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Mitigating medication errors
Comparing medication administration errors
Mitigating medication errors
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When looking to implement the 2 key strategies previously mentioned for reducing medication administration errors there are many barriers and facilitators for both smart IV pumps and BCMA. For successful implementation of the smart IV pump there is a lengthy set up stage (Heron, 2017) This stage involves creating the drug library for all care areas and setting the soft and hard limits. Heron (2017) proposes for successful implementation multidisciplinary teams of senior managers ward nurses, pharmacists, doctors and IT must effectively communicate and cooperate for creation of drug libraries and policies and establishing guidelines. Barriers may arise if not correctly done as it is argued nursing staff can become frustrated if data is not comprehensive …show more content…
To achieve successful implementation of BCMA nursing and pharmacy staff must be active partners in the implementation phase (Ross, 2008). A multidisciplinary team must be able to work together to access problems that may arise and collectively problem solve for solutions (Ross, 2008). Ross (2008) outlines the importance of these team to be able to work together with mutual respect, understanding and maintain balance for the initial implementation phase to be …show more content…
(2009) found there was nurse dissatisfaction in relation to the new system being implemented as they felt that it took to longer for stat orders to be completed and placed on the system. They conclude that for this issue to be elevated there needs to be good communication in place between pharmacist and doctors to speed up the process of stat orders. Furthermore, nurses in this study report that they felt that a side effect of BCMA was that it gave them less time with patients (Fowler et al., 2009). This is a sentiment that is echoed in a study by Ross (2008) where nurse reported a fear that this new system slowed them down and took them away from patient care. According to Ken et al. (2015), the barcodes need to be adapted to wards to ensure it is cohesive with their workloads and workflows. If this is not put in place to coincide with different wards needs work arounds will to taken by staff due to their view of the technology, training they received or the policies that are in place (Kopple et al., 2008). Kopple et al. (2008) concludes that as a result staff will blame the software if too many problems arise for it being
For my research paper, I will be discussing the impact of medication errors on vulnerable populations, specifically the elderly. Technology offers ways to reduce medication errors using electronic bar-coding medication administration (BCMA) systems. However, skilled nursing facilities (SNFs) are not using these systems. Medication is still administered with a paper or electronic medication administration record (eMAR), without barcode scanning. In contrast, every hospital I have been in: as a patient, nursing student, and nurse uses BCMA systems. The healthcare system is neglecting the elderly. Nursing homes should use BCMAs to reduce the incidents of medication errors.
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.
The Sigma Spectrum achieved an average of 97% drug library compliance within the first 30 days of implementation (Sigma Spectrum Infusion System, 2016). Consistently using drug libraries is especially critical in identifying and preventing harmful medication errors (Sigma Spectrum Infusion System, 2016). Every year in the U.S. an estimated 1.2 million individuals are harmed by preventable medication errors (Sigma Spectrum Infusion System, 2016). The defining features of smart pumps are drug libraries. Drug libraries are created to help clinicians identify mistakes before they have a chance to harm a patient by allowing the clinician to choose from a list of medications/fluids within appropriate dose ranges (Sigma Spectrum Infusion System, 2016). Sigma Spectrum pumps automatically default to the drug library that is already installed when it is powered on, allowing the clinicians to remain compliant with every infusion in the drug library (Sigma Spectrum Infusion System, 2016). Errors associated with the use of all smart pumps are a possibility when not used appropriately by HCPs. Errors that occur are generally when a HCF chooses to bypass a dose error-reduction software in smart pumps or do not use smart pumps in all settings which may lead to a mistake that effects patient safety (Sigma Spectrum Infusion System, 2016). The ISMP recommends some best practices that include using smart pumps in all
“The team is faced with creating cohesion and unity, differentiating roles, identifying expectations for members, and enhancing commitment. Providing supportive feedback and fostering commitment to a vision are needed from the team leaders (Developing Management Skills).” ... ... middle of paper ... ...
An Bord Altranais (2007) Guidance to Nurses and Midwives on Medication Management. (http://www.nursingboard.ie/en/policies-guidelines.aspx) (accessed 15th October, 2011) (Internet).
