At nursing homes, almost nothing is more important than medication safety. However, errors can happen anytime, from prescribing to dispensing to administration. And it's imperative to pay close attention when medication changes to ensure it's working and that the side effects don't outweigh the patient's benefits.

One challenge is the wide range of education levels in nursing home staff. For example, the staff members who spend the most time with patients daily and thus can spot potential medication problems may need training on how to do so. In addition, nursing assistants and other staffers have not traditionally been empowered to observe and record medication side effects in medically complex patients.

One method you may want to consider trying is the huddle board. According to a new study in the Journal of Multidisciplinary Healthcare, a team used a three-pronged intervention in a nursing home to see if they could improve documentation of medication, including:

• A huddle board to identify at-risk patients
• Staff training on how to observe and document medication use and side effects
• Frequent feedback on the staff's success rate in terms of documentation

Stephen Ore of the Oppsalhjemmet Nursing Home Norlandia in Oslo, Norway, and colleagues implemented this system in a nursing home with 151 residents with an average age of 87 who needed 24-hour care. The facility had 28 full-time registered nurses, 83 part-time auxiliary nurses, and 18 nursing assistants.

The project team introduced the use of huddle boards to list critical tasks, risk factors, and what the patients identified as their most essential needs. The huddle boards were placed in the main staff room in each of the six wards and included a brief list of the main side effects of some of the most common medications. Important and potentially risky changes to medication were noted on the board, and it was used as a tool to identify patients needing closer observation for medication problems. Staffers were trained to write reports based on what they observed.

There was a significant improvement in observation reporting during the study, and after six months, a goal of 100% average reporting was met.

"Our findings show that introducing and applying huddle boards combined with regular feedback to the staff about the outcome was useful for improving the documentation of medication observations in patients' records," the author concluded. The researchers first implemented the system in the lowest-performing ward. Although the ward was still a low performer at the end of the study compared to five other wards, performance did improve.

Ore and colleagues were concerned that the method would add one more task to the busy nursing staff but found that the program "energized the staff."

"The enthusiasm we experienced on every ward when involving the staff in small-scale modification might provide ownership and thereby make adoption of a new method much more likely," they concluded.

Although medication safety is paramount, consistent observation and documentation can be tricky to implement. Huddle boards have been shown to help improve communication and reduce safety issues in other areas. If you're trying to empower your staff to take a sense of ownership over medication documentation, you may consider trying huddle boards combined with staff training and feedback.