Addressing Medication Errors In Nursing: An Essay.

The Role of Medication Administration and Management in Nursing

Discuss about the Addressing Medication Errors Occurring in Nursing.

In any healthcare scenario, the process of achieving effective therapeutic outcomes depends on various factors like treatment process, patient safety, communication, nursing care, drug interventions etc. (Fletcher, Fletcher & Fletcher, 2012). Any kind of minor or major mistake in any of these factors can lead to drastic loss of patient health and healthcare organisation. Out of these factors drug intervention or medication is the most fundamental requirement to achieve treatment. Any kind of mistake or negligence in drug intervention process can result in direct side effect on patient’s health (Grove, Burns & Gray, 2014). According to Raban & Westbrook (2014), medication error is reported to be a reason for thousands of demises and millions of hospitalisation globally. Hence, fixation of any medication error becomes a fundamental requirement in healthcare scenario.

The medication administration and management is one of the fundamental nursing roles that critically depend on the nursing skills and knowledge. The nursing staffs have the responsibility to administrate, monitor and manage the drug intervention for hospitalised patients. Therefore, continuous observance, alertness and approaches are required in healthcare scenario to avoid the potential chances of medical error (Grove, Burns & Gray, 2014).

According to Unver, Tastan & Akbayrak (2012) studies the proper definition for medication error is “any avoidable incident that risks to incongruous medication use causing or leading patient harm, although being under the control of medical professional, carer or consumer”. The medication error incidences are related to healthcare products, medical practices, medical prescriptions, procedures, nursing practices, product labelling, compounding, distribution, education, dispensing, monitoring, utilisation and communication. Any kind of negligence in these events can lead to medication errors. Therefore, adopting best possible strategies to avoid this medication error in healthcare scenario is one of the major priority concerns (Fletcher, Fletcher & Fletcher, 2012).

As a registered nurse, it is been noticed in my clinical scenario that issue of medication error is gaining a possible position where around 60% risk event in hospital occur due to medication negligence’s in the nursing care unit. Some of the most common factors related to these medication errors are new staff, insufficient training, incorrect administration technique, prescription errors (incorrect dosage), expired medication usage, wrong patient identification, and preparation errors (mixing incorrect multiple medications, dose calculation errors). These factorial causes of medication error indicate nursing medication negligence in the clinical scenario. Therefore, it is critically required to minimise these events and manage medication error to improve medical care facility provided by nursing care unit.

This Quality Improvement Project is specifically designed to manage this issue of medication error in healthcare scenario. The various negligence’s and issues in nursing care will be addressed as per the quality improvement process provided in this project to get a control over events of medication error in the organisation.

The medication errors described above are clearly indicating the lack of knowledge, calibre and guidance provided to the nursing staff of the hospital. The administration, prescription and preparation errors directly specify the issue in nursing skills and practice. Therefore, this quality improvement project will work to improve the nursing skills by providing a Short-term Periodic Training (STPT) Program that will acknowledge the staff about different strategies to avoid such medication error while dealing with patients in the hospital. This nursing training program is safe and specifically developed to improve nursing practice within the short duration of time to improve medical care.

Defining Medication Error

Project Aim

The aim of this quality improvement project will be to implement Short-term Periodic Training Program (STPT program) to overcome nursing issues and mishandling that are increasing the risk of medication errors in healthcare scenario of selected organisation.

The medication error is always considered to be a major clinical issue because it directly affects the patient safety and treatment process. Any kind of minor negligence in medication process is prone to develop major clinical consequences (Fletcher, Fletcher & Fletcher, 2012). This project will help to decrease the risk cases occurring due to medication errors caused by mishandling and negligence’s of nursing staff in the healthcare organisation. The Short-term Nursing Program will work to overcome the identified factors leading to the medication error in nursing care unit causing high risk to patient safety. Hence, this quality improvement intervention will help to overcome the medication error harming medical care process.

Nursing and medication error

The establishment of patient safety and health betterment is the very first priority of quality healthcare services management. There are various faults and errors that lead to the imbalance in quality outcomes where medication error holds a top most position. After doctors prescribe a medicine the major role players are the nurses whose fundamental work is to manage the treatment of their patient (Grove, Burns & Gray, 2014).

