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Running head: BAR-CODED MEDICATION SYSTEM IN THE ICU 1
Implementation of a Bar-Coded Medication System in the ICU
Anne Marie Wouapet
Walden University
NURS 6053 - 04 Interprofessional Organizational and System Leadership
Dr. Cathleen Colleran-Santos
March 27, 2016
Implementation of a Bar-Coded Medication System in the ICU
Everyone enjoys the status quo; this phenomenon makes organizational change a hard concept to execute. However for organizations to offer quality services to clients change is inevitable. Organizations change to anticipate adapt and respond to the environment and be able to meet the changing demands. Departmental and organizational change require certain strategic approaches for any team to implement effectively and counter the resistance to change as is the case for numerous organizations. The purpose of this paper is to identify the problem with implementing a bar-coded medication administration sytem in the intensive care unit (ICU). In doing so, the paper will focus on Kurt Lewin theory of change as a guideline for the identification of the necessary change process, various stakeholders involved in the change process and highlight how the change will align with the general mission, vision, and values of the hospital.
Selected Inefficiency
A common and significant inefficiency in nursing practice is the safety and appropriateness of medication. The errors that occur with medication have a significant effect on patient health, the costs of treatment and in worst cases can lead to death. Medication errors are very life threatening and, therefore, hospitals must ensure that they are minimized and even eliminated. To curb the problem, most facilities have introduced electronic bar coding to prevent such medication errors In this paper, we will utilize Kurt Lewin's change management model as a framework to introduce barcode medication system at an established medical facility. The model's idea can help in the analysis of how the change will be managed and how it will affect the institution. It is also important in determining the obstacles to successful change implementation and significant for settling the opposing forces and human behavior that lead to resistance to change (Marquis, & Huston, 2015). The model is, therefore, vital for overcoming the resistance and hence the successful acceptance and implementation of the new technology by the various medical personnel.
The Most Realistic Change Strategy
To curb the problem of medication errors, a wide hospital change in operational procedures is necessary. Whereas some factors like high nurse to patient ratio are beyond the practitioners mandate but rather administrative, other factors must be modified to alleviate the problem. The change will require staff to adopt new behaviors and operational styles to cope up with the situation. The staff must change their mindset and see connection between their action and the medications errors to realize how change in behavior and attitude can improve patient care (McAlearney et al., 2014).
How the Change Would Align with the Hospital’s Vision, Mission, and Values
When the changes are implemented, it means that operations within the hospital will be hastened as a result of increased efficiency. This will improve productivity and service delivery for the patients therefore, not only have aligned it with the hospital’s mission and vision, but also the expected professional standards of a healthcare institution. The medical personnel will embrace their duties and ensure that they give the best of their skills for quality service delivery (Mitchell, 2013).
When such changes are recognized, the hospital will be able to accomplish its missions, vision, and values. The hospital’s mission is to provide quality and timely healthcare to its patients, while its vision is to realize its values of patient centeredness and to be number one health provider in the region. The best practice standards require nurses to provide care based on the best available evidence or best practice (UMMC, 2016).
The Main Challenge to Change
"Lewin's model suggested that people like feeling safe, comfortable, and in control of their environment. For change to occur, then, the balance of driving and restraining forces must be altered. The driving forces must be increased or the restraining forces decreased." (Marquis & Huston, 2015, p. 166). Transforming plans into action present a major complexity in the vital process of change. Most change attempts fails because change agents use unstructured approach to implementation. It is important therefore that change agents identify an appropriate change model to provide a framework to implement, manage and evaluate the desired change (Mitchell, 2013).
The Stages of Implementing Lewin’s Model
Kurt Lewin came up with a transformational model for change management that comprised of three steps, namely; unfreezing, changing, and refreezing (Marquis & Huston, 2015). Lewin's Model outline a quite simple and practical blueprint for approaching change. The model begins by developing a notion that transformative change is required shifts the stakeholders towards the change and solidifies the new change as the norm. Lewin’s theory is widely applied in many organizations and is the foundation of modern organizational change management (Marquis & Huston, 2015).
The model has three phases beginning with the unfreezing phase, in this juncture the clearer understanding of the central issue of the department or organization is sought. Upon identification of the problem, techniques aimed at strengthening the driving forces while weakening the restraining forces are suggested. The unfreezing stage also involves the determination of the principle actors and those who are likely to be affected by the proposed change, thus getting feedback from them regarding the potential driving forces and restraining forces (McAlearney et al., 2014).
The second phase is known as the change phase where the actual change eventually takes place upon equalizing the restraining forces while allowing the driving forces to steer the change process. The implementation of the unfreezing plans leads to the implementation of the proposed change, leaving all the communication lines open. The last stage of the model is the refreezing phase, which is significant in evaluating the sustainability and the suitability of the change besides its effectiveness in nursing practice (McGarry, Cashin, & Fowler, 2012).
