Medication Errors Jake Callahan Baker School of Nursing Medication Errors Medication errors are a significant nursing problem that still exist to this day. Did you know that medication errors are preventable but still remain a high cause of death in hospitals? First we will discuss the problems of medications errors, safety precautions, uses of electronic devices in aiding management of medications and related statistics to medications being given. Furthermore, medication errors are a huge part of the nursing community. Nurses are in charge of giving medications and they are to be held accountable if things are to go wrong. However, sometimes it not exactly the nurses fault if a medication error is to occur. To go a little bit …show more content…
deeper on that subject, nurses should at least be given the chance and opportunity to gain further knowledge about medications. The more a nurse knows about a particular medication, the less likely an error is to occur. First, it is hard to realize that the average aging adult currently takes about eight medications a day. During this time, when giving these patients their medications, about 40-50% of staff are in charge of giving, ordering, dispensing and charting medications. (Nazarko, 2015). On top of giving all these medications, most of the errors seemed to be reported more frequently during the morning hours. An explanation to this is that a lot of patients in the home are being given baths/showers, getting dressed, eating breakfast, having their dressings changed or taking medications. (Wright, 2014). That’s no small amount of work for anyone. For those tasks, it has become relevant that nurses either lose track of time and miss a dose or don’t give a dose all together. Or, because the nurse is busy or may get distracted, the nurse can simply make the mistake of giving the wrong dose to the patient. Some medications are time sensitive and are to be given every so often. Missing a dose can result in therapeutic effects not being achieved or possible side effects of not having the medication. The goals of medication administration are to improve the quality of care and reduce the risks of a resident suffering harm from any medication. It is the nurses’ responsibility to ensure that the resident receives the appropriate medication. (Nazarko, 2015). With that being said, it has been found that research has shown that about 40% of older people living in nursing homes are prescribed or given the wrong medications. (Nazarko, 2015). Also, older adults are more susceptible to adverse drug reactions and about 5-15% of people are admitted to the hospital because of harmful effects of medications. (Nazarko, 2015). The Food and Drug Administration (FDA) estimates that about thirty thousand medication errors were reported since 1992. (FDA, 2015). All of those reports were voluntary. How many other medications errors have occurred out there that haven’t been reported? Also, around 7,000 deaths occur annually as a result from medication errors and a lot of those are due to drug name confusion. (FDA, 2015). Secondly, to pursue this topic a little further, we will look at the medication technology side of things and rules/regulations and policies to avoid medication errors and see how it gives insight on preventing medication errors and how there are still flaws in the system. Automated dispensing cabinets have been around since the 1980’s and have been introduced in about 94% of all hospitals since 2007. (Mandrack, Cohen, Featherling, Gellner, Judd, Kienle, & Vanderveen, 2012). These devices are simply a mechanical medication dispensing device that allows you to get medication at any point in time for a certain patient. One big downfall to this, regarding safety, is the ability to manage overrides, making selection errors, high alert medications and using practices for medication removal that are not permissable and transporting to the patient’s beside. (Mandrack et all, 2012). Even though there are a lot of possible errors that can occur with dispensing cabinets, there are also a lot of advantages. Automated dispensing cabinets can limit the control of nurses who don’t or shouldn’t have access to them. They also limit the access of a nurse practitioner to high-alert medications/drug products. Another good quality aspect of an ADC is that it can be separated or separate drugs that may have confusing or similar names and arrange them to fit their counterparts in the same categories. To get the most accurate results of an ADC, it should be placed around or near the nurse’s station to avoid individuals getting access to it who don’t have access. To make that simpler, it should not be placed in hallways or open rooms so anybody can get in it or to it. One other good aspect of the automated dispenser, is it can have locked drawers that allow certain access to only one pre-selected medication at a time. A downfall of this though is that these can be used for an array of drugs in low security drawers that hold large quantities of multiple medications. A minor solution to this problem is to keep some of the least or lowest risk medications in those drawers. To continue, another option of safety measures are bar code technology or bar code medication administration. (BCMA) In 1995, the VA in Kansas were the first ones to implement BCMA. In only a 4-year study, the results were amazing. The bar code technology (BCT) saw a 74% decrease in giving the wrong medications, a 57% decrease in errors caused by the administering of incorrect doses, a 91% decrease wrong patient errors and a 92% decrease in wrong time errors. (Keane, 2014). This technology allows for a certain medication to be ordered, scanned, taken from the cart, rechecked in the chart and at the patients’ bedside and re-scanned before giving the medication. This technology is to ensure that there are no medication errors occurring. This bar code technology also is influenced by the administration of medications via the 5-7 rights. We will go into those a little more in depth in just a little bit. Reducing medication errors involves a lot of people, a lot of time and a lot of training.
