse who works directly with the surgeons during a cesarean delivery by passing instruments, etc, to the physicians; postpartum nurse who provides care to patients who have recently delivered and nursery nurse who provides care to newborns. Labor and delivery registered nurses also may work as clinical coordinators responsible for patient assignments and coordinating patient care. Labor and delivery nursing requires empathy, critical thinking, decision-making, and communication skills. Most labor and delivery registered nurses have some general medicalsurgical nursing background. They must be able to communicate well with patients, families, and other health care providers. They must be skilled in prioritizing patient needs and cope well with a fast-paced, sometimes stressful environment. Labor and delivery room nurses also take care of pregnant women who are forced to stay in the hospital due to complications. When needed, they help the doctor deliver the baby and provide care to both mother and child until they are both ready to go home. A labor and delivery room nurse also communicates important information to the mother about childcare. If necessary, they help mothers cope with post-partum depression. Labor and delivery nurses also must be trained in neonatal resuscitation and other critical skills, so they are able to assist in an emergency situation. For some women, having children can be a scary and stressful experience. Fatal complications can arise for both mother and baby, and it is often important for a woman to

have a medical professional she can trust. A labor and delivery nurse helps to make the mothers pregnancy and delivery as safe and stress-free as possible In general, the delivery room nurse is skilled in obstetrics and has broad knowledge of labor, delivery and postpartum and nursery care. She is also skilled in principles and practices of sterile technique and controlling infection. Delivery room nurses have technical skills in caring for new mothers and newborns. She is also a leader with excellent communication skills. Once said, hospital is a place where financial issue remains to be debated and unresolved due to high hospital bills. It is so amazing where another phase of life begin to breathe, the moment we see another life on earth, the place where a new child is born: the delivery room. Perhaps, to some or mostly indeed, but for what nurses and midwives do believe in every bad thought there is always a place where ideal care promises great competency. Delivery room, an area where nurses and midwives always perceive and integrate proper assessment, heartily diagnosis, good planning, right implementation and steadfast evaluation. Gat Andres Bonifacio Memorial Medical Center (GABMMC) is a government hospital located at Delpan St. Tondo, Manila. This hospital has different hospital area and one of which is the delivery room. It is located at the third floor of the institution. Delivery room is connected at the hospitals Operating room for easy access in case of cesarian delivery, and Neonatal ICU (NICU) where newly born babies are being handed over. The main entrance of the delivery room is considered semi-sterile wherein nurses have to wear their scrub shoes. There is another door leading to the sterile area connected to the NICU and pelvic room. At the sterile area is an entrance to the delivery area. Passing the right side of the sterile area is the NICU. Before NICU is the dressing room where student nurses can change for their scrub suits. Passing the sterile

area is the pelvic room with two bed capacity, wherein the expectant mothers are being assess for admission. Included in the pelvic room is a cabinet where sterile gowns and bed linens are placed. Passing the pelvic room is a small lobby wherein soiled linens and trash are placed and being collected by crews and where the instruments are being washed. This lobby also leads to the other side of the operating room. In the pelvic room is another door leading to the labor room wherein the admitted mothers take labor. It has four beds. When the baby is already crowning, the mother is then carried to the delivery area. It is composed of four beds. In proximity to the head of the beds is the medication area. Beside the medication area is a cabinet for IV fluids and IV sets. In proximity to the foot of the beds is where the sterile instruments are placed and being prepared in case of actual delivery. At the corner of the room is the hand washing area. In proximity to the handwashing area is a sliding window connected to NICU wherein newborn babies are being handed over the nurses in NICU for cord care.

