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Observational Study by Westbrook et al.

Discuss about the Errors in Intravenous Medicine Administration.

In the recent years, healthcare sectors are highly concerned with the increasing rate of errors in intravenous administration of medicines. There has been a high degree of mortality rate in the nation mainly due to intravenous administration errors.  Different contributing factors have been recognized by researchers that had helped in shedding light over the increasing rate of the errors. This essay will also portray two important articles where researchers have conducted experiments to discuss the errors that occur during intravenous medication administration and will also compare both the articles to find out different positive and negative aspects of the papers.

Westbook et al. had published an article in the year 2016 where they had worked extensively to study the frequency, type and severity of the intravenous administration errors in different healthcare sectors. Before proceeding into the experimental part, they have explained in details about how such errors have been the most detrimental among all types of medication errors. They have given the information that in United Kingdom a total of about 62% of the cases of medicine errors constitutes of intravenous administration errors. They have also stated that United States also have a similar higher rate of administration error of intravenous medication. They have conducted an observational study where they have taken two hospitals of Australia in consideration. They have included an observation of 568 intravenous medication administration over a larger number of six to seven wards that included both surgical and medical patients. For this assessment they had prepared a structural observational tool which was followed by its incorporation into software in a handheld computer that used a personal digital assistant called PDA.

After conducting the entire observational studies, the researchers noted down each practice of the nurses along with the procedures they have followed. They also carefully noticed, the doses, procedure of administration and other important factors in their observational studies. after properly noting down each of the instances and carefully analyzing the practice of each nurses, they put forward important data which had shed light on the current practices that nurses follow in intravenous medication administration.

They have noted down a large number of procedural failures that they have observed in the practices of the nurses. They can be listed as the failure of the healthcare staffs to read medication labels and failure of a nurse to properly check patient identification. Nurses were seen to neglect their duty of checking the patient’s wristband or the patients’ name and date of birth and aligning them with that of the medication information chart of the same patient before administering their scheduled dose (Ohasi et al., 2014). Moreover, nurses were also found to store medication in unsecured environment. They were also found to fail severely in documenting their medication records and upgrading the medication charts. They were also observed to not maintaining hand hygiene and thereby administering intravenous medicines without washing hands.           Procedural failures were also observed in properly checking pulse before intravenous administration or monitoring the blood sugar level before introducing insulin. While application of dangerous drugs, failures were noted with two nurses signing the medication chart, checking preparation and in witnessing dangerous drug administration.

Severity of Errors

From the data they have collected, they also showed that besides procedural errors, clinical errors have also been noted. Wrong intravenous rate is also observed in the practices of the nurses. They were seen to administer intravenous drug at a much faster rate than the Australian injectable drug handbook have advised to. They were also found to prepare a wrong mixture, which was either much diluted or much concentrated than the Australian injectable Drugs Handbook. Wrong volume preparation is also observed among the nurses. Drug-Drug interaction was also recorded which results when one administered drug reacted with another causing adverse reaction to the patients.


While assessing for the severity of the errors that had been noted by researchers, it was found that administrations that took place through bolus had higher error rates and more severe than those with infusions. The bolus intravenous infusions had higher rate and more types of errors like wrong rates, wrong volume, wrong mixture or incompatible drugs. For intravenous infusions, wrong rate and wrong volume showed higher severity and were much serious for patients (Keers et al., 2013). Moreover, nurses, especially those who were less experienced, did not properly utilize infusion pumps. This is mainly due to their failure in the use of devices as intended. These nurses were not aware of the potential of infusion pumps to decrease the rate of the errors and the higher rate of errors is also found to be in nurses who are less experienced. Researchers have denoted that they have found that when nurses achieve an experience of 6 years, their rate of making errors in intravenous drug administration gets reduced to a large extent. Their severity of the errors also is reduced. Researchers have denoted that in most of the cases errors in medication administration was mainly found to be the result of insufficient knowledge among the nurses and the rates of such errors gradually decreased in them as the years of experiences went on increasing (Cheragi et al., 2014). They also remarked that many of the errors took place because the nurses were associated with routine violations that they should learn at workplace only and this persisted even when clinical expertise was achieved.

The researchers have therefore recommended supervising the new nurses who are on duty. Important training sessions should also be introduced so that they can properly develop proper idea about the different procedures and clinical skills required for proper intravenous medication administration. This would help in maintaining more patient-safety.

Recommendations

Another article that had been chosen is the work of Keers et al., which was published in the year 2015. Unlike the previous article, which denoted the frequency, type and severity of the medication errors, it mainly depicted the main causes that contribute to such intravenous medication errors. In this article, the researchers have conducted interviews of 20 nurses who worked in two NHS teaching hospitals in North West England. The previous study was conducted in Australia and was an observational study unlike this one, which is an interview, conducted by researchers. The replies of the nurses were transcribed and analyzed using the Framework approach. They used the Reason’s model of accident causation to categorize the emerging themes.


