Medication Administration Services Continuous Quality Improvement Practice

Table of Contents

Continuous quality improvement (CQI) practice is a nursing leadership initiative that the school nurse uses to eliminate or reduce medication errors, increase medication minimization, reduce medication waste, increase efficiency, and strengthen internal (nurses, school personnel) and external (families/students) satisfaction. 

It is an ongoing process that evaluates how the process of medication administration works (from the time the student first enrolls in school to the time the student requires medication administered at school) and ways to improve its processes. Medication errors can occur anywhere along the route: from the healthcare provider who prescribes the medication, the pharmacist who fills the script, the parent who completes the medication consent form, to the school nurse or delegatee who administers the medication. 

  1. Schools should use standardized, comprehensive, detailed forms for:
    1. parent consent for medication administration,
    2. medication administration documentation,
    3. medication error reporting including identification of contributing factors and risk-reductions strategies /corrective action,
    4. standing orders for voluntary stock emergency supply (if applicable),
    5. self-administration consent forms
  2. A systematic review of medication administration should be conducted at least annually.
  3. Review alignment between state laws and district policy annually for updates (Note: CPGs may be more rigorous than state laws that are not based on evidence).
  4. Conduct an audit of the medication administration process annually:
    1. An audit should include:
      1. all documentation:
        1. consent form
        2. medication administration records.
  5. Procedure for field trips/off-campus medication administration with school nurse notification
  6. Create a culture of safety
    1. Increase culture of safety by decreasing stigma and increasing vigilance for medication errors.
    2. Create a nonpunitive, fair and just culture and reporting system through training and forums on culture and continuous quality improvement.
    3. Provide Second Victim support for the licensed provider or UAP who experiences a medication error.
    4. School district policy should include medication error reporting protocol;
      1. standard forms are recommended.
      2. “Sentinel events” where significant patient harm occurs” reported to school leadership.
      3. Consider community partnerships with local pharmacists and community healthcare providers in the quality improvement