Interview topic
The reasons behind the high rate of medication error among the nurses in the emergency unit
Reason for the selection of the topic
According to the reports published in CNBC News (2018), medication error is the third leading causes of death in the United States. According to the population survey published by the Johns Hopkins laboratory, at least 250, 000 people in US die each year due to medication errors. The high rate of occurrence of the medication error is encountered in the emergency unit. The reason behind the medication error mainly arise inappropriate medication administration. Medication errors apart from increasing the causality rate, its outcome related impact increases the overall length of hospital stay along with increase in the cost of care. Thus, proper analysis behind the reason behind the medication error will helpful in devising appropriate plan in reduction of the same (Hartnell et al., 2012).
Interviewee
- Registered nurses (RN) in emergency care unit with experience of one year (number: 2 individual)
- One performance improvement nurse (PIN)
Reason for the selection of this interviewee group
The main defaulters of the medication errors are the registered nurses this is because; it is the nurses who play a major role in the administration of medicines or drugs (Flynn et al., 2012). A performance improvement nurse is selected because they ate the best once to suggest the suitable recommendation in order to overcome the current situation. The small sample size was selected because of lack of adequate funding and proper resources to back an interview format of high sample size.
Interview type
Face-to-face interview with open ended questionnaire
Interview duration
60 minutes (approx)
Interview location
Within the hospital premises
Interview time
As per the convenience of the participants without hampering their duty hours
Ethical consideration taken before conducting the interview
Before initiation of the interview, the hospital ethical committee was notified about the interview process and upon their consent a letter was circulated among the prospective participants of the interview. The nurses who showed interest were asked to sign a consent form and then the interview was initiated. All the ethical guidelines of the interview were maintained strictly (Mealer & Jones, 2014).
Interview consideration
- No personal questions were asked in the interview
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- Interviewee’s identity was kept confidential
- Participants were allowed to leave the interview at any point of time without prior notice
- Participants was made to understand before the signing of the consent letter that they are not compelled to participate in the interview and this has no relation with their professional career.
(Holloway & Galvin, 2016)
Research of scholarly resource before conduction of interview
According to Tzeng, Yin and Schneider (2013) it is the duty of the nurse to practice in a safe and competent manner in order to provide best quality care to the patients. This help to promote better health and well-being for the patient. Tzeng, Yin and Schneider (2013) further highlighted that lack of adequate nursing force in the emergency unit, lack of proper communication skills among the change of shift nurses and lack of proper stress and workload management skills (especially among the inexperienced nurses) lead to increase in the rate of medication error. Dolansky et al. (2013) highlighted that nurses have one of the major responsibility in uplifting the overall quality of care. So it is there duty of overcome the compassion fatigue and commit less medication error. This will help to reduce the cost of care and length of hospital stay. In the domain of training Dolansky et al. (2013) highlighted the requirement of the proper co-ordination among the senior and the junior nurses and implementation of the computerized physicians order system in order to reduce the chances of medication error.
In the domain of interprofessional communication skills, I review the study conducted by Hagemeier et al. (2014). Hagemeier et al. (2014) are of the opinion that the proper interprofessional communication skills help to extract best responses from the participants of the interview. In the domain of GIGO (garbage-in/garbage-out) I review Kim, Huang and Emery (2016). Kim, Huang and Emery (2016) study highlighted which analysis the response from the interview, it is the duty of the reviewer to follow the steps of garbage in and garbage out in order to filter out the informative sentences of themes from the long excerpts. This further helped to increase the information quality of the nursing information system.
Interview Questions for the RN
- Do you think increase in the workload is the main factor behind the medication error?
- Do you think that lack of proper communication skills between the change of shift nurse is the main reason behind the medication error
- What do you want to say about medication error if I say that it occurs due to lack of proper training or knowledge about the medication administration?
- Anything you want to recommend in order to reduce the medication error (optional question)
Interview question to the PIN
- Do you think that the newly appointed registered nurses are common defaulters of the medication errors?
