Sekieta Farris
Capella University
Improving Quality Care Patient Safety NHS-FPX 4020
23March 2022
Introduction
Medication administration errors are a key concerto towards the realization of the patient safety, cost reduction and realization of quality health outcomes. They are a result of the failure in the realization in any of the right patient, medication, timing, dosage or the route. A case scenario is the case in my hospital where the nurse administering medication administered the drugs on the wrong patients. A 10-year old 30kilograms by weight with acute osteomyelitis and an eight-year old boy of 24kilograms doing day one post appendicectomy. The nurse exchanged their medication for these patients for two subsequent doses and was only realized during the process of handing over to the next shift. Such errors including wrong dosage and timing of administration are very common. Fekadu et al. (2017) states that in the US, more than 1.5 million people experience injury due to medication errors. On average, every hospital patient suffers from a medication error every day. Additionally, around 7,000 to 9,000 people die annually due to medication errors. According to the World Health Organization (2017), medication errors leave an extra cost for the patient that exceeds $42 billion annually. Robertson & Long (2018) adds that, they also come with psychological and physical suffering.
Causes of medication administration errors
Medication administration errors are cause by issues that include lack of communication of drug orders and with the patients, poor illegible handwriting as well as confusion over the drugs with similar packages and names (Tariq et al., 2018). Other causes of errors include wrong dosing unit and inaccurate weight. Human related factors that are a key cause of medication administration errors include high workload among the stuff, poor pharmacology literacy and fatigue and long working hours. Others include lack of medication administration guidelines and provisions at the facility level.
Solutions to improving patient safety
Medication administration errors are preventable and the solutions can be undertaken with minimal resources. It takes the form of standardized communication, patient education, optimization of workflow and taking a focus on high risk agents. The use of standardized communication serves to endure the right medication are administered (MacDowell, Cabri and Davis, 2021). The labeling of medication should take note of the likelihood of drug similarities and alert the nurses. Also, there is need to have standardized abbreviation and numerical conventions that have are acceptable by The Joint Commission. This includes the elimination of the use of decimals to avoid confusion.
Schroers, Ross & Moriarty (2021) state, that, there is need to optimize nursing workflow. Distracters in the process of healthcare deliver increase the risk and severity of errors. This can be worked on through in safety checks. There can be “do not interrupt” posters that serve to minimize interruption in medication administration. A study by Westbrook et al (2017) found that that nurses experience a significant rate of interruption and exposes them to errors in medication administration and the use of this sign minimizes distractions and ensure guarantees patient safety.
According to Koyama et al. (2020) says there is need have in place independent double checks. It involves two different nurses to intercept any errors prior to administration of medication. MacDowell, Cabri and Davis (2021) argue that approximately 93% of all errors can be detected by use of independent double checks. There is need to have adequate staffing to nursing to patient ratio within the hospitals to ensure optimum are through timely delivery of medication, ensure proper checks during administration
Rodziewicz, Houseman, & Hipskind (2021) found out that classifying medication and label them into high-risk and low-risk agents reduces the occurrence of medication errors especially at the emergency area. Those medications carrying high risk should ensure that they are well labeled to attract the attention of the administering staff. Examples of high alert medications include insulin, chemotherapeutic agents and opioids among others. Rodziewicz, Houseman & Hipskind (2021) further state, that, clear labeling and storage of these medications serve to minimize errors and the severity of risks. To minimize effects associated with wrong route of medication, some medication can be supplied in pre-packed and ready to use format, like the EpiPen will aid nurses to reduce the errors related to the wrong route
Medication errors can also be reduced by incorporation of technology in the delivery of medication should be appreciated and put into practice. They take the form of barcode administration. A study by Hutton, Ding, & Wellman (2021) found, that, there is a link between use of barcodes to the realization of the right medication, the right patient and the right timing of medications. MacDowell, Cabri and Davis (2021) state that, the use of barcodes and electronic recording of medication have a 41% reduction in medication errors and a 51% reduction in the potential severe drug reactions. Additionally use of smart pumps will help deliver right doses at the right time over the right duration.
How nurses can help coordinate care to increase patient safety
Nurses play a critical role in the process of prevention of medication errors. They are the champions of patient safety and wellbeing. The nurses, working with other staff in the hospital, must always work to ensure that there is a significant reduction of errors through initiative that include the use of double checks, and enhancing their knowledge of pharmacology. Nurses working with other members of the staff, and the multidisciplinary teams and the hospital administration work to ensure that there is incorporation of the use of independent double checks in the process of administration of medication as provided by the Institute of Safe Medication Practices (Koyama et al, 2018). Additionally, nurse can coordinate with the pharmacists and the physicians to reduce these errors by taking a proper and thorough medication review during the process of handing over, the rationale for the medications and insisting on the use of proper, legible and written handwriting and proper abbreviation.
