A Systems Approach to Quality Improvement in Long-Term Care: Safe Medication Practices Workbook


A Systems Approach to Quality Improvement in Long-Term Care: Safe Medication Practices Workbook


This 200-page resource manual outlines a systems approach to medication management in long-term care. It is designed to provide nursing home staff with a step-by-step guide through the key processes of a comprehensive medication management system and address areas that can lead to the reduction of medication errors. In addition, tools are offered as strategies to reduce the incidence and harm of errors.

The topics addressed in this manual include the following:

  • Organizational commitment to medication safety
    • Key points in creating a culture of safety
    • System plan of action for medication error prevention
    • Checklist for action planning
  • Medication management policies
    • Key points in medication management policies
    • Checklist for medication management and policies
  • Educating staff
    • Planning learning activities and establishing learning outcomes
    • Case study as a teaching strategy
    • Checklist for assessing staff education/training and medication administration competency
  • Prescribing
    • Types of prescribing errors
    • Drugs frequently associated with adverse drug events
    • Components of a complete medication order
    • Checklist for assessing medication prescribing
  • Documenting – Transcribing
    • Factors affecting transcribing
    • Checklist for assessing transcribing
    • Steps to consider to reduce transcription errors
  • Dispensing
    • Checklist for assessing dispensing
  • Administering
    • High-alert medications
    • Administration tips
    • Checklist for assessing medication administration processes
  • Monitoring
    • Types of monitoring errors and adverse events related to monitoring
    • Monitoring for the use of unnecessary drugs
    • Tools and measures for medication monitoring
    • Monitoring for appropriate discontinuation of medication
    • Who is responsible for medication monitoring?
    • Medication monitoring and technology
    • High-risk drugs and medication monitoring
    • Checklist for medication monitoring
  • Error tracking and analysis
    • Making the most of the incident report
    • National medication error reporting
    • Additional methods of error detection
  • Quality improvement
    • Rapid cycle change model
    • Data tracking tool
  • Warfarin
    • Warfarin audit tool
  • Reconciliation
    • Incident reporting of medication errors
  • Monthly edits
    • Effective practices for monthly edits
    • Workload and other issues
    • Environment
    • A note about “house stock” medications
    • Sample monthly edit procedure
    • Checklist for monthly edits
  • Educating residents and families
  • National resources and regulations



Massachusetts Coalition for the Prevention of Medical Errors (MassPRO); Massachusetts Extended Care Foundation

Funding Sources:

Betsy Lehman Center for Patient Safety and Medical Error Reduction; Massachusetts Department of Public Health


Release Date: 2006
Review Date: 2007
Recent Summary: January 2008
Original Summary: February 2007
Last Updated: 01/30/13

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