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How to analyze the problem of medication errors
How to analyze the problem of medication errors
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The Institute of Medicine and its article titled Preventing Medication Errors highlights the dire need that the medical community has in trying to prevent adverse drug events (ADEs). The article listed different ways to attempt to reduce the number of ADEs, some methods including; more extensive provider-patient teamwork and communication, using improvements in technology and prescribing medications, improved labeling for medications, and policy recommendations.
While my research on these safeguards has shown me that they have been successful in reducing some errors, new errors in the medicating process have developed. For example, in a computerized provider-order entry system, medical facilities have experienced a reduction in confusion
During the 1980’s and 90’s there were many studies done that showed that medical errors were occurring in inpatient and outpatient settings at a very high rate. Computer Provider Order Entry (CPOE) systems were designed to reduce or eliminate mistakes made by using hand written orders. The CPOE system allows users to directly enter their orders into the system on computers which are then sent directly to the healthcare providers that will be implementing the orders. Previously orders were placed by writing on order sheets on patient charts. This was sometimes done by the doctor or by a nurse acting on behalf of the doctor. Order sheets were then signed by the doctor and then the information was input into the patient’s record. This left room for error due to misreading bad handwriting, confusing medications with similar names, etc.
Springfield General Hospital (SGH) is committed to high quality healthcare for patients, and providing tools to support physicians, nurses and pharmacists. SGH leadership approved the computerized physician order entry (CPOE) system as a solution to reduce prescription errors, and the results of the CPOE project are disappointing. The data show increased prescribing errors after implementing the CPOE; resulting in increased costs for adverse drug events, rather than the planned cost reduction (Spector, 2013). This change management plan provides the SGH board of directors and executive management team pragmatic steps to increase quality for patients by assessing the root issue of hospital
Electronic health information systems prevent errors by involving everyone in a primary health care setting which mainly includes specialists office, emergency department to access the same
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.
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.
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.
Woo, A., Ranji, U., & Salganicoff, A. (2008). Reducing medical errors with technology. Retrieved March, 2012, from http://kaiseredu.org
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.
Staton, R., Bautista, A., Harwell, J., Jensen, L., Minister, A., & Roller, S. (2013). Computerized Provider Order Entry Awareness for Nursing: Unintended Consequences and Remediation Plan. CIN: Computers, Informatics, Nursing, 31(9), 401–405. doi:10.1097/CIN.0000000000000005
Wright, A., FebloWitz, J., Phansalkar, S., Liu, J., Wilcox, A., Keohane, C., … Bates, D. (2012). Preventability of adverse drug events involving multiple drugs using publicly available clinical decision support tools. American Journal of Health-System Pharmacy, 69, 221-227.
Correcting typos before the claim is submitted will decrease denials and resubmission process time, and result in accelerated payer payments. Verify patient contact information at each appointment. Check the patient’s eligibility and benefits at each appointment. Having the correct information on the patient and their coverage, coinsurance, copayment, and deductibles benefits your facility. Are you an in-network or out-of-network facility?
O’Shea, E (1999) Factors contributing to medication errors: a literature review. Journal of Clinical Nursing. 8, 5,496-503.
Medical errors can happen in the healthcare system such as hospitals, outpatient clinics, operating rooms, doctor’s offices, pharmacies, patients’ homes and anywhere in the healthcare system where patients are being treated. These errors consist of diagnostic, treatment, medicine, surgical, equipment calibration, and lab report error. Furthermore, communication problems between doctors and patients, miscommunication among healthcare staff and complex health care systems are playing important role in medical errors. We need to look for a solution which starts changes from physicians, nurses, pharmacists, patients, hospitals, and government agencies. In this paper I will discuss how does the problem of medical errors affect our healthcare delivery system? Also how can these medical errors be prevented and reduced?
Since a great number of Americans use applications such as email, instead of hand written letters, and Microsoft Word, in place of pen and paper, the need for manual effort has lessened. In the medical field, the Government now requires doctors to use electronic medical records, replacing hand-written charts to document information on patients. Recently, my parents’ Ophthalmology clinic ceased using paper charts. They transferred each old and new patient’s medical record to a computer, allowing the partnered doctors to easily access one another’s charts. After making the change, the doctors no longer need to spend time writing information down on paper, but instead enter it into a computer. With functioning computers, this new and improved method works well. However, if the computer’s system fails the stored information may become temporarily inaccessible or completely lost. One morning my father arrived at work to find the computer system “down”. He had no list of patients, past history or any information on the patient’s reason for scheduling the appointment. Not only did this frustrate him, but also inconvenienced the clients. Had he retained paper charts rather than computer records, all required information would still remain accessible. Although this mishap rarely occurs, dependence on technology to replace hand-written documents halted my father’s