- Are all the errors reported or many gets unreported
- What steps do you thing will be helpful in reducing the medication error among the nurses?
- Do you thing the proper training in the computerized physician based order entry will help to reduce the chances of medication errors
Response of the RN
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Response for Question 1
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Response for Question 2
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Response for Question 3
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Response for Question 4
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RN (1)
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Yes. I think it is the high workload. In emergency unit there is immense work pressure along with the increase in the flow of patient. This 24X7 service with no proper shift timings make us paranoid which increase the chance of committing errors
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Yes, I think so. The senior nurses are at times remain in such a hurry that that either did not communicate us the medication requirement of the patients or they deliberately do that in order to look down us. In wee hours we also do not get access of the doctors and at time run out of proper information about the medication
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I do not think it is the lack of proper training
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I think it would be increase in the nursing workforce and decrease in the working hours
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RN (2)
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I will not say that that we nurses deliberately make medication errors. Even if we make few errors, it is high workload at time which takes a toll in our concentration
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Yes, the this gap in communication is mainly between we the junior nurses and the senior nurses. The senior nurses due their long year of experience knows how to handle critical situations but they do not help us during change of shift and this creates stress an might increase the chances of medication error
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Yes I think it is the lack of proper training which causes medication error. At times we do not know to to perform the inta venous cannulation and adjustment of the proper dosage through intravenous cannulation and this increases the chance of medication error
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I think it would be providing the junior nurses proper training
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Response for Question 1
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Response for Question 2
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Response for Question 3
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Response for Question 4
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PIN
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It will not be wise to tell that the newly appointed RN are the major defaulters in the medication errors but yes the statistics highlights that I would also like to say that they do not perform it deliberately but such errors decreases the quality of care plan and increase the cost of care
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No. Not at all. Nurses in the fear of getting penalized at times do not report the cases of the medication errors and this further creates a gap in drafting interventions based on the problem area
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I think, proper training in clinical skills and stress management skills will help to increase the overall scenario
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No I don’t think so because that would further require training and will increase the overall cost of the organization
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References
CNBC (2018). The third-leading cause of death in US most doctors don't want you to know about. Access date: 18th August 2018. Retrieved from: https://www.cnbc.com/2018/02/22/medical-errors-third-leading-cause-of-death-in-america.html
Dolansky, M. A., Druschel, K., Helba, M., & Courtney, K. (2013). Nursing student medication errors: a case study using root cause analysis. Journal of professional nursing, 29(2), 102-108.
Flynn, L., Liang, Y., Dickson, G. L., Xie, M., & Suh, D. C. (2012). Nurses’ practice environments, error interception practices, and inpatient medication errors. Journal of Nursing Scholarship, 44(2), 180-186.
Hagemeier, N. E., Hess Jr, R., Hagen, K. S., & Sorah, E. L. (2014). Impact of an interprofessional communication course on nursing, medical, and pharmacy students’ communication skill self-efficacy beliefs. American Journal of Pharmaceutical Education, 78(10), 186.
Hartnell, N., MacKinnon, N., Sketris, I., & Fleming, M. (2012). Identifying, understanding and overcoming barriers to medication error reporting in hospitals: a focus group study. BMJ Qual Saf, 21(5), 361-368.
Holloway, I., & Galvin, K. (2016). Qualitative research in nursing and healthcare. John Wiley & Sons.
Kim, Y., Huang, J., & Emery, S. (2016). Garbage in, garbage out: data collection, quality assessment and reporting standards for social media data use in health research, infodemiology and digital disease detection. Journal of medical Internet research, 18(2).
Mealer, M., & Jones, J. (2014). Methodological and ethical issues related to qualitative telephone interviews on sensitive topics. Nurse Researcher, 21(4).
Tzeng, H. M., Yin, C. Y., & Schneider, T. E. (2013). Medication error-related issues in nursing practice. Medsurg nursing, 22(1).
