Introduction
Medication error is one of the major causes for the morbidity and mortality of patients in the hospital settings. According to Hughes and Blegen (2008), it accounts for one out of 854 in-patient deaths. As defined by the National Coordinating Council for Medication Error Reporting and Prevention, a medication error refers to any preventable event that may cause or lead to inappropriate harm to a patient while the medication is under the control of a health professional (Cousins, 1998). Owing to the greater reliance of patients to medications as an indispensable part of their treatment, the occurrence of medication error has an implication towards patient safety issues. Nurses have the accountability to ensure that the patients are protected against the potential harm from medication error. Being one of the biggest concerns involving patient safety standards, this paper will discuss about the potential measures and indicators for the occurrence of medication error, underpinning the causes of why these happen and what can be done to improve the quality of patient care to avoid the potential harm caused by medication errors. In this paper, indicators that will be discussed regarding medication errors include the bar code safeguards (functionality of equipment and nursing workarounds), structural or environmental indicators in the hospital setting (staffing and organizational settings) and workplace facility and technology. These indicators will be measured using a qualitative review on the literatures and evidence based practice researches to help identify potential improvement in reducing medication errors and enhance patient safety in the hospital setting.
Discussion
The administration of improper medication has an implication to patient safety. While not all medication errors will result in an adverse drug event, the high risk of potential adverse outcome that compromises patient safety cannot be ignored. Fatal adverse drug reactions, deaths and disability are just among the many potential serious harms resulting from medication errors. Anderson (2010) reported that about 1.5 millions of Americans suffer from injuries every year, with a resulting cost of $3.5 billions due to loss in productivity, wages and additional medical expenses. The more adverse effects of medication errors usually occur within the specialty areas in the hospitals, such as the intensive care units and emergency department, where complex medication dosing regimens is likely to be administered (Duthie, et al 2005). Considering the magnitude of the implication of medical errors in patient safety, identifying the potential indicators why medication errors occur can help prevent its serious harm to patients.
The errors in medication are influenced by a variety of factors. One indicator involves the functionality and efficiency of the bar code equipment. Medication errors usually arise either in the prescribing step or in the administration step of medications, and the introduction of the bar code technology helped in eradicating these mistakes (Wilkinson and Treas, 2011). The bar coded medication administration system is used by hospitals as an inventory control system in medication prescription in order to ensure that patients correctly receive their medication. However, using the system is without any flaws and nurses are often required to work around the problems caused by the bar code system. Among these issues include unreadable bar codes on the drugs, missing patient ID bands, lost connectivity, drugs that were not barcoded, as among many others. As a consequence, nurses are confronted with the task of affixing the copy of the patient medication chart on the bedside table of the patient, on clipboards or the door knob or anywhere else just to have access to the medical information required for a patient (Koppel, et al., 2008). Potential consequences of nursing workarounds may include the administration of the wrong dosage, improper formulation of medication and incorrect drug administration. Gooder (2011) views some potential problems with nurse workarounds, which is described as a process of bypassing the safety features of the bar code system, such as doing shortcuts, instead of going through the systematic process of ensuring the proper medication prescribed to the patient is appropriately identified and administered accordingly. In Gooder’s evidence based research, nurses have admittedly performed shortcuts whenever the bar code system fails or unavailable, such as taping the armband on the patient’s bed instead. It can be noted that nursing workarounds may be influenced by the nurses’ own perception on using the bar code system. With a negative perception or doubts on the effectiveness of using the bar code system, nurses tend to perform workarounds which consequently bypass the safety features of the system, thereby compromising patient safety.
In order to remedy this potential cause of why the bar code system and nurse workarounds can compromise patient safety involving medication errors, it is essential to provide the nursing staff sufficient training in using the bar code system, while implementing a standard protocol on what to do once the bar code system fails. For instance, the necessity of returning the medication to the pharmacy to be scanned properly must be emphasized. Training will help re-educate the nurses regarding their perception in using the bar code system and re-affirm that the safety features provided by the equipment will foster a higher level of patient care. In case of equipment failure, hospitals must have an in-house information technology expert who can immediately troubleshoot the problem considering the high reliance of the administration of patient medication to the system. A protocol of policies involving steps that nurses should observe in case the bar code is unavailable to use is also crucial. This will help avoid workarounds or shortcuts that nurses may be compelled to do knowing they can take other initiatives instead of using a standardized protocol that will ensure patient safety.