Medical errors are always disturbing, but perhaps the most heartbreaking are those that occur in the delivery room. Approximately 1.3 million people are injured annually in the United States following so-called "medication errors". The National Coordinating Council for Medication Error Reporting and Prevention defines a medication error as "any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. Such events may be related to professional practice, health care products, procedures, and systems, including prescribing; order communication; product labeling, packaging, and nomenclature; compounding; dispensing; distribution; administration; education; monitoring; and use." The council urges medication errors researchers, software developers, and institutions to use this standard definition to identify errors. One type of medication error is the dispensing error. Dispensing is an integral part of the
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quality use of the medicines and together with the patient counseling from the core professional activities of a pharmacist. These activities allow the safe and efficient provision to the general public of what would normally be dangerous or restricted drugs. The squeal to serious is dispensing errors may be far-reaching, including patient morbidity and mortality, increased health expenditure due to hospitalization and treatment, and loss of credibility and professional standing for the pharmacist along with the risk of litigation and financial loss. Dispensing errors generally refers to errors in the dispensing process like wrong drug, incorrectly labeled directions or drug dispensed to wrong patients. Main risk factors associated with the dispensing errors were found to be prescription overload, lighting levels, noise, interruptions and distractions and stress. Also the major parts of the dispensing errors were related to wrong drug. While the majority of physicians and nurses practice quality medicine and do their jobs admirably, they are also human. Because of the environment, delivery rooms can become disorganized and stressful, and an overworked staff is often required to deal with emergencies and multitask in less than optimum conditions.

In general, this action research aimed to plan, implement and evaluate an effective strategy to lessen, if not avoid, possible medication error at GABMMC delivery room. Medication errors are serious problems throughout the world. These errors have a huge economic impact on healthcare system and patients. There is a need to make such area safer as accidents often happen unexpectedly. Careful planning of specific strategies, excellent communication, teamwork and constant vigilance are essential components of exposure prevention plan. Nurses may have not made great in-roads into changing habits and products in the delivery room to this point but we should not give up on trying.

CHAPTER II Methodology Conceptual Framework

SWOT Analysis and Prioritization of controllable problems

Formulation of Plan of Action

Implementation and Evaluation

FIGURE 1: Conceptual Paradigm

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This action research aimed to find out an effective action plan with regards to the medication error in GABMMC Delivery room. The box on the left represents the SWOT analysis done in the hospital area and the prioritization of the problems identified. It is connected to the box on the right side which represents the action plan to be formulated when the problem had already been identified and prioritized. This action plan was then implemented and evaluated at the said hospital area which is represented by the box below. These boxes are connected by a one-way arrow that shows the step by step process of the entire action research. Research Procedure: The researcher spent 2 days to observe how GABMMC delivery room render services to their patient. Direct observation in the entire area and direct communication to the staffs were used in gathering the data needed. SWOT Analysis and Prioritization of Controllable Problems SWOT Analysis was then used to identify the problems. SWOT analysis is a simple framework for generating strategic alternatives from a situation analysis. It is applicable to either the corporate level or the business unit level and frequently appears in marketing plans. SWOT stands for: Strengths, the internal attributes that help organization to achieve its objectives; Weaknesses, the internal attributes that challenge the organization in meeting its objectives; Opportunities, the external condition that promotes achievement of the organizations objective; and Threats, the external conditions that challenge the achievement of the organizational
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objectives. It is then a useful technique for understanding the Strengths and Weaknesses, and for identifying both the Opportunities open to the hospital area and the Threats they face. The SWOT analysis provides information that is helpful in matching the firm's resources and capabilities to the competitive environment in which it operates. As such, it is instrumental in strategy formulation and selection.

Strengths

Weaknesses

(Internal Analysis)

Opportunities

Threats

(External Analysis)

FIGURE 2: Sample SWOT Analysis Internal Analysis

The internal analysis is a comprehensive evaluation of the internal environment's potential strengths and weaknesses. Factors should be evaluated across the organization in areas such as:

Company culture Company image Organizational structure

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Key staff Access to natural resources Operational efficiency Operational capacity Financial resources

The SWOT analysis summarizes the internal factors as a list of strengths and weaknesses.

External Analysis

An opportunity is the chance to introduce service that can generate superior returns. Opportunities can arise when changes occur in the external environment. Many of these changes can be perceived as threats and may necessitate a change in development of services in order for the institution to remain competitive. Changes in the external environment in hospital setting may be related to:

Patients Suppliers Social changes New technology Economic environment Political and regulatory environment