Young, J., Slebodnik, M., & Sands, L. (2010). Bar code technology and medication administration error. Journal of Patient Safety, 6(2), 115-120. doi:10.1097/PTS.0b013e3181de35f7
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.
A group of people working on a team means a group of different sets of minds working together. Thus, it is inevitable that there may arise conflicts on a certain topic within the team, as certain viewpoint may seem right for the circumstances for some teammates and may different for others. However, it is not that they are not solvable.
Seven tasks must be included in consideration of team dynamics and structure. The first of which is defining the goal, mission or function of a specific team. The team must know what it is being asked to accomplish. The second area of consideration is assessing what skills, abilities, knowledge or potential to acquire such would be needed amongst selected team members. Identification of potential team members should include an assessment of the skills, knowledge and abilities or the potential to acquire such so that ultimately the team has the building blocks with which to succeed in its mission, goal or function. This assessment must include an understanding of realistic potential contributions by potential team members with the included assessment of whether or not the acquisition of skills and knowledge can be made available through research and analysis.
Larson, C. and LaFasto, F. (1989), Teamwork: What Must Go Right/What Can Go Wrong. Newberry Park, CA: Sage Publications, Inc.
Based on the 1993, research of Meredith Belbin, a successful team consists of nine roles. The first of these roles is the coordinator. The coordinator is one that has a clear view of the teams’ objective. This person is usually self-disciplined and confident. Secondly, the shaper. This individual is full of drive, makes things happen, and loves a challenge. Third, the planter. The planter is the individual who has original ideas and their strength is to provide the team with new insights and possibilities for change. Fourth, the resource investigator. This individual has the strongest contacts and networks. They are enthusiastic and brings information from the outside. Fifth, the implementer. Implementers are well organized and effective in turning ideas into tasks. Sixth, the team worker. This person is aware of all the teams’ needs and concerns. Team workers are supportive, sensitive, and promotes harmony to reduce conflict. Seventh, the specialist. The specialist provides specialist skills and knowledge but does not always see the whole picture. Eighth, the monitor evaluator. The evaluators are good at seeing all options from every angle. They have a strategic perspective and can judge situations accurately. Last is the completer/finisher. The completer/finisher is the individual that drives the deadlines and makes sure they are achieved. (Teamwork,
Standards of practice for LTCP have evolved over several decades in response to a complex set of Federal and state regulations governing the provision of prescription drugs in the LTC setting (CMS, 2014). The law that regulates the practice of pharmacy in nursing facilities are developed to safeguard the health and well being of nursing facility residents. This group of population have atypical care needs that would require alternative forms of medication or more intensive medication management. Federal law regulation mandates LTC facility in conjunction with LTCP to develop a system to decrease medication errors and adverse drug events; assure proper medication selection; monitor drug interactions; assess for over-medication, and under- medication; improve medication documentation (CMS, 2014). In order to be compliance with the federal law, it is imperative that the pharmacy and nursing facility work collaboratively to develop policy and procedure that meet the regulations.
Working in teams provides an opportunity for individuals to come together and establish a rapport towards others within a group. Teamwork is classified as people with different strengths and skills who work together to achieve a common goal. When a team works well, specific objectives are fulfilled and satisfied. Teamwork plays a crucial role in implementing and fulfilling a common goal in a team project. Each member plays a role and takes on different responsibilities combined together. In different stages of teamwork, conflicts and arguments may occur for as members have different standpoints which need to be harmonized within the team. The key to having an effective teamwork is to explore each member's unique abilities to motivate them.
A work team will be defined for the purposes of this paper by a definition borrowed from Bateman and Snell (2004). A team is formed of people (usually a small number) with complementary skills who trust one another and are committed to a common purpose, common performance goals, and a common approach for which they hold themselves mutually accountable. Teams generally see themselves and are seen by others as a social entity, which is interdependent because of the tasks performed as members of a group.
Building a core team in project management is essential because it encourages shared belief in the importance and the possibility of achieving project goals and objectives. By sharing the vision of the project, to play a key role in ensuring that all team members in order to achieve a similar goal, helping to eliminate potential conflicts of interest during the implementation of the project. Building an important team in project management because it helps team members understand their respective roles in achieving the objectives of the project. Recognition of the role of others is essential in reducing conflicts and facilitate teamwork best practices