Application of the Model to the Proposed Change
Unfreezing Stage
The first phase includes an analysis of the change's focal point that is; introduction of a bar code medication system at an established medical facility. The key components for this step include communicating with stakeholders such as administrators, nurses and managers. Manchester et al., (2013) asserts that an important consideration for stakeholder communication is using open and sincere channels of conversation. This technique creates an atmosphere of trust and protection for the stakeholders concerned with the change process. The frontline personnel will be involved in primary determination and planning groups making the approaches that promote a sense of empowerment hence assist in overcoming their resistance to change (Manchester et al., 2013). It also allows them to identify with the value of the change and its importance to customer service and business as a whole (McAlearney et al., 2014).
In the process of the unfreezing, the involved teams will hold a roundtable discussion aimed at establishing the restraining forces and the driving force, so as to have a baseline on where the proposed change begins. The possible restraining forces for a nursing department, or a medical facility may include the resistance of staff to the utilization of computerized devices. Other forces are the lack of computer skills, lack of trust among the nurses and management, and resistance to the introduction of new systems (Mitchell, 2013).
The driving forces include adequate funding, staff training, support for the management and the potential advantages of using the barcode system such as efficiency and time management will be highlighted. The important factor in this process is the engagement of the events such that it diminishes the restraining forces while accentuating the driving forces to ensure an efficient adoption of the barcode medication system (Shirley, 2013).
Changing Stage
This stage represents the process of executing the change mission. The introduction of a bar coding medication system across the facility calls for a combined effort across the identified teams. The teams include the nursing educators, information science, program managers, pharmacy and medical records. The implementation of this change will influence all the mentioned departments hence specific methods are required in organizing a workout plan, and the participation of all stakeholders is vital. Implementation timelines are important to note beside the training, workflow effect and organizational culture. It is also important for the implementation teams to work on a central mission that guides the implementation plan through all the phases (Mitchel, 2013).
Refreezing Stage
It is the last stage of Kurt Lewin's model. In this stage, the freezing of the implemented change happens under a focus on steadiness and analysis. The support given to the nursing staff and other stakeholders is vital for the continuation of the change process, especially if all the users are conversant with the introduced technology. Once the change has been implemented, and the new system is completely operational, timely monitoring and evaluation are conducted. An analysis of successes and challenges are presented, and measures are put in place to ensure that the new system remains efficient and fully operational (McGarry, Cashin, & Fowler, 2012).
Conclusion
When preparing to introduce a new regime or alter the existing system, it is vital to put in place a model in which the change is to be implemented. Barcoding technology comes with numerous advantages and a few challenges for the nursing staff. Using a Lewin’s model for change management to monitor the implementation of barcode technology in the ICU is effective in gaining the support of Frontline nurses as it involves them in all the stages of planning and execution (Manchester et al., 2013). The Frontline nurse managers have the leadership and management qualities such as the supervisor, inspiring juniors, innovation and supporting the ideas put across. The utilization of the Frontline managers builds a sense of autonomy and ownership of the project ultimately leading to success. The use of roundtable meetings helps in establishing the resisting forces and the driving forces to be applied to implementing the change. The use of Lewin’s model helps reduce the resistance and identifies the positive drivers using a conceptual plan and ensures the enforced change is maintained so that the staff subscribes to it (Marquis & Huston, 2015).
References
Manchester, J., Gray-Miceli, D., Metcalf, J., Paolini, C., Napier, A., Coogle, C., & Owens, M. (2014). Facilitating Lewin's change model with collaborative evaluation in promoting evidence-based practices of health professionals. Evaluation and Program Planning, 47, 82-90. http://dx.doi.org/10.1016/j.evalprogplan.2014.08.007
McAlearney, A., Terris, D., Hardacre, J., Spurgeon, P. Brown, C., Baumgart, A., Nyström, M. (2014). Organizational coherence in health care organizations: Conceptual guidance to facilitate quality improvement and organizational change. Quality Management in Health Care, 23(4), 254-267 doi: 10.1097/QMH.0b013e31828bc37d
McGarry, D., Cashin, A., & Fowler, C. (2012). Child and adolescent psychiatric nursing and the reflections on the implementation of change drawing insights from Lewin’s theory of planned change. Contemporary Nurse, 41(2), 263-270. http://dx.doi.org/10.5172/conu.2012.41.2.263
Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing: Theory and application (8th Ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.
Mitchell, G. (2013). Selecting the best theory to implement planned change. Nursing Management - UK, 20(1), 32-37. doi: 10.7748/nm2013.04.20.1.32.e1013
Shirey, M. R. (2013). Lewin’s theory of planned change as a strategic resource. Journal of Nursing Administration, 43(2), 69-72. doi:10.1097/NNA.0b013e31827f20a9
UMMC, (2016). Vision, Mission, and Values. Greene Street, Baltimore, MD: University of Maryland Medical Center. Retrieved from http://umm.edu/about/mission-and-vision