SWOT Analysis helps identify: 1. Internal Strengths: core competencies, corporate capabilities and resources that provide the basis for strategy
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2. Internal Weaknesses: what critical parts of institution must be strengthen or hide from competitors 3. External Opportunities: the benefits that are likely to accrue from pursuing the vision and external opportunities 4. External Threats: the pitfalls and the dangers, the variations and exceptions possible. After the problems had been identified through Swot analysis, they are then prioritized. Priority setting can be defined as making a choice based on a ranking process, although occasionally the term is used as a synonym for rationing or resource allocation. Priority setting is a process where decisions are made about the allocation of healthcare resources following the completion of a needs assessment. Prioritizing takes place in all parts of the health care system where demands and needs exceed resources. Priorities establish the order in which problems will be approached. Priority setting is a challenge because it involves making tough decisions about how finite healthcare resources will be utilized. Invariably, the needs assessment will lead to the identification of multiple problems and unmet patient health needs that will be impossible to address all at once. There is no agreement on one best or one size fits all approach for healthcare priority setting. Current strategies emphasize economic, evidence-based or ethical approaches. Depending on the complexity of the healthcare situation, each of these approaches may have limitations when used alone or in combination. Sometimes the number of problems that need to be resolved can be overwhelming. It is important to know how to prioritize the problems to focus on solving the most critical and

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solvable problems first. The researcher began by having some criteria to classify problems according to prioritization. Criteria for prioritizing problems in order to focus on developing interventions 1) Urgency of the problem to solve 2) Possibility of solving problem quickly/in short time 3) Availability of resources to solve the problem 4) Ability of staff members 5) Availability of support by other stakeholders The problems are then ranked according to which problem should be attended first. Template for Prioritizing Problems A scale of 0, 1, and 2 is used to rank the problems. The higher the total score, the problems meets more of the criteria for being a priority among the other problems. Prioritization criteria Availability Ability of Support of staff and from other resources QC to stakeholders solve problem with own resources

Problem description

Urgency to solve

Possibility of solving problem quickly/in short time

Total Priority Score

Problem 1 Problem 2 Problem 3 Problem 4 FIGURE 3: Sample Prioritization Criteria

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Scale for Criteria: Urgency to Solve: 0= not urgent; 1= to some extent; 2= Very urgent Possibility of solving problem quickly/in short time: 0= long time to solve; 1= can be solved fairly quickly; 2= can be solved quickly; Availability of resources to solve problem: 0 = do not have the resources; 2= have the resources available. Ability of staff/QC to solve problem: 0 = problem cannot be solved easily by us; 2 = problem can be solved easily by us. Support from other stakeholders: 0= no support available from stakeholders; 2= support available from stakeholders.

Formulating an Action Plan

The key to strategic priority action planning is to identify incident problems, classify each problem strategically, and then prioritize classified problems tactically. After the problem had been prioritized, action plan was then formulated by using SMART criteria. Action plan is a series of activities that must be performed for a plan to succeed. The problem identified together with the plan of action formulated was then addressed to the hospital area.

Activities Strategy

Objectives

Person Time Responsible Frame

Resources

Evaluation

FIGURE 4: Sample Action Plan

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Objectives that are SMART are likely to be achieved. These targets assist development of individual work plans, and also provide a guidance system for supervisor-staff performance review discussions. The acronym SMART has a number of slightly different variations, which can be used to provide a more comprehensive definition for goal setting: S - specific, significant, stretching M - measurable, meaningful, motivational A achievable, agreed upon, attainable, acceptable, action-oriented R - realistic, relevant, reasonable, rewarding, results-oriented T - timely, time-based, tangible, trackable SMART can be used to help ensure that effective objectives or goals are set. Specific Specific objectives are clear and well-defined. This helps both the performer and the manager, as the performer knows what is expected of them and the manager is able to monitor and assess actual performance against the specific objectives. Specific objectives may well include a scope description, which includes details of what is not included.

To help set specific objectives it helps to ask the following questions:

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WHAT is to be done? This are best written using strong, action verbs such as conduct, develop, build, plan, execute, etc. This helps objective to be action-orientated and focuses on whats most important.

WHY is this important to do? WHO is going to do what? Who else need to be involved? WHEN should this to be completed? HOW to do this?

Diagnostic Questions

What exactly to do, with or for whom? What strategies will be used? Is the objective well understood? Is the objective described with action verbs? Is it clear who is involved? Is it clear where this will happen? Is it clear what needs to happen? Is the outcome clear? Will this objective lead to the desired results?