According to a recent study related to Medication Safety in Australia provided by Chiang et al. (2010) the faults in nursing administration leads to 70% medication errors. Faults like wrong dose, wrong rate, wrong volume or dose incompatibility were reason of 90% medication error in nursing care unit resulting in surgical requirement, long patient stay and permanent health defects in the patients.

Unver, Tastan, & Akbayrak (2012) studied the causes of medication error as per nurse’s viewpoint where the findings indicated more than ten leading factors of medication error responded by paediatric nurses. The major once were stress (70%), burnout (45%), complicated prescription (30%), unfamiliar medicines (40%), work pressure (35%), knowledge deficiencies (20%), and lack of facilities (4%). Further, in a survey studied by Pham et al. (2012) indicated that majority of nursing staff is not aware of the correct form of medication error. Only 20% nurses mentioned medication error as the wrong dose, incorrect time of dose, and wrong mode of transmission and wrong administration process. However, rest 80% of nurses mentioned medication error as lack of documentation and reporting as the medication error. Hence, this literature indicated a lack of proper nursing education that detects the wrong perceptions of nurses about medication error.

Kalisch & Aebersold (2010) indicated that nursing experience and education is one of the critical factors that is directly linked to medication error. The less experienced and skilled nurses cause 50% of medication errors that includes wrong patient, incorrect dilution calculations, incorrect dosage, incorrect administration and improper reporting. Seys et al. (2012) supported by indicating that naïve nurses are generally not able to recognise their medication error as well as they lack proper knowledge in warrant reporting. This indicates a lack in professional training system of the healthcare organisation.

Factors Contributing to Medication Errors in Nursing

In the study of Sears, Goldsworthy & Goodman (2010) related to nurse’s viewpoint on medication error, it is clearly indicated that lack of pharmacological knowledge is a major reason for medication error as per viewpoint of 237 professional nurses. Hence, this directly indicates a requirement of improved training intervention in nursing practice. Chhabra et al. (2012) studied in a survey that 80% of new nurses commit medication error in first six months of their nursing practice where 70% remained unreported by them and 10% caused serious health hazards to the patient.

There are different strategies and programs implemented at various organisations in a different manner to cope up with the medication error. Agyemang & While (2010) Opine the use of different strategies to avoid three major causes that are knowledge gaps, performance lapse, and failure of the safety system of medication. The strategies of MEDMARX program are described below: -

• Implementation of health record reviewing process
• Patient and clinician education
• Bar-code medicine management
• Reviewing the medication reporting format
• Computerised medical entry

Further, Mueller et al. (2012) studied that E-learning is the most contemporary form of nursing education with the help of which nurses can get instant solutions for their issue related to medication process. This e-learning strategy helped to improve pharmaceutical knowledge and dosage calculation for nurses. The E-learning facility is new to nursing practices but possesses potential positive outcomes. Seys et al. (2012) studied the use of one nursing education program named as SCRIPT study that was developed to improve the issues like unreadable prescriptions, improper antibiotics documentation, and poor communication leading to medication error. The SCRIPT abbreviation was used in a manner to detail educational message about the program that indicated, S: Senior doctor cross-check, C: Check allergies, R: wRite indications for antibiotics, I: (Initial Date) of charting medicine in parenthesis, P: PRINT and sign your name, T: Appropriate Targets for infusions in the nursing practice. The post education results indicated a decrease in prescription error, dose infusions and communication errors.

Mohammad et al. (2010) studied an Evidence-based quality improvement program (IQ program) used in hospitals of sixteen states where 30% of 616 critical care hospitals participated in program implementation. The findings indicated that project was successful in improving medication quality and safety in 90% of hospitals. The program used five strategies that are maintaining skilled nursing and pharmacist staff, use of pharmacological reconciliation techniques, implementing technological software’s (telehealth), improving nurse workflow and improving cultural defects in the organisation. Kwan et al. (2013) indicated that reviewing and updating service techniques with education and training on the periodic basis is effective to refine the nursing staff as per dwelling issues and problems in healthcare. This periodic training program can help to regularly update healthcare services as per the changing environmental complex situations.

