Artefact 5: MAHS Module Development MAHS report

    Working for the local school district for 13+ years, I noted a continual and quite cumbersome issue around Medication Administration within a school setting, specifically the high school I was working in.   Initially, I found myself considering my co-workers and their own skill sets and knowledge around delivering medication to their own students.   I came up with the idea to create a training course regarding ‘Medication Administration within a High School Setting’ (MAHS) after extensive job task analysis and consultation with subject matter experts.

The Noted Area of Concern

    I noted a few problems within the high school I work in regarding the Education Assistants (EA’s) knowledge of the district medication policies and the procedures with Fraser Health guidelines when delivering medication to students with exceptionalities and physical impairments.  From my observations, I noted errors in medication administration that centered around documentation, environmental influences, training, and basic medication knowledge.  For example, one medication error occurred due to lack of training which led to seizure medication being delivered two hours late (past the allotted time frame) as well as having no record of the error besides a verbal report at the end of the day (should be documented at the time of delivery.)  This specific situation was what caught my attention to which my manager and I began a deep dive into the previous 3 months of data and decided to conduct a baseline (job task analysis) on the current EA's and the manager to see if we could do the following:

1) find frequency, situational/episodic, time-stamped, and anecdotal data to calculate medication errors

2) highlight the top 3 main areas of concern

3) implement solution to those main 3 areas of concern

4) track the progress of the solution for post 3 months after

The overall process took us 10 which is deemed a full year from a school based calendar perspective.  It should be noted the baseline data began in December of 2016 and concluded the end of Nov 2027.  The two months off for summer vacation we were not able to continue with this project as our jobs with the students and staff were not commencing.  The project continued again in September with the start of the 2017 school year and concluded the first run of MAHS in December 2017.

Baseline Data

     Essentially, we began collecting data to better comprehend what the issue was regarding the medication administration with the high-school students after noting a few problems ourselves.  We tracked the person, the route, the time, and documents the EA's were using themselves.  Below is a sample of our data (names are protected for privacy and confidentiality) for a three month period to demonstrate what we found.  

*Sept 16 - Nov 30, 2017 data was collected Monday thru Thursday by my manager and myself at the end of each day from each medication administration site - there at two*

The main 3 areas of concern noted were 1) wrong timing of administration, 2) improper sanitary methods, and 3) lack of reporting and documentation of medication delivery.

Our immediate and first response to these 3 solutions was to provide a more comprehensive, detailed, and hands on training for the EA's and staff who work with students with exceptionalities.  Hence the beginning of our course entitled 'Medication Administration within a High-School Setting' (MAHS.)  Granted, there are some other areas of errors we noted but the solution created encompassed many of these other areas.

The Beginning of MAHS

    The MAHS training course included: 1) comprehend medical definitions 2) demonstrate procedures for MAHS with correct documentation, 3) sanitary and hygienic procedures for safe medication administration, 4) ensure all documentation is completed for all medical related information per administration, and 5) review checklist and printables for staff to keep with them.

     Through the development of this MAHS module, there was many meetings with my co-workers in order to ensure that this MAHS course would be applicable once the course is over and my efforts were not going to waste and valued by those taking it.  Without their underlying collaborative feedback, my manager and I would not have been able to have accurate and up to date training within the course.  Specifically, the collaborative efforts included:

1) group collaboration efforts with the EA staff as well as holding meetings to document ideas, progress, and feedback

2) Fraser Health Nurse appointed by the local school district, which we will call Mrs. A, met with us during the baseline data phase and the solution phase as she was a Subject Matter Expert on proper medication administration guidelines.

3) principal and vice principal meetings bi-monthly to report on progress, establish confidentiality guidelines are maintained, and overall 3 party feedback on comprehension.

The Creation of MAHS with technology

     The next stage of development for this course started with our technological medium phase otherwise known as our learning management system (LMS); we needed to select a software based technology that was familiar, easy to access, and met the needs of the job.  After consultation, we decided on 2 main presentation software programs: PowerPoint and Powtoon.   We chose PowerPoint for its familiarity within the school district and its 'sharable' nature via email, downloadable and printable options.  Additionally, we chose Powtoon which illustrated the procedures within the MAHS as we added graphics, animations, and real-time videos.  We embedded the Powtoon link within the PowerPoint to allow easy access to modeling videos (https://www.powtoon.com/)  An example of one of the downloadable printables is displayed as MAR data sheet in this report.

After implementation of MAHS
     Once our LMS was complete and the training course was sent to our principal, Fraser Health Nurse Mrs. A, and the district for approval, we implemented the course during a professional development day in May 2017.  My manager called all the EA staff (27 or the 28 were present) and began the 2 hour training course.  The course was sent to the EA's in the work email for reference, the printables were hung in the allotted medication administration area for ease of reference, and we held a 'modeling' session immediately after the course.   The modeling session was role-playing with volunteers from the EA staff.  Personally, I noted the role-playing was received with positive reviews and ironed out a few nervous errors from the EA's performing them.  

   Armed with the new training, EA's went on delivering their medication to their students with exceptionalities from May-June and then again Sept-Dec of 2017.  It should be noted, new EA hires increased the staff from 28 to 31 and the 3 new hires where given the same MAHS course in the first 2 days of work in Sept 2017.  In Nov 2017, my manager, the principal, Fraser Health Nurse Mrs. A and I met to review the documentation process and consult over our anecdotal data.

   During our review of May, June, Sept, Oct, and Nov 2017 medication administration documentation, we noted a 26% decrease in medication administration errors with staff.  This was monumental as it supported our biggest suspicion; the lack of training and comprehension given during the Education Assistant Program at various local colleges was not sufficient for on the job performance.