In our March 12, 2026 newsletter, we invited hospitals to participate in a short survey to establish a baseline of implementation for the three new Best Practices released in the 2026-2027 ISMP Targeted Medication Safety Best Practices for Hospitals. The three new Best Practices are associated with safeguarding use of intravenous (IV) push medications (Best Practice 23), optimizing the use of scanning machine-readable codes on patient identification (ID) bands and products to prevent medication errors (Best Practice 24), and improving the culture of safety (Best Practice 25).
We sincerely thank the ninety-three respondents who participated in our survey and shared their valuable lessons learned regarding the barriers and enablers for the new Best Practices. Among respondents, 28% worked in hospitals with 500 or more beds, 27% in hospitals with 100–299 beds, and 26% in hospitals with 300–499 beds. Nine percent worked at hospitals with 26-99 beds, and 10% with 25 beds or less. Overall, almost three-quarters (73%) reported employing one or more part- or full-time medication safety officer(s) (MSO). Most (98%) respondents were located in the United States or a US territory. An overview of the survey findings is detailed in Table 1 below.
| Best Practice | Percent Compliance | Common Barriers (B) or Enablers (E) | ||
|---|---|---|---|---|
| None | Partial | Full | ||
| Best Practice 23: Improve safety with use of intravenous (IV) push medications. | ||||
| Optimize the use of ready-to-administer medications. | 2% | 58% | 40% | E: Purchase from multiple 503B outsourcers |
| Minimize unnecessary dilution and reconstitution of IV push medications outside a pharmacy. | 9% | 51% | 40% | E: Focused on drugs that were frequently diluted unnecessarily and optimized workflow, purchased from 503B outsourcers, educated nurses |
| Eliminate the practice of diluting medications in sodium chloride flush syringes. | 6% | 36% | 58% | E: Bundled the diluent (e.g., sodium chloride vial, sterile water vial) and drug at dispense for those that need to be reconstituted, linked a sodium chloride vial to medications requiring reconstitution within the ADC to dispense together |
| If the rate of an IV push medication is not practical to be administered manually (e.g., over 5 minutes), use an infusion pump with dose error-reduction systems (DERS). | 18% | 24% | 58% | E: Dispense these drugs in an intravenous piggyback (IVPB) infusion bag, purchased syringe pumps, ensured these medications are built into the drug library |
| Manually pushed medications should be continuously administered and not left unattended. | 8% | 17% | 75% | E: Directly observed practice after educating nurses and confirmed that this is no longer occurring |
| Monitor for and understand each workflow to address deviations from IV push safe practices. | 20% | 46% | 34% | E: Monitor and gather feedback on IV push practices, completing a pilot evaluating administration workflow |
| Best Practice 24: Optimize use of scanning machine-readable codes (e.g., barcode, radio-frequency identification [RFID]) on patient identification (ID) bands and products to prevent medication errors. | ||||
| Proactively scan the barcode on new products received by pharmacy to ensure there are no issues with scanning for end users. | 2% | 20% | 78% | E: This is a dedicated responsibility for a pharmacy technician shift, purchasing team scans all products during the receiving process, this is a current process improvement project, created a dashboard |
| Review the type and number of medication barcodes on products dispensed by the pharmacy (e.g., on labels, overwraps). | 10% | 25% | 65% | E: Review at medication safety committee each month with key stakeholders to ensure action plans are implemented and successful, standard practice training for staff to understand why only one barcode should be available |
| Develop an escalation process for barcode scanning failures and include steps for users to follow if a barcode will not scan. | 5% | 21% | 74% | E: A team group chat with pictures has been immensely helpful for troubleshooting barcode issues, developed a policy and procedure for nurses |
| Take steps to avoid scanning “proxy” barcodes. | 5% | 42% | 53% | E: Regularly evaluate what is happening on the units, power of storytelling to provide examples of how this has caused patient harm |
| Engage the information technology (IT) team to proactively identify, escalate, and resolve internet connectivity issues that result in the inability (or failure) to successfully utilize barcode medication administration (BCMA) software as intended. | 7% | 26% | 67% | |
| Regularly review compliance and other metric data to assess utilization and effectiveness of this safety technology (e.g., scanning compliance rates, bypassed or acknowledged alerts). | 1% | 23% | 76% | E: Created a dashboard, owned by nursing unit managers and nursing leadership, frequent monitoring using data to identify workarounds, highly engaged nursing leaders |
| Force scanning of the actual product (manufacturer) barcode by removing the pharmacy-generated barcode from pharmacy labels placed on commercially available premixed products. | 18% | 24% | 58% | E: Removed extra barcodes on labels to ensure this occurs, do not apply a pharmacy-generated barcode to medications that have a scannable manufacturer barcode |
| When possible, cover the manufacturer’s barcode with the pharmacy label for compounded sterile preparations, driving the nurse to scan the barcode on the patient-specific label and not the manufacturer barcode on the diluent bag. | 10% | 33% | 57% | E: Standard practice training |
| Similarly, 503B compounding pharmacies should place the barcode on compounded sterile preparations in a way that drives end users to scan the product barcode, minimizing confusion. | 8% | 32% | 60% | E: Evaluate and select 503B outsourcers following recommendations |
| Technology vendors should optimize barcode scan alert language and sound for warnings and ensure end users are educated about the meaning of each alert generated when using barcode technology. | 26% | 41% | 33% | E: Provided feedback to the technology vendor |
| Dispensing cabinet vendors should provide users with the configurable option to scan each individual dose of a particular product when stocking or restocking as defined by the organization. | 34% | 17% | 49% | |
| Best Practice 25: Improve the culture of safety. | ||||
| Avoid the use of error rates as an indication of safe practices. | 3% | 27% | 70% | E: The focus is on encouraging reporting and ramping up reporting events that do not reach the patient |
| Create a good catch program for medication safety. | 5% | 20% | 75% | E: “Fab 50 program” where the greatest 50 best catches are recognized, good catch program that encompasses medication safety catches, share good catch safety stories during every huddle |
| Increase the number of close call/near miss reports in your organization. | 2% | 33% | 65% | E: This is ingrained in our culture |
| Create an organization medication error-reduction plan and ensure that it includes an assessment of organizational culture. | 13% | 41% | 46% | E: California hospitals require MERP, this is a regulatory requirement in my state |
| Educate staff on the importance of error and close call/near miss reporting and the need to proactively look at risk. | 1% | 25% | 74% | E: This is done through our good catch program and sharing stories during safety huddles |
| Learn from medication errors. | 0% | 21% | 79% | E: Share ISMP newsletters, created a quarterly medication safety newsletter |
| Optimize the use of culture of safety surveys by ensuring that data are regularly reviewed by leadership and action plans are implemented to improve the culture of safety in the organization. | 4% | 30% | 66% | |
These survey results suggest there is room for improvement with the three new Best Practices. Notably, the most common barriers were resource constraints (e.g., cost, staffing, time), workflow/practice drift, and technology limitations. The most frequently reported enablers among all interventions were ongoing monitoring, particularly observing the practice and workflow changes that make the right action easier. We hope that hospitals will use these survey results to prompt interdisciplinary discussions that take note of the barriers and enablers while implementing these Best Practices. An Implementation Worksheet for all of the Best Practices for Hospitals is available and might be helpful to document your assessment of implementation status, actions required, and assignments.
