4.2.3 Administering
Causes of administration errors.
-Quantitative short answer surveys/questionnaires or direct observation methods are most effective are identifying important causes of administration errors (Keers, Williams, Cooke, & Ashcroft, 2013 [1]).
- 29 studies found slips and lapses as common causes of error (Keers et al., 2013). Misidentification of medication or a patient are the most frequent and misreading a medication label/ product, prescription or other documentation are also common.
- Errors are heavily influenced by local working conditions and culture.
- Error- or violation-producing conditions. This includes patient characteristics, such as patient behaviour through non-cooperation; policies and procedures, such as policies
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One study demonstrated significantly decreased interruptions during medication administration with the use of a checklist outlining specific steps to administer medications (Lapkin, Levett-Jones, Chenoweth, & Johnson, 2016 [5]).
- Double checking is a procedure that involves independent, simultaneous, two-person checking of medications before administration to the patient, particularly to high risk patients and high risk medications (Lapkin et al., 2016 [5]). However, increasing studies have produced results showing the ineffectiveness of double checking, which raises some questions about previous evidence demonstrating reduction in medication errors with double checking. Some research shows that single checking is as safe as double-checking, particularly in adult inpatient settings and low-risk medications (Lapkin et al., 2016 [5]).
- Education and training targeted at improving front line workers’ medication practices are widely applied. Evidence shows that self-directed learning does not appear to have an impact on reducing errors but simulation-based exercises and clinical pharmacist-led training are more effective at this (Keers, Williams, Cooke, Walsh & Ashcroft, 2014 [1]; Lapkin et al., 2016
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PODS involves the use of patient’s own medications that they have obtained in the community setting and bring to the hospital. One UK study conducted in a palliative care unit found that PODS reduced the time of drug rounds by up to 75% and empowered patients and enabled greater autonomy in their own self-administration (Wright et al., 2016
Many medication errors occur due to abbreviated words symbols, and dosage that cant be read and become misunderstood. These mistakes can cause harm if no one notices it. Many patients end up with a life threatening problem due to a medical error. A nurse might give the patient the wrong dose because of the handwritten abbreviation the doctor wrote is not clear. Many abbreviations are similar and this can cause complication. If abbreviations are similar the best thing to do is write the abbreviation completely out and always ask if not sure. Providing unabbreviated prescriptions, communication, and writing all abbreviations out can reduce errors in the healthcare setting. Another consideration would be to make sure in the healthcare setting written policies are mentioned and used.
Most undergraduate nursing students are not being properly educated on proper medication administration. Clinical instructors and registered nurses need to be updated on medication administration reporting, so students do not develop bad habits when they become registered nurses. Registered nurses must also continue their education on med error prevention to prevent future errors. Another significant problem with registered nurses was that they did not have positive attitudes when reporting an error. Once these negative attitudes were changed, more errors were reported (Harding & Petrick, 2008). The three main problems that cause medication errors...
Baccalaureate nurses are responsible for providing and ensure our patients safety. The knowledge from others mistakes can help informs nurses of extra precautions that we can take to ensure our patient’s safety. Risk Analysis and Implication for practice course helped me understand the steps I as a nurse can take as well as the facilities I work for to help reduce the number of medication errors that occur. Interviewing the pharmacist help me get a better insight to what facilities already have in place to help prevent medication errors. However like most things you have to have educated and compassionate caring staff to enforce and follow the guidelines set in place.
Some method such as audits, chart reviews, computer monitoring, incident report, bar codes and direct patient observation can improve and decrease medication errors. Regular audits can help patient’s care and reeducate nurses in the work field to new practices. Also reporting of medication errors can help with data comparison and is a learning experience for everyone. Other avenues that has been implemented are computerized physician order entry systems or electronic prescribing (a process of electronic entry of a doctor’s instructions for the treatment of patients under his/her care which communicates these orders over a computer network to other staff or departments) responsible for fulfilling the order, and ward pharmacists can be more diligence on the prescription stage of the medication pathway. A random survey was done in hospital pharmacies on medication error documentation and actions taken against pharmacists involved. A total of 500 hospital were selected in the United States. Data collected on the number of medication error reported, what types of errors were documented and the hospital demographics. The response rate was a total of 28%. Practically, all of the hospitals had policies and procedures in place for reporting medication errors.
Agyemang, REO, and A While. "Medication errors: types, causes and impact on nursing practice." British Journal of Nursing (BJN) 19.6 (2010): 380-385. CINAHL Plus with Full Text. EBSCO. Web. 7 Mar. 2011.