Measurable Progress towards objectives often needs to be to be monitored whilst work is under way. It is also very useful to know when that work has been done and the objectives are completed. A measurable objective achieves this end.

Diagnostic Questions
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How will it be known that the change has occurred? Can these measurements be obtained?

Achievable When giving objectives, the person may not be able to achieve it for various reasons, including a lack of skill, not having enough resources (computers, tools, etc.), not having access to key people and not having management support. Achievable objectives ensure that everything is in place and that if the person does not reach the goals they cannot reasonably point the finger elsewhere.

Diagnostic Questions

Can it be done in the proposed timeframe? Are the limitations and constraints understood? Can it be done with the resources available? Has anyone else done this successfully? Is this possible?

Realistic Objectives should also add useful value within the context where they are being set, being aligned with strategies and higher goals.

Diagnostic Questions

Are the resources available to achieve this objective? Is it needed to revisit priorities in life to make this happen?
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Is it possible to achieve this objective?

Timely Descriptions of objectives should also include timescales of what is required by when. This may also include details of delivery, stating (if relevant) where objectives are to be completed. Giving a time scale adds appropriate sense of urgency and ensures that the objectives do not dribble out over an unreasonably long timescale.

Diagnostic Questions

When will this objective be accomplished? Is there a stated deadline?

Implementation and Evaluation

After creating a plan of action, it was addressed to GABMMC for implementation. After implementing, it was then evaluated. It is critical to evaluate the plan, including the strategies and associated activities, to determine the impact on the selected priority. Evaluation is a systematic process of reviewing data to assess the value or worth of something. Through evaluation, it will become clear whether or not the team is making progress toward achieving the plan's goal.

The purpose of this evaluation is to assess the degree of success the plan has had in positively impacting the priorities. When reviewing the results of your plan's activities,
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strategies, and objectives, determine whether or not progress is being made toward the goal and priority. Evaluation results validate or invalidate the effectiveness of the activities within the plan.

Problem statement __________________________________________________ Action Steps Estimated Time Frame Actual Time Frame Responses Modifications to the Plan Continuing Action Needed

FIGURE 5: Evaluation Tool

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CHAPTER III Results and Discussion This chapter represented the findings and analysis of the data gathered. For easier comprehensions of the details, texts and tables were likewise presented at every discussion. This table represented the result of the SWOT Analysis done through direct observation and direct communication with the staffs. TABLE 1: SWOT Analysis Strengths 1. There is a hand washing area Weaknesses 1. The towel is place at the medication area instead of the hand washing area because it is also used as protection in opening ampules. 2. There is a medication kit with labels 2. It is still not organized. Due to stressful environment, 3. The is a plastic bag for empty vials 4. There is a cabinet for gowns and linens Opportunities 1. There is a reduced risk for infection 2. There would be a less medication error medication labels are

sometimes not observed. 3. No trash bin to support the plastic bag 4. Gowns and linens are not organized Threats 1. Violation of aseptic technique principle 2. Labels of medication being administered are not 3. There is a segregation of sharp and vials 4. Easy access to gowns and linens since they are separated to other equipments being checked resulting to

medication error. 3. Vials could broke and could cause accidents if plastic bags are not supported. 4. Time is wasted in checking if it is a linen or a gown.

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It is clear in the table that the strengths given have its own weakness, opportunities and threats. The first strength of the delivery room was having a hand washing area. The hand washing area also has instruction for proper hand washing. Hand washing is the number one way to prevent infection. While sanitizing hand lotions have become increasingly popular, studies show that a good hand washing with soap and water is still more effective for visibly soiled hands. But the weakness correlated to this is the absence of towel to dry hands. In the area, the supposed hand towel for drying hands after hand washing is being used as a protection in opening ampules. Using this hand towel to dry hands after handwashing clearly violates the principle of aseptic technique. Hands are needed to be dry because most of bacteria thrive in wet area. A single-use towel should be used to maintain sterility and observation of principles of aseptic technique. Another strength showed was having a medication kit in the medication area. The medication kit has labels where the medication given to the mother is placed and get for preparation of meds. The use of this medication kit is merely to avoid medication error. One type of medication error is the dispensing error. Dispensing errors generally refers to errors in the dispensing process like wrong drug, incorrectly labeled directions or drug dispensed to wrong patients. Also the major parts of the dispensing errors were related to wrong drug. Upon direct communication to one of the staffs, she verbalized that sometimes the medications were still being placed on the wrong medication kit because of stress in the area. She instructed that right medication should be double checked before administration. The medication kit is for the organization of the medications and should be used to minimize stress and the possibility of errors. Medication errors are serious problems throughout the world. These errors have a huge economic impact on healthcare system and patients.
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The figure below illustrated by Kevin Gibbs a Clinical Pharmacy Manager of Bristol Royal Infirmary showed a summary of the causes of medication error, the person and system approach and their reaction to medication error.

