“Nursing’s Role in Promoting Quality and Patient Safety Assignment” Nurses inherently are concerned with patient safety. They are best positioned to prevent medical errors at the bedside. There is a moral and legal imperative to implement safe practices at all times. Nurses and the profession are negatively impacted when medical errors occur. Until recently the Centers for Medicare & Medicaid Services (CMS) mandated that all patient medications be administered 30 minutes before or after a scheduled time (Department of Health & Human Services [DHHS] & Centers for Medicare & Medicaid Services [CMS], 2011, December 22). Given the expanding role of nurses, the CMS mandate is now unrealistic and counter-productive. The Institute for Safe Medication Practices (ISMP) addressed this issue by creating an Acute Care Guideline for the timely administration of schedule medications.
Institute for Safe Medical Practice

The ISMP is dedicated to preventing medical errors by promoting safe medication administration procedures (ISMP, 2013a). The ISMP reviews all facets of safe medication administration. Medication errors frequently result in debilitating injuries or death. The ISMP posits that the most frequent medical error is medication administration. Medication error affects over 1.5 million people annually (ISMP, 2007b, p. 1). The ISMP has committed staff and resources to reduce medication errors. It has developed training and educational programs for health care staff and consumers. “30-minute rule” Challenged In 2010, ISMP conducted a survey to assess nurses concerns and the efficacy of the CMS Interpretive Guidelines. The survey revealed that nurses felt pressured when forced to give medications on an unrealistic schedule. Adhering to an unrealistic schedule often times interfered with a nurse’s ability to implement safe practices. The CMS mandate did not consider patient to nurse ratios, complexity of care, or volume of prescribed medications per patient (ISMP, 2011c). The ISMP guideline was designed to distinguish between time sensitive and non time-sensitive medications. Time sensitive medications are to be administered in compliance with the original mandate. The most significant change in the guideline was that non-time critical medications now have a window of one to two hours. As a result of the ISMP revised guidelines, the CMS revised the “30-minute rule”.
Nurses to utilize critical thinking skills The revised ISMP guidelines insist that nurses apply their critical thinking skills when administering medications. The revision resulted in minimizing the risk of active failures at the bedside. Given the inability of eMAR to differentiate among patients, there is potential for latent failures. Nurses have the ability to differentiate and establish priorities in the face of changing circumstances. In high reliability organizations (HBOs), nurses must embrace five key processes. The processes are painstaking concern focused on potential failure, unwillingness to explain away a potential problem with basic information, maintenance of awareness as to the role of team members, ability to resolve unexpected errors, and willingness to seek help from a more experienced team member. (Good, 2011, p. 412) These processes create effective communication. Implementation of Guidelines ISMP guidelines encourage nurses to rely on their multi-disciplinary team. When concerned about a medication, nurses are to seek advice from pharmacists and physicians. As the last line of defense against medication errors, nurses have an obligation to withhold a medication if they are concerned. Toyota developed a concept called “Stop the Line” and health care embraced the idea (Good, 2011, p. 413). “Stop the Line” permits a nurse to seek further clarification before proceeding with a treatment or medication (Good, 2011, p. 413).
Safety within my practice I was caring for a psychiatric patient who had an emergency appendectomy. I was not familiar with a medication ordered. I was concerned about the medication prescribed. The patient had tolerated several doses before my shift. Because the patient had tolerated several doses prior to my shift, my fellow nurses assured me that the medication was safe to administer. With the revised ISMP guidelines in mind, I was able to delay administering the medication and act on my concern. The medication was not time critical. I prepared a detailed SBAR and contacted the patient’s physician and pharmacist. According to TJC (2005), miscommunication is a major cause of avoidable patient injuries and fatalities (as cited in Good, 2011, p. 414). For my patient, communication was a lifesaving even. The physician’s order was entered incorrectly. The medication was to be administered PRN, not scheduled every 6 hours. It was determined that the patient was one or two doses away from death. He was moved to ICU because he required extensive monitoring.
Conclusion
Medication administration errors can have devastating impact on a patient’s life. Once a medication is given it cannot be retracted. The ISMP guidelines provide a viable solution for reducing medication errors. The guideline mandates a rational and safe method for a nurse to administer all non time-critical medications in a calm rational manner versus being forced to administer all medications within what is frequently an unrealistic time frame.

References
Department of Health & Human Services (DHHS), & Centers for Medicare & Medicaid Services (CMS). (2011, December 22). Revised appendix A: Interpretive guidelines for hospitals (CMS Manual System: Pub. 100-07 State Operations Provider Certification, Transmittal 77, Advanced Copy). Retrieved from http://www.cms.gov/Regulations-and- Guidance/Guidance/Transmittals/downloads/R77SOMA.pdf
Good, V.S. (2011). Patient safety. In J. L. Creasia & E. E. Friberg (Eds.), Conceptual foundations: The bridge to professional nursing practice (5th ed.; pp. 407-418). St. Louis, MO: Mosby Elsevier.
Institute for Safe Medication Practices (ISMP), (2013a). About ISMP. Retrieved from http://www.ismp.org/about/default.asp
Institute for Safe Medication Practices (ISMP), (2007b). A Call to Action: Protecting U.S. Citizens from Inappropriate Medication Use. Retrieved from http://www.ismp.org/pressroom/viewpoints/CommunityPharmacy.pdf
Institute for Safe Medication Practices (ISMP), (2011c). ISMP Acute Care Guidelines for Timely Administration of Scheduled Medications. Retrieved from http://www.ismp.org/Tools/guidelines/acutecare/tasm.pdf