As mentioned above with the bar code technology, getting nurses trained on the equipment is the number one priority. If the nurses don’t know how to use the technology, medication errors are more than likely to reoccur. Most medication errors, about 49%, are related to a dose not given or the wrong amount of the dose which is around 21%. There are many aspects as to why medication errors occur and they can include a high workload, being interrupted frequently, lack of training on certain technologies or items, staff not sticking around and not being familiar with patients on the floor. (Nazarko, 2015). Some of these are easy fixes. A high workload would require more staff and sometimes that is not feasible. Lack of training on technology needs to be a number one priority to reduce medication errors and every patient should have a least some sort of identifying picture within their medical chart. That would also help in misidentifying patients. As mentioned above, during the morning rotation, most medication errors occur during the morning. This could also be a staffing issue, workload and not being familiar with patients. Each patient should be given their medications before/after meals and before they do anything else. I believe that this would reduce the amount of time errors or interruptions the nurse may face. A massive amount of errors occurs due to not knowing or re-checking the …show more content…
5-7 rights. To give a medication, you should be able to identify the date and time the order is written, the name of the drug to be administered, dosage of the drug, patient’s name and date of birth, the route by which the drug is to be given, frequency of the administration of the medication and the signature of the person writing the order or giving the order. (Taylor, Lillis, Lynn, 2015). The person writing the order is almost as a double-checker for the right medication for the right person. Following those steps and precautions should never elicit a medication error unless for some reason there are system errors. Medication errors have and more than likely will always continue to be a part of the nursing cycle until definite precautions are taken to eliminate them and even that may be impossible. During this discussion, we’ve talked about medication errors in the home and ways to try and avoid them. We’ve also talked about the technology side of things discussing automated dispensing cabinets and BCMA devices and how they help reduce medication errors. This being said, nurses should be required to undergo safety classes or briefings on new technology being brought into the hospital. These nurses should also be up to date on medications or at least have common knowledge of them. With all kinds of information and steps to avoid medication errors they still occur due to lack of attention. Nurses are in charge of giving medications and they are to be held accountable if things are to go wrong. Nurses are the front line of giving medications and should take all precautions as to avoid any type of medication error. These types of errors are preventable and with all the steps in place to ensure accidents don’t happen, even though they still do, is there a better way to avoid medication errors? References Food and Drug Administration. (2015). Strategies to reduce medication errors: Working to improve medication safety. Retrieved February 21, 2016, from http://www.fda.gov/Drugs/ResourcesForYou/Consumers/ucm143553.htm Keane, K.
(2014). Reducing medication errors by educating nurses on bar code technology. Med-Surg Matters, 23(5), 1-10. http://web.b.ebscohost.com.bakeru.idm.oclc.org/ehost/detail/detail?vid=116&sid=7d1a7ff0-47e6-4393-abaf-dba8f3afa50d%40sessionmgr120&hid=106&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#AN=109799108&db=c8h Mandrack, M., Cohen, M. R., Featherling, J., Gellner, L., Judd, K., Kienle, P. C., & Vanderveen, T. (2012). Nursing Best Practices Using Automated Dispensing Cabinets: Nurses' Key Role in Improving Medication Safety. MEDSURG Nursing, 21(3), 134-144 11p. http://web.b.ebscohost.com.bakeru.idm.oclc.org/ehost/detail/detail?vid=122&sid=7d1a7ff0-47e6-4393-abaf-dba8f3afa50d%40sessionmgr120&hid=106&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=c8h&AN=104460858 Nazarko, L. (2015). Medication management: Eliminating errors. Nursing & Residential Care, 17(3), 150-154. http://web.b.ebscohost.com.bakeru.idm.oclc.org/ehost/detail/detail?vid=115&sid=7d1a7ff0-47e6-4393-abaf-dba8f3afa50d%40sessionmgr120&hid=106&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#AN=103760680&db=c8h Taylor, C., Lillis, C., Lynn, P. (2015). Medications. (8th ed.). Fundamentals of Nursing. chapter 28 (pp. 750-851) Philadelphia: Wolters
Kluwer Wright, K. (2014). The rules and regulations for Medication management. Nursing & Residential Care, 16(4), 232-235 4p. http://web.b.ebscohost.com.bakeru.idm.oclc.org/ehost/detail/detail?vid=127&sid=7d1a7ff0-47e6-4393-abaf-dba8f3afa50d%40sessionmgr120&hid=106&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#AN=104055899&db=c8h
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.