FIGURE 6: Summary of Medication Error Causes, the Person and Systems Approach and Reaction to Medication Error

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Another strength presented on the table was having a plastic bag for empty vials. As verbalized by one of the staffs, the empty vials are being used for another purpose. It is a strength having these empty vials separated from other sharp wastes but it is also hazardous if the plastic bag has no support. If the vials are not organized inside the plastic bag, it can fall and break and may cause unexpected accident. The medicines should be collected into a leak-proof storage container. It is important to ensure that solid and liquid medicines are kept separate. This type of waste includes all empty multidose bottles, vaccine vials and contaminated tablet pots. These are best collected into a pharmaceutical waste bin separate from whole medicines. A detailed list is not required as these are classified as non-hazardous waste. It should be ensured that all syringes placed in the bin have been fully discharged of content. Snap-top vials should not be placed in these bins. Snap-top glass should be placed in the sharps bin. The last strength identified was having a separate cabinet for the gowns and linens. This also adds to the organization of equipments inside the delivery room. Through direct observation, it was noticed that linens and gowns have the same folds and color, thus often interchanging them. This is time consumable especially in emergency cases wherein the mother has to wear gowns right away for proper assessment. The gowns and linens should be wellorganized inside the cabinet to avoid disorder and time wasting when the nurse got the wrong supply to use.

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TABLE 2: Prioritization Criteria

Problem description

Urgency to solve

Possibility of solving problem quickly/in short time

Problem 1 Problem 2 Problem 3 Problem 4

1 2 0 0

2 0 2 2

Prioritization criteria Availability Ability of Support of staff and from other resources QC to stakeholders solve problem with own resources 2 2 0 2 2 2 0 0 0 2 2 0

Total Priority Score

7 8 2 6

Scale for Criteria: Urgency to Solve: 0= not urgent; 1= to some extent; 2= Very urgent. Possibility of solving problem quickly/in short time: 0= long time to solve; 1= can be solved fairly quickly; 2= can be solved quickly. Availability of resources to solve problem: 0 = do not have the resources; 2= have the resources available. Ability of staff/QC to solve problem: 0 = problem cannot be solved easily; 2 = problem can be solved easily. Support from other stakeholders: 0= no support available from stakeholders; 2= support available from stakeholders.

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Table 2 showed how the problem was prioritized. A scale from 0 2 was used in rating prioritization criteria. In the Urgency to solve the problem, problems were rated with 0 being the not urgent to solve, 1 as being urgent to some extent and 2 being very urgent. The possibility of solving problem in short time was rated with scales of 0 being the long time to solve, 1 being the problem which can be solved fairly quickly and 2 as the problem which can be solve very quickly. Availability of resources to solve problem was rated with scales of 0 for not having resources and 2 for having resources available. In the ability of staff to solve the problem, it is rated in the scale with 0 being the problem that cannot be solved easily and 2 being the problem that can be solved easily. For the support from the stakeholders it is rated in scale with 0 for having no support from the stakeholders and 2 for having support from stakeholders. All the rates of each problem were summed up as the total priority score. The problem with the highest priority score is the priority problem of this action research. Based on the result, Problem no. 2, which is the problem regarding the medication error, got the highest priority score despite the fact that it requires a long time to solve.