The nurses can coordinate with the pharmacists to enhance their knowledge of pharmacology to ensure that they administer medications that they are familiar with, understand their doses and side effects. This will help them be ambassadors of proper medications and dosages. This can be achieved through continuous medical education and trainings. Nurses can coordinate with the hospital administration to ensure that there is adequate staffing, and work distribution to the nurses across all the departments. This will reduce workload, increase efficiently, reduce fatigue and ensure delivery of excellent high quality care to the patients.
Stakeholders in the realization of medication and patient safety
For the success of these initiatives by the nursing teams, there is need to collaborate and work with other disciplines including the administrators, the clinical staff and the communities (Al Mardawi et al., 2021). By working with the administrative personal at the hospital and other policy makers the nurses stand chance to oversee the realization of good institutional protocols, guideline and policies relating to the medication safety. The administration will also serve e to be the champions of patients safety and unwanted and additional reduce cost of care. Also, working with the staff in the facility including the clinical team is a great way of coordinating care and promoting the patient safety. Al Mardawi et al. (2021) notes that physicians, pharmacists, assistants and other specialized members serve as a crucial link to the realization of medication safety and can be of great value as advocates of change through proper prescription, development of education programs, knowledge sharing and trainings as well as ensure smooth flow of information. By working with the communities including the patients and the families, as well as institutions of patient safety like IPSM nurse will see a shift towards medication consciousness and incorporation of the best practices into the nursing practice and care.
Conclusion
Medication administration errors are a common occurrence in the hospitals. They are associated with physical, emotional, and psychological suffering and come with a high financial cost to the patient. Nurses, as ambassadors of change, can always strive to see a reduction in these errors and enhance patient safety through initiatives that include working with other members of the healthcare delivery team. Nurse can work to see maximization workflow, promoting change in medication administration protocols and incorporation of technology to the care of patients.
References
Al Mardawi, G. H., Rajendram, R., Alowesie, S. M., & Alkatheri, M. (2021). Reducing nonsentinel harm events due to medication errors by using mini–root cause analysis and action. Global Journal on Quality and Safety in Healthcare, 4(1), 27-43.
Fekadu, T., Teweldemedhin, M., Esrael, E., &Asgedom, S. W. (2017). Prevalence of intravenous medication administration errors: a cross-sectional study. Integrated pharmacy research & practice, 6, 47.
Hutton, K., Ding, Q., & Wellman, G. (2021). The effects of bar-coding technology on medication errors: a systematic literature review. Journal of Patient Safety, 17(3), e192- e206.
Koyama, A. K., Maddox, C. S. S., Li, L., Bucknall, T., & Westbrook, J. I. (2020). Effectiveness of double checking to reduce medication administration errors: a systematic review. BMJ quality & safety, 29(7), 595-603.
MacDowell, P., Cabri. A., Davis M. (2021). Medication Administration Errors. https://psnet.ahrq.gov/primer/medication-administration-errors
Robertson, J. J., & Long, B. (2018). Suffering in silence: medical error and its impact on health care providers. The Journal of emergency medicine, 54(4), 402-409.
Rodziewicz, T. L., Houseman, B., & Hipskind, J. E. (2021). Medical error reduction and prevention. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK499956/
Schroers, G., Ross, J. G., & Moriarty, H. (2021). Nurses’ perceived causes of medication administration errors: a qualitative systematic review. The Joint Commission Journal on Quality and Patient Safety, 47(1), 38-53.
Tariq, R. A., Vashisht, R., Sinha, A., &Scherbak, Y. (2018). Medication dispensing errors and prevention.Medication Dispensing Errors And Prevention - StatPearls - NCBI Bookshelf (nih.gov)
Westbrook, J. I., Li, L., Hooper, T. D., Raban, M. Z., Middleton, S., & Lehnbom, E. C. (2017). Effectiveness of a ‘Do not interrupt’bundled intervention to reduce interruptions during medication administration: a cluster randomised controlled feasibility study. BMJ quality & safety, 26(9), 734-742.
World Health Organization (2017). The Global Patient Safety Challenge: Medications Without Harm. http://www.gims-foundation.org/wp-content/uploads/2017/05/WHO-Brochure- GPSC_Medication-Without-Harm-2017.pdf