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
Medication errors in children alone are alarming, but throw an ambulatory care setting into the mix and it spells disaster. When it comes to children and medication in the ambulatory care setting, the dosage range is drastically out of range compared to those that are treated in the hospital setting (Hoyle, J., Davis, A., Putman, K., Trytko, J., Fales, W. , 2011). Children are at a greater risk for dosage errors because each medication has to be calculated individually, and this can lead to more human error. The errors that are occurring are due to lack of training, dosage calculation errors, and lack of safety systems. Medication errors in children who are receiving ambulatory care can avoided by ensuring correct dosage calculation, more in-depth training of personal and safety systems in place.
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
Over the past several years extended work shifts and overtime has increased among nurses in the hospital setting due to the shortage of nurses. Errors significantly increase and patient safety can be compromised when nurses work past a twelve hour shift or more than 40 hours a week. Hazardous conditions are created when the patient acuity is high, combined with nurse shortages, and a rapid rate of admissions and discharges. Many nurses today are not able to take regularly scheduled breaks due to the patient work load. On units where nurses are allowed to self-schedule, sixteen and twenty-four hour shifts are becoming more common, which does not allow for time to recover between shifts. Currently there are no state or federal regulations that restrict nurses from working excessive hours or mandatory overtime to cover vacancies. This practice by nurses is controversial and potentially dangerous to patients (Rogers, Hwang, Scott, Aiken, & Dinges, 2004). Burnout, job dissatisfaction, and stress could be alleviated if the proper staffing levels are in place with regards to patient care. Studies indicate that the higher the nurse-patient ratio, the worse the outcome will be. Nurse Manager’s need to be aware of the adverse reactions that can occur from nurses working overtime and limits should be established (Ford, 2013).
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.
Collaboration with Others, a key principle of the NMBI Code, applies to the standards of medicines management. Nurses and midwives share responsibility with colleagues from other health care disciplines for providing safe quality health care. Additionally, collaborating and working together helps to achieve safe and effective management of the patient’s medication. Any authorised person administering a medicine to a patient or checking the administration must be satisfied that she or he knows the therapeutic uses of the medicine, its normal licenced dosage, side effects, precautions and contra- indications[ref]. It seems to be a best practice that a second suitable person to check all medicines for accuracy before administering.
Implementing technology in a clinical setting is not easy and cannot be successful without a well-organized system. It is important that healthcare providers understand the electronic medication administration record (eMAR) and its role in improving patient safety. One of the most significant aspects of healthcare is the safety of our patients. Medication errors account for 44,000-98,000 deaths per year, more deaths than those caused by highway accidents or breast cancer. Several health information technologies help to reduce the number of medication errors that occur. Once of these technologies is bar-code-assisted medication administration (BCMA). These systems are designed to ensure that the right drug is being administered via the right
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.
Administration of medication is a vital part of the clinical nursing practice however in turn has great potential in producing medication errors (Athanasakis 2012). It has been reported that over 7,000 deaths have occur per year related to medications errors within the US (Flynn, Liang, Dickson, Xie, & Suh, 2012). A patient in the hospital may be exposed to at least one error a day that could have been prevented (Flynn, Liang, Dickson, Xie, & Suh, 2012). Working in a professional nursing practice setting, the primary goal is the nurse and staff places the patient first and provides the upmost quality care with significance on safety. There are several different types of technology that can be used to improve the medication process and will aid staff in reaching a higher level of care involving patient safety. One tool that can and should be utilized in preventing medication errors is barcode technology. The purpose of this paper is to demonstrate how implementing technology can aid patient safety during the medication administration process.
Overall, I retain three goals for this clinical day: Safely and efficently administer medication, enhance my nursing/CNA skills, and determine how to implement infection control into a health care setting. This week reflects my assigned time to administer medication in a health care setting for the first time, with a resident who retains nearly twenty medications. I except this experience will be a great learning experience, but it will also subsist slightly stressful. With the assistance of my FOR, my goal is to administer all of my resident 's medications without complications. To ensure that medication safety, I will perform the six medication rights and three checks prior to administration. Along with medication administration, a goal
Tzeng, H., Yin, C., & Schneider, T. E. (2013). Medication Error-Related Issues In Nursing Practice. MEDSURG Nursing, 22(1), 13-50.
O’Shea, E (1999) Factors contributing to medication errors: a literature review. Journal of Clinical Nursing. 8, 5,496-503.
Computerized provider order entry systems, or CPOE, was designed as a computer application that would allow physicians to input their medical orders over a secured network and transmit the data to other healthcare professionals to carry out the orders. This system has the capabilities to include standard physician orders, clinical decision support for patient specific conditions, safety alerts, point of care utilization, and a method to securely keep permanent records (Moniz, 2009). With the safety guards provided by CPOE it has the potential to reduce the number of medical errors thus increasing the medical field’s efficiency in patient care. CPOE’s main focus surrounds the nursing utilization of electronic medical administration records,
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.