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CHAPTER IV Recommendation Medication errors strike at the heart of being a nurse the responsibility to do well and avoid harm. Medication errors have serious direct and indirect results, and are usually the consequence of breakdowns in a system of care. Direct results include patient harm as well as increased healthcare costs. Indirect results include harm to nurses in terms of professional and personal status, confidence, and practice. Based on research of Ann Mayo (2004), Labor and delivery nurses rank 2nd in the Top 10 Nurse Practice Setting that commits medication error with 9.7% of the sample population. Consider that a hospital nurse in the delivery room grabs the wrong vial or ampule of medication to administer to the patient - a potentially life threatening mistake -- because the packaging closely resembles that of the correct medication stocked one shelf over. Nurses are accountable for the drugs they administer and therefore require knowledge of the action, side-effects and correct dosage of any drug they administer. Several authors have cited distractions as a factor in the occurrence of medication errors (Scholz, 1990; Walters, 1992; Williams, 1996). Nurses administer medications in a sometimes chaotic environment, with many demands on their time. Davis (1994) suggests that being able to concentrate while preparing and administering medications will greatly assist in preventing errors. Although little research was located on the extent of the relationship between interruptions and medication errors, several authors have recommended that distractions be kept to a minimum or that nurses who administer medications have a quiet area in which to prepare drugs (Davis, 1994; Segatore et al., 1994; Williams, 1996).
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In relation to this common nursing problem, the researcher was able to come up with a recommendation which was presented to GABMMC Delivery room. 1. Proper organization of the medications in the area. Proper use of medication kits with labels would help reduce erroneous medication administration to patients. Right drug must be placed on the right medication container to avoid swapping of medication during medication administration. 2. Read medication labels and how to properly administer medication. This is to prevent a great error in administering the drug for the patient. Know the right dose and right route of the right drug to be administered. 3. Observing the 5 Basic Rights in Medication Administration. A poster must be posted on the wall of the medication area to help remind the nurses on the rights in medication administration. Strictly observing these 5 basic rights will help reduce medication error in the hospital area. 4. Monitor vital signs that should be taken into consideration for some drugs that would be administered to the patient. Methergyn is a drug administered to patient after giving birth that causes an increase in blood pressure. Toxicity to this drug is highly-risked to patients. 5. Make sure that medications are not yet expired. Discard immediately medication that are out of dates and place a new stock immediately in the medication container.

The other problems identified in the SWOT analysis was also addressed to said hospital area.

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V. APPENDICES

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ACTION PLAN

Strategy 1. Organize properly the medication area.

Activities a. Continuous use of medication kits with labels b. Organize items according to size, within their groups.

Objectives

Person Responsible Staff Nurses

Time Frame

Resources Medication kit with labels

Evaluation

To be able to achieve a systematized medication area: a. to avoid confusion of each drug b.to easily pinpoint drugs needed c. to avoid swapping of medication

8 hours (every shift)

The medication area maintained to organize.

c. Place right drug on right medication container

2. Strictly observe the 5 Basic Rights of Medication Administration

a. Read medication label before administering drug. b. Review on how to administer the medication

To be able to minimize medication error by: a. giving the right medication to the mother

Staff Nurses

8 hours (every shift)

Poster of the 5 Basic Rights in Medication Administration

The 5 rights in medication administration was observed.

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that is to be given to the mother.

c. Know the right dose and right route of the drug to be administered.

b. being able to give the medication in the proper and right way. c. remembering the 5 basic rights before administering drug to the mother 15 minutes

d. Place a poster indicating the 5 basic rights of medication administration on the wall of the medication area

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EVALUATION Problem statement: Prone to Medication Error Action Steps Organizing Medication area: Continuous use of medication kits with labels Organize items according to size, within their groups. Place right drug on right medication container Within the shift Within the shift The staff nurses were able to do all the action steps None All action steps should be done religiously Estimated Time Frame Actual Time Frame Responses Modifications to the Plan Continuing Action Needed

Observing the 5 Basic Rights: Within the shift Read medication label before administering drug. Within the shift The staff nurses was None able to do all the action steps All action steps should be done religiously

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 Review on how to administer the medication that is to be given to the mother. Know the right dose and right route of the drug to be administered. 15 minutes Place a poster indicating the 5 basic rights of medication administration on the wall of the medication area 5 minutes The staff nurse was able to place a poster of the 5 Rights in Medication Administration on the medication area wall within the estimated time None Poster should be kept posted on the wall and be replaced if it is already worn out

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