This Quality Improvement research proposal will work to rectify the on-going medication errors that clearly highlight a lack of pharmaceutical knowledge, skills and training in the nursing staff of the organisation. The identified issue are insufficient training, incorrect administration technique, prescription errors (incorrect dosage), expired medication usage, wrong patient identification, and preparation errors (mixing incorrect multiple medications, dose calculation errors) that are leading to medication error establishment. Therefore, to overcome these factors that dwell medication error a Short-term Periodic Training Program (STPT) will be proposed in this project that will help to overcome these issues in the clinical scenario.

The Need for Quality Improvement to Address Medication Errors

This STPT will be a short-term 5 days training that will be provided to nursing staff of organisation in every six months to address the identified medication errors. As per the detected causes of medication error, this STPT will be designed and modified in every 6 month period by the experts to upgrade the nursing education and knowledge to cope up with changing healthcare environment and to address the medication errors for medical care improvement. This STPT program will involve an array of five strategies where each strategy will be guided to nurses on each day of the program. These strategies will be produced as per the identified medication error and mistakes in healthcare functionality.

The establishment of STPT program will help to achieve equilibrium to manage the regular issues in medication services as well as the program will work to regularly upgrade the skills, education and knowledge of nursing staff within the organisation. Hence, this intervention will provide a regular process to control the medication complexity and establish the proper working environment.

This quality improvement intervention will be planned using PDSA approach to regularly analyse the outcomes of this program. According to Nakayama et al. (2010) P-plan, D-do, S-study and A-act is a cycle that helps to analyse the impact of any trail or change in particular scenario. The planning phase involves the planning of change, do phase involves the implementation of change, study phase is accessing or studying the outcomes of change, and act phase involve determining the modification required in next change cycle. PDSA is considered as the ideal model of improvement.

Figure 1: PDSA approach for quality improvement

(Source: Nakayama et al. 2010, p. 337)

In this project, PDSA cycle will be used to implement and test the effect of STPT program for addressing medication error. The below provided is the PDSA design and processes that will lead to development and evaluation of quality improvement program STPT for addressing the medication error in the present clinical scenario.

P-Plan

·         Team assembly ·         Creating aim statement ·         Determining the current approach ·         Identifying the potential solutions

For the planning phase, the required authorities that include management committee, medical specialists, senior nursing staff and senior pharmacist will be invited to attend a meeting where the medication issues identified will be discussed in details. The aim statement will be to educate nursing staff as per the identified medication error causes in the clinical scenario. The issues will be identifies using the baseline performance audit and health information data of the involved patients. As per the discussion, possible solutions or strategies will be identified to manage these issues. As the current issues are lack of pharmaceutical knowledge, skills and training in nursing staff the proposed training and education strategies are: - ·         Educating about five rights of medication administration that are the right drug, right patient, right time, right route and right dosage. ·         Educating about reconciliation procedures ·         Educating about e-learning process to improve knowledge ·         Educating about process to documenting medication information and reporting medication error ·         Guiding about the use of drug guide and suggesting to carry it all the time (Jones & Treiber, 2010).

D-Do

·         Analyse the improvement theory ·         Initiate the STPT program intervention ·         Collect the data to analyse ·         Document the collected information

The education program will be conducted with complete medical, pharmaceutical and surgical nursing staff. The program process will be carried for five days (2 hours) where each day a particular strategy will be taught by nursing teachers to the staff using audio-visual presentations. The education program will be designed as time efficient and simple. After the completion of the program a feedback form will be generated that is required to be filled by each participant of the program. This feedback data will help to analyse the effectiveness of program among audiences. After the completion of the educational program, a post-intervention will be checked for next five-week to detect the improvements in medication errors.

S-Study

·         Studying and analysing the collected data ·         Identifying the errors and improvements

In this phase of PDSA analysis, the collected feedback and audit information will be analysed to detect the improvement in medication error factors, mortality and serious hospitalisation, and impact on nursing staff for the implemented STPT program.

