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Medication error in clinical setting
Medication error in clinical setting
Medication error in clinical setting
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INTRODUCTION Pharmaceutical error refers to any unintended error in prescribing, dispensing or administering a medicinal product in control of health care professional. Drug use is a very complex process and there are drug related challenges at different levels, involving prescribers, pharmacists and patients. Medication errors can occur anytime, anywhere in the health care system from prescriber to dispense to administration and lastly to patient use.
There are many errors that can be prevented and pharmacists play vital role in appropriate use of drugs. Medication errors do not always lead to Adverse Drug Reactions (ADRs) but if they do, they may cause harm and are considered preventable. Most medication errors are known as latent errors,
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2. Barcode Medication Administration (BCMA)
The recent efforts in order to reduce recurrence of ADEs have focused on eliminating errors in medication dispensing and administration. Barcode Medication Administration software enables users to document electronically the administration of medications at the bedside to improve the accuracy of medication administration.
Nurse carries out barcode scanning at the patient’s bedside to identify the administered medication to assure it is the prescribed medication and dose.
This system is done by placing a barcode on a patient wrist bracelet as identification (ID) badge so that they can assure an identical match between patient and medication and capture the practitioner administering the medication.
3. Computerized Physician Order Entry (CPOE)
CPOE is an application that enables users to key in medical orders into a computer system that is located within an inpatient setting. CPOE replaces traditional methods of placing medication orders so as to reduce errors in prescribing
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Automated Medication Dispensing
Automated dispensing is unified medication management system help in removing the time-consuming tasks from the medication process. It enhances the safety and efficiency of the whole complete medication process as well as improving efficiency of nursing and pharmacy staff by cutting down a few manual steps and processes. Automated dispensing of medications will effectively reduce medication errors and the correct dosage will be committed. Package that contains the medication would be wrongly labeled and sometimes the label is unclear. This caused confusion to the health care professionals to dispense the drugs and leads to incorrect medication being dispensed to the particular patient. Dispensing the wrong medication will cause the individual patient to develop allergic reactions or in some cases it might put patients’ lives at risk if there is severe recurrence of adverse drug effects.
5. Smart Infusion Pump
In recent years, "smart" infusion pumps have become increasingly sophisticated and include close error reduction software. The smart pump's "brain" consists of customized software that contains a drug
The pros of the CPOE system included that the prescribing of wrong medications was reduced, there were fewer errors with the patient’s basic information, orders for lab work, blood work, and medications were standardized; and mistakes in the ordering...
I am truly amazed by the positive impact of bar-code medication administration (BCMA). Since we have a fully integrated electronic health record, it is a true closed loop-system, with medication order entry, pharmacy validation of medications, and clinical decision support. Implementing technology such as BCMA is an efficient way to improve positive identification of both the patient and medication prior to administration. It is estimated that the bar-code medication charting can reduce medication errors by 58% (Jones & Treiber, 2010). Even though we have good adoption of BCMA, nurses still make drug administration errors. In many of the cases, errors are caused by nurses, because they do not validate and verify. The integration of technology
This technology assist the nurse in confirming patients identify by confirming the patients’ dose, time and form of medication (Helmons, Wargel, & Daniels, 2009). Having an EHR also comes with a program that allows the medical staff to scan medications so medication errors can be prevented. According to Helmons, Wargel, and Daniels (2009) they conducted an observational study in two medical –surgical units one in the medical intensive care (ICU) and one in the surgical ICU. The researchers watched 386 nurses within the two hospitals use bar code scanning before they administrated patients’ medications. The results of the research found a 58 % decrease in medication errors between the two hospitals because of the EHR containing a bar code assisted medication administration
Nurses were the professional group who most often reported medication errors and older patients were those most often affected in the medication errors reports analyzed for this study (Friend, 2011). Medication error type’s revealed omitted medicine or dose, wrong dose, strength or frequency and wrong documentation were the most common problems at Site A where the traditional pen and paper methods of prescription were used; and wrong documentation and omission were the most common problems associated with medication errors at Site B where the electronic MMS was introduced (Friend, 2011). Reports of problems such as wrong drug, wrong dose, strength or frequency, quantity, wrong route, wrong drug and omitted dose were less frequent at Site B (Friend, 2011). The reduced incidence of omission errors at Site B supports suggestions that an advantage of the MMS is easy identification of patient requirements at each drug round time slot. Despite the finding of less omission errors at site B where the MMS had been introduced, there was a relatively high frequency in the incident reports of medication errors related to both omission and wrong dose, strength and frequency at both sites (Friend, 2011).
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. doi:10.1111/j.1440-172X.2012.02052.x
medications is more than the act of getting drugs to a patient. The delivery of medication is directly tied to the charge for the medication. Thus the responsibility for charging or crediting medication belongs to technicians. This aspect of their job is strictly governed by federal regulations. These laws hold the technician directly responsible for the accuracy of a patient’s account’s charge and credit transactions. Because every dose is related to a specific day and time, when technicians credit they must apply that change to the corresponding dose. Assignificant as accuracy is to the patient’s account, accuracy in the making of their medications is even more important.
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.
A medication error is any preventable event that may cause or lead to inappropriate medication use or harm to a patient (NCCMERP 2014). The death rate for medication errors averages around 7,000 deaths per year. Lawsuits for medication errors were mainly made against registered nurses because nurses are the last people to check a medication before it is administered. 426 medication error related lawsuits were made against registered nurses. (RightDiagnosis 2014).
Properly implemented and medication-use technology has the potential to moderate these costs. Bar-code-assisted medication administration (BCMA) has been shown to reduce medication administration errors by as much as 54-86%. BCMA, along with computerized electronic prescriber order entry and an electronic medication administration record, closes a technological loop that extends from the transmission of the order to the administration of the medication at bedside (Strykowski, Hadsall, Sawchyn, VanSickle, Niznick,
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.
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.
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...
Tzeng, H., Yin, C., & Schneider, T. E. (2013). Medication Error-Related Issues In Nursing Practice. MEDSURG Nursing, 22(1), 13-50.
Bar-code-assisted medication administration (BCMA) has replaced the traditional paper-based medication administration (PBMA) systems in some health care facilities. The BCMA system’s objective is to verify the five rights of medication administration meaning that “the right patient receives the right dose of the right drug by the right route at the right time (Grissinger).” The process begins with the pharmacy ensuring that all medicines are labeled correctly and that all medicines have appropriate bar codes that identify the name, dose, and form of the medication. Patient...
O’Shea, E (1999) Factors contributing to medication errors: a literature review. Journal of Clinical Nursing. 8, 5,496-503.