Unlike the previous study where the researchers found out the types of errors in form of procedures and clinical intervention, here the researchers mainly pointed out six important perceived reasons that contribute to failure in proper intravenous administration. The first reason they marked is the cases of actual failures. In this category, they included casual behaviour of the nurse during dose checking that resulted in missing and slops. Executional failures were also noted mainly due to look alike medicines, distractions and familiarity with patients (ong et al., 2013). Though look-alike medications were remarked as a type of failure by the previous article, it did not pinpoint distractions caused by the patients on wards that affect a nurse’s safe practice. This point might have come up as the nurse’s personal experiences were shared in the article. Knowledge based mistakes were also stated by the present paper and shared a common view with the previous one as both depicted this reason as one of the factors resulting in errors.

Just like the previous paper, the current paper also have denoted the nurse’s tendency to not follow the proper rules regarding the medication administration during dosage adjustments or prescription stated activities. Another factor that the recent paper marked but was absent in the previous paper is the practice of nurses in not consulting another nurses or not preventing another nurse when confusions arise while administering a particular medicine. Mainly their relationship with the other nurses was not friendly enough that prevented them in insulating with them besides the uncomfortable feeling of showing one’s knowledge gaps (Parry, Barribal & While, 2015).

Another factor that they have noted is the increasing workload and the distractions that often accompany the care provided to clinically deteriorating patients and their family members, which contribute to slips and lapses. The previous authors did not point patients, being a source of distortion and medication errors in busy shifts. The author of the second paper has also pointed out that nurses often cause mistakes in medication errors because of their unfamiliarity with frequently used medicines, which was previously mentioned. However, the previous authors did not consider the nurses overconfident, which later authors pointed out. They said that familiarity of patients for a large number of years made them overconfident and this led their overlooking the prescription. These cause medication errors. Moreover, fear of portraying oneself as less competent prevented them from consulting with others (Nguywn et al., 2013). The author had provided enough instances, which have shown that the relationships shared by the nurses are not cordial enough that, often lead to miscommunications.

Interview Study by Keers et al.


The author of the previous paper had not mentioned anything about the working environment of the nurses as the contributing factor. However, the current paper had shown that noisy, chaotic and distracted environment act as contributor to medication administration error. The author of the present paper had also stated that lack of proper staff skill mix, nursing shortages, busy shifts and others are other contributors. Moreover, equipment related lack of knowledge was also found to be contributing factors.

From the entire discussion on the two papers, it was noted that both the papers were capable enough to point out the important factors that often lead to medication error in intravenous administration. However, the later paper seems to have a more detailed approach than the previous one. The various factors of both the papers can be taken into consideration by the authority so that they can introduce policies to handle the issues and promote safe practices in healthcare sectors.

References:

Cheragi, M. A., Manoocheri, H., Mohammadnejad, E., & Ehsani, S. R. (2014). Types and causes of medication errors from nurse’s viewpoint. Iranian journal of nursing and midwifery research, 18(3).

Keers, R. N., Williams, S. D., Cooke, J., & Ashcroft, D. M. (2013). Prevalence and nature of medication administration errors in health care settings: a systematic review of direct observational evidence. Annals of Pharmacotherapy, 47(2), 237-256.

Keers, R. N., Williams, S. D., Cooke, J., & Ashcroft, D. M. (2015). Understanding the causes of intravenous medication administration errors in hospitals: a qualitative critical incident study. BMJ open, 5(3), e005948.

Keers, R. N., Williams, S. D., Cooke, J., Walsh, T., & Ashcroft, D. M. (2014). Impact of interventions designed to reduce medication administration errors in hospitals: a systematic review. Drug safety, 37(5), 317-332.

Nguyen, H. T., Pham, H. T., Vo, D. K., Nguyen, T. D., van den Heuvel, E. R., Haaijer-Ruskamp, F. M., &nlike the previous study where the researchers found out theamp; Taxis, K. (2013). The effect of a clinical pharmacist-led training programme on intravenous medication errors: a controlled before and after study. BMJ quality & safety, bmjqs-2013.

Ohashi, K., Dalleur, O., Dykes, P. C., & Bates, D. W. (2014). Benefits and risks of using smart pumps to reduce medication error rates: a systematic review. Drug safety, 37(12), 1011-1020.

Ong, W. M., & Subasyini, S. (2013). Medication errors in intravenous drug preparation and administration. Med J Malaysia, 68(1), 52-57.

Parry, A. M., Barriball, K. L., & While, A. E. (2015). Factors contributing to Registered Nurse medication administration error: A narrative review. International journal of nursing studies, 52(1), 403-420.

Prakash, V., Koczmara, C., Savage, P., Trip, K., Stewart, J., McCurdie, T., ... & Trbovich, P. (2014). Mitigating errors caused by interruptions during medication verification and administration: interventions in a simulated ambulatory chemotherapy setting. BMJ quality & safety, bmjqs-2013.

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.

Westbrook, J. I., Rob, M. I., Woods, A., & Parry, D. (2011). Errors in the administration of intravenous medications in hospital and the role of correct procedures and nurse experience. BMJ quality & safety, 20(12), 1027-1034.

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