A-Act

·         Re-analysing the STPT program strategies ·         Establishing future strategies ·         Improving errors in plan

This phase of PDSA cycle is to re-examine the error in program development and implementing the possible solution for mistakes detected as per analysis. The modifications will be made in program education strategies in the next STPT program as per the identified medication errors in clinical functionality.

As per this quality improvement project of implementing a Short-term periodic training program to overcome medication error in organisation, it is expected that findings will demonstrate a clear decrease in the medication error events and improvement in patient safety. The PDSA approach applied for quality improvement development and analysis allows reviewing the program strategy in every periodic repetition of STPT program. Hence, this technique can be modified as per post education intervention outcomes using PDSA model of quality improvement.

References

Fletcher, R. H., Fletcher, S. W., & Fletcher, G. S. (2012). Clinical epidemiology: the essentials. Lippincott Williams & Wilkins.

Grove, S. K., Burns, N., & Gray, J. R. (2014). Understanding nursing research: Building an evidence-based practice. Elsevier Health Sciences.

Agyemang, R. E. O., & While, A. (2010). Medication errors: types, causes and impact on nursing practice. British journal of Nursing, 19(6).

Chhabra, P. T., Rattinger, G. B., Dutcher, S. K., Hare, M. E., Parsons, K. L., & Zuckerman, I. H. (2012). Medication reconciliation during the transition to and from long-term care settings: a systematic review. Research in Social and Administrative Pharmacy, 8(1), 60-75.

Chiang, H. Y., Lin, S. Y., Hsu, S. C., & Ma, S. C. (2010). Factors determining hospital nurses' failures in reporting medication errors in Taiwan. Nursing outlook, 58(1), 17-25.

Jones, J. H., & Treiber, L. (2010). When the 5 rights go wrong: medication errors from the nursing perspective. Journal of Nursing Care Quality, 25(3), 240-247.

Kalisch, B. J., & Aebersold, M. (2010). Interruptions and multitasking in nursing care. The joint commission journal on quality and patient safety,36(3), 126-132.

Kwan, J. L., Lo, L., Sampson, M., & Shojania, K. G. (2013). Medication reconciliation during transitions of care as a patient safety strategy: a systematic review. Annals of internal medicine, 158(5_Part_2), 397-403.

Mohammad Nejad, I., Hojjati, H., Sharifniya, S. H., & Ehsani, S. R. (2010). Evaluation of medication error in nursing students in four educational hospitals in Tehran. Iranian Journal of Medical Ethics and History of Medicine, 3, 60-69.

Mueller, S. K., Sponsler, K. C., Kripalani, S., & Schnipper, J. L. (2012). Hospital-based medication reconciliation practices: a systematic review.Archives of internal medicine, 172(14), 1057-1069.

Nakayama, D. K., Bushey, T. N., Hubbard, I., Cole, D., Brown, A., Grant, T. M., & Shaker, I. J. (2010). Using a plan-do-study-act cycle to introduce a new OR service line. AORN journal, 92(3), 335-343.

Pham, J. C., Aswani, M. S., Rosen, M., Lee, H., Huddle, M., Weeks, K., & Pronovost, P. J. (2012). Reducing medical errors and adverse events. Annual review of medicine, 63, 447-463.

Raban, M. Z., & Westbrook, J. I. (2014). Are interventions to reduce interruptions and errors during medication administration effective?: a systematic review. BMJ quality & safety, 23(5), 414-421.

Sears, K., Goldsworthy, S., & Goodman, W. M. (2010). The relationship between simulation in nursing education and medication safety. Journal of Nursing Education, 49(1), 52-55.

Seys, D., Wu, A. W., Van Gerven, E., Vleugels, A., Euwema, M., Panella, M., ... & Vanhaecht, K. (2012). Health care professionals as second victims after adverse events: a systematic review. Evaluation & the health professions, 0163278712458918.

Unver, V., Tastan, S., & Akbayrak, N. (2012). Medication errors: perspectives of newly graduated and experienced nurses. International journal of nursing practice, 18(4), 317-324.