“Don’t you worry, I’ll make sure we will get everything sorted out for you,” spoked the pharmacist to an overwhelmed patient. This was my first day shadowing a pharmacist at the UC Davis Medical Center during my winter break from college. I witnessed my shadowing pharmacist patiently consulted this patient on multiple medications, ensuring he followed the instructions with his take home prescriptions before discharging from the hospital. Over the course of this shadowing experience, I observed how pharmacists collaborated with doctors to provide the best pharmaceutical care and helped facilitate smooth discharge process. I was amazed at their extensive knowledge of not just pharmaceutical drugs but also on different disease states, social
Tzeng, H., Yin, C., & Schneider, T. E. (2013). Medication Error-Related Issues In Nursing Practice. MEDSURG Nursing, 22(1), 13-50.
Medication errors made by medical staff bring about consequences of epidemic proportions. Medical staff includes everyone from providers (medical doctors, nurse practitioners and physician assistants) to pharmacists to nurses (registered and practical). Medication errors account for almost 98,000 deaths in the United States yearly (Tzeng, Yin, & Schneider, 2013). This number only reflects the United States, a small percentage in actuality when looking at the whole world. Medical personnel must take responsibility for their actions and with this responsibility comes accountability in their duties of medication administration. Nurses play a major role in medication error prevention and education and this role distinguishes them as reporters of errors.
... for every pharmacist. This ratio dictates that pharmacists can not oversee every aspect of technicians’ jobs. It is this singular fact that very few people realize. The pharmacy technician who receives no formal training is responsible for not just the delivery of a patient’s medication, but also for their bill, their confidential information, and their life. The question now is, how can an uneducated individual be given so much responsibility? Technicians are granted these responsibilities because a pharmacist can not do the job alone. Pharmacists strive to mold each new technician into an employee that will realize what technicians really do. Pharmacists and technicians provide patients with safe and accurate medication in a timely manner. This is not a task for pharmacists or technicians alone; it is task that requires both personnel in order to be accomplished.
Polypharmacy among the elderly is a growing concern in U.S. healthcare system. Elderly who have comorbities and take multiple medications are at a higher risk for potential adverse drug reactions. Elderly who take over-the-counter medications, herbs, and supplements without consulting their physician are at risk for adverse reactions associated with polypharmacy. Polypharmacy can result from patients having multiple prescribers and pharmacies, and patients who continue to take medications which have been discontinued by the physician. There is a great need for nursing interventions regarding polypharmacy, including medication reviews also known as “brown bag”. As nurses obtain history data and conduct a patient assessment, it is essential to review the patients’ medications and ask open-ended questions regarding all types of medications in which the patient is taking. In addition, the patient assessment is also an opportunity for the nurse to inquire about any adverse reactions the patient may be experiencing resulting from medications. Nurses are in a unique position to provide early detection and intervention for potentially inappropriate medications and its associated adverse drug reactions.
Drug administration forms a major part of the clinical nurse’s role. Medicines are prescribed by the doctor and dispensed by the pharmacist but responsibility for correct administration rests with the registered nurse (O'Shea 1999). So as a student nurse this has become my duty and something that I need to practice and become competent in carrying it out. Each registered nurse is accountable for his/her practice. This practice includes preparing, checking and administering medications, updating knowledge of medications, monitoring the effectiveness of treatment, reporting adverse drug reactions and teaching patients about the drugs that they receive (NMC 2008). Accountability also goes for students, if at any point I felt I was not competent enough to dispensing a certain drug it would be my responsibility in speaking up and let the registered nurses know, so that I could shadow them and have the opportunity to learn help me in future practice and administration.
What classifies as a Medication errors? An error can occur any time during the medication administration process. A medication error can be explained as “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer” (National Coordinating Council for Medication Error Reporting and Prevention, 2014, para 1). Rather it is at prescribing, transcribing, dispensing or at the time of administration all these areas are equally substantial in producing possible errors that could potentially harm the patient (Flynn, Liang...
Nurses are expected to provide a competent level of care that is indicative of their education, experience, skill, and ability to act on agency policies or procedures. In a study of 1,116 hospitals Bond, Raehl, and Franke (2001) found, “Medication errors occurred in 5.07% of the patients admitted each year to these hospitals. Each hospital experienced a medication error every 22.7 hours (every 19.73 admissions). Medication errors that adversely affected patient care outcomes occurred in 0.25% of all patients admitted to these hospitals/year”(p. 4). This means at least one medication error occurs every 24 hours in those facilities studied, and these are preventable errors. The main responsibilities of nurses when administering medications are to prevent or catch error, and report such error. Even if the physician or prescribing health care professional has made a mistake in the order, it is the nurse’s job to question the
The highest cause of medication errors is the lack of knowledge.
Medication errors are an unfortunate occurrence in medical settings all throughout the world. Despite the best efforts of both nurses and physicians, medication errors occur on a daily basis. A medication error is not simply giving the wrong medication, it may consist of giving a drug via the wrong route, at the wrong time, or at the wrong dose. Statistics reported often vary, however the Food and Drug Administration reports that at least seven thousand people die annually as the result of medication errors. Every patient is at risk for being the victim of at least one medication error (“Strategies,” n.d.).