The structural indicator is another factor that merits an evaluation on why medication errors occur. This involves the environmental setting within an organization that may contribute to the incidents of medication errors. For instance, the lack of policies in reporting medication errors can also contribute to the prevalence of medication error incidents. Wolf and Hughes (2008) examined in their research why the error in reporting can consequently contribute to medication error and reported that there is a lack of imposed accountability to the healthcare practitioners in their work performance. Patient safety initiatives, such as identifying and reporting medication errors, can be a good preventive measure that can reduce the incidence of future medication errors in the hospitals. Structural indicator on medication error may also involve the workforce condition. Under staffing can impose an additional burden to nurses and this may result in fatigue and tiredness, which is pointed out by Sharokhi, Ebrahimpour and Ghodousi (2013) as the second most effective factor causing medication errors within the standpoint of nurses as based on his evidence based research. The organizational setting and culture can also have an implication in medication error incidence. Lapses within the organizational level may also foster high incidence of medication errors, such as the failure to impose a standard policy in the administration of medicine to patients, knowledge based mistakes of the nursing staff and even the deliberate violation of hospital protocols (Keers, Williams, Cooke and Ashcroft (2013).
In order to improve the efficiency in the delivery of patient care during the administration of medications, a culture of accountability must be fostered by the administration. A standard policy regarding the reporting of medication errors must be integrated into the hospital safety standards in order to address the potential window of errors in medication administration and prevent future incidence of the same. Moreover, the workforce system must be organized by the human resource system in a manner that will optimize nurses’ productivity and efficiency, such as adjusting the work schedules of nurses, prevent under staffing and sending nurses to trainings to improve and update their knowledge, skills and efficiency in delivering high quality patient care. Heavy overtime workloads must also be avoided by planning a contingent initiative of hiring nurse’s relievers in case of under staffing, especially within the critical areas or specialty units. A sound organizational structure can help implement a higher patient safety standard that can mitigate the risks of medical errors.
Lastly, the workplace facility and technology are helpful indicators to measure compliance involving patient safety against medication errors. The assessment of this indicator will help evaluate the quality of care provided to patients in terms of medication preparation that may implicate the occurrence of medication errors. In some hospital settings, nurses transcribe and dispense medication orders and may perform both the dispensing and administration of the medicine. The quality of medication preparation may be influenced by several factors, such as the resources and facility available in the work setting. One of the critical aspect of medication administration is ensuring that the patient receives the right medication at the proper doses. Deficiencies in the processes involved in complying with the doctor’s order may result in medication errors with any adverse effects to the patient. The healthcare facility can help eradicate the incidence of medication errors, especially when there is an increased number of patients that nurses have to tend to. The use of modern technology, such as the bar coded medication administration system is an efficient addition to the healthcare facility available that can help improve the accuracy in the administration of medicine to patients.
Improvements in the healthcare facility can eradicate a nurse’s confusion, such as when tending to patients admitted in multiple bedrooms during critical work hours and emergencies. Based on the evidence based research of Ulrich, et al (2008), the structural design of the workplace, including the facilities available, can have an impact on the quality of patient outcomes, such as the reorganization of the hospital settings by providing adequate rooms for patients that reduced medication errors by 67% in the Methodist Hospital in Indianapolis. The availability of proper storage equipment for the medication and an accurate labeling process can also also mitigate the risk of medication errors in the healthcare settings. This can help reduce the risk of dispensing errors that may result in giving the wrong medication to the patient. Owing to the shifts in the schedule among nurses and the number of in-patient requiring medications, organizing the processing of the doctor’s order may be enhanced by the use of a computerized prescriber order entry system (CPOE). This is known to eradicate medical errors within the prescribing error aspect in medication use. Considering that medication management and administration involves complex steps and multiple people involved in the process, the quality of healthcare facility and technology can improve the nurses’ ability to maintain patient safety standards and reduce the incidence of medication errors.
Conclusion
In conclusion, varied factors may affect the medication error incidence that can result in the occurrence of adverse events that compromise patient safety. The identification of the important indicators of medication errors is crucial in order to improve the safety in medication management and administration within the healthcare setting. Bar code safeguards, structural or environmental and workplace facility and technology indicators are important aspects that affect the nurses’ ability to comply and perform adequate safe nursing care to patients who are receiving medication treatments. The quality improvement involving patient safety to reduce medication errors does not only involve nurses, but the organizational management as well. Improving the organizational policy to reduce the risks of medication errors must be in place to assist nurses in observing protocols whenever an alternative process is required in the administration of medication to patients, such as when barcode system fails or becomes unavailable. Providing adequate support to the nursing staff by improving the quality of their working condition is also helpful, such as resolving under staffing and imposing reasonable work shifts is recommended. The employment of modern facility and technology can foster a better organization process of recording, management and administration of medication that enhance patient safety, while mitigating the risks of medication errors.
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