Medication Error

Medication administration is a very important part of a registered nurses’ job. Multiple medications, patient issues, and technology all contribute to the complexity of medication administration. A medication error is defined 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 health care professional, patient, or consumer’. In addition an error can also be the wrong drug, route, dose, preparation, time, technique, or documentation. Errors can be a serious problem for patients’ health. (Härkänen, Ahonen, Kervinen, Turunen, & Vehviläinen-Julkunen, 2015)

The Study

A low number of errors are reported, about 10-20%, in clinical practice and very few are

noticed. An observation method can help shed light on these errors and some of the factors causing the errors. In addition, a literature search was done to study some of the factors that contribute to medication errors. These factors from previous studies were classified as person-specific (RN), patient-specific, team, work environment, and medication-related. For this study, person-specific (RN) factors included insufficient drug knowledge, lack of experience, fatigue, and overtime. The patient-specific factor included the gender, age, and the number of medications and how often those are taken per day. Team factors were the support and communication among registered nurses. Work environment factors included distractions, patient-nurse ratio, work dynamics, and the amount of bedridden patients. The medication-related factors included various types of medications and the administration routes.

The purpose of this study was to discover the types of medication errors including the frequency and severity. In addition, the study was used to find factors that caused medication errors. (Härkänen, Ahonen, Kervinen, Turunen, & Vehviläinen-Julkunen, 2015)

Methods
Between April and May of 2012, the study was conducted at a 800 bed university hospital in Finland in four adult wards (A-D), two medical and two surgical. Both direct observations and reviews of medication records were utilized for the study. A sample of thirty two registered nurses (out of one hundred thirteen) were randomly selected. The aim was to observe the administration of one thousand medications. During the study, one thousand and fifty eight medication administrations were observed. The medications were dispensed by pharmacists and the registered nurse double checked the medications in the medication room before administering. (Härkänen, Ahonen, Kervinen, Turunen, & Vehviläinen-Julkunen, 2015)
A structured observation form was created and reviewed by a professional team.

The team comprised of five registered nurses, five pharmacists, and two physicians. This team found and classified the errors based on seriousness. The observation was done by two independent individuals with a background in nursing. The observers followed the registered nurses as they administered medications to one hundred twenty two patients. The medication lists and the pharmacist dispensed medications were compared by the observers before the registered nurse began administering the medications. The observers also collected information about the experience of the registered nurse, the patient-nurse ratios, if the nurse double shaded medications, and/or if the nurse asked for help from other workers. The route, timing, rate, and handling of the medications were recorded. If a nurse appeared nervous, sick, or tired it was noted on the observation form. All distractions such as phone calls, noise, and interruptions were noted. The observations made were compared with the electronic medication list for the patient to check the route, dose, and timing matched up. All the data was reviewed by the professional team and the errors were classified by severity ranging from no harm to death. (Härkänen, Ahonen, Kervinen, Turunen, & Vehviläinen-Julkunen,

2015)
Results
The medication error rate was 22.2% (235 errors out of 1058 medication administered).

63.4% (149) were administration errors and 18.3% (43) were documentation errors. Out of the administration errors, 37.9% (89) were wrong technique and 26.8% (63) were omission. In about 24.3% (57) of cases, the error was caught before reaching the patient. In 51.1% (120) of cases, the error reached the patient but did not cause any harm. The rest of the errors, 21.3% (50) required monitoring to make sure there was no harm to the patient. Out of these errors, 3% (7) caused temporary harm and required intervention, and in one case, 0.4%, the error caused the patient to remain in the hospital longer. (Härkänen, Ahonen, Kervinen, Turunen, & Vehviläinen-Julkunen,

2015)
A factor that was observed that increased medication errors was the day of the week, for example Saturday the risk was the highest. Also, morning shifts were three times a greater risk than evening shifts. An increased risk occurred when nurses asked for help from other team members during administration. Nurses that were rushing increased the risk of error. The more medications a patient had and when the medications needed to be given more frequently. .

Some factors that decreased the risk of errors included giving medications orally, nurses double checking the drugs and when additional people were in the medication room at the same time.

Conclusion
Errors occurred in approximately every fourth medication during the study. Unfortunately, this is what other similar studies also showed. In this study, no error caused death to the patient. However, medication errors can cause great harm and/or death to patients. Preventing medication errors should be a top priority of all healthcare professionals. Most of the error were because of administering a medication incorrectly, such as intravenous administration. Intravenous administration has been found in this study and previous studies to be a problem. Nurses need to pay close attention to administration to improve safety for patients.
Not leaving medications with patients for self administration
Cut down on distractions, busy and rushing