Enhancing Quality and Safety: Medication Errors
Quality and safety are two of the most sought-after initiatives in the healthcare sphere. Patients place a high value on healthcare providers and regard them as second only to deities in terms of healing and restoring life. Healthcare providers, on the other hand, work relentlessly to provide the best possible care to their patients. However, a situation may arise during care that jeopardizes the patient’s and the healthcare provider’s lives.
Medication error is an example of such a situation, with potentially life-threatening consequences for patients, as well as medicolegal consequences for healthcare providers. The National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP) (2021) defines a medication error as any preventable harm that causes or leads to inappropriate medication use or patient harm while the medication is in the control of a patient, care provider, or consumer.
Further, the NCCMERP (2021) asserts that preventable events could be related to the care provider, procedures, healthcare products, and systems such as communications, prescription, labeling, dispensing, and packaging. Regardless of how dangerous a medication error may appear, the welcoming news is that it is avoidable. Find an in-depth discussion of the factors that may pose a risk to patient safety during the medication use processes, evidence-based solutions to these risks, and the role of nurses and stakeholders in ensuring patient safety below.
Factors Related to Specific Patient-Safety Risk Focusing on Medication Administration
The medication use process consists of a sequence of events such as prescription, transcription, dispensing, administration, and monitoring. An error can occur at any stage of the medication use process, putting the patient’s health at risk. Patient-safety risks during medication administration may stem from the care provider, the patient, the work environment, or computerized information systems (Tariq et al., 2022).
The care provider may have insufficient knowledge of the patient, resulting in medication being administered to the incorrect patient. Furthermore, care providers with insufficient therapeutic training and knowledge of a drug may end up administering the incorrect medication. Physicians undergo adequate therapeutic training, contrary to nurses, who lack comprehensive therapeutic training and, in some states, such as Arkansas, have limited prescriptive authority (Germack, 2021).
In such cases, if a nurse administers a medication without adequate knowledge, medication errors may occur. Furthermore, care providers can become fatigued after long work shifts. When administering medications, they may rush through the process without thoroughly checking the patients’ and drugs’ information, potentially leading to medication errors. Poor communication between healthcare providers during shift changes may also result in incorrect information transmission, increasing the risk of medication errors.
Patient factors also contribute significantly to medication errors. Patients with low literacy may not comprehend information well and may take medications in excess or insufficient dosage or fail to adhere to the administration route or duration of treatment, increasing the risk of medication errors (Parekh et al., 2018). Some patients may not understand the medication instructions given to them due to language barriers, putting them at risk of a medication error.
In terms of work environment factors, a physician is tasked with several duties such as taking history, physical examination of patients, ordering laboratory tests, and may be asked to administer a drug to a patient. They may administer the medication in a hurry without paying attention to the details of the drug and the patients, resulting in medication errors.
A compelling statistic reveals that distractions account for the vast majority (75%) of medication errors (Tariq et al., 2022). Finally, while computerized information systems have been used to solve the problem, they can potentially cause medication errors if handled by poorly trained care providers, are not serviced regularly, and when inadequate designs are used.
Evidence-Based and Best Practice Solutions to improve Patient Safety during Medication Administration
While there are several approaches to reducing medication errors, three are the most effective: automated information systems, medication reviews and reconciliation, and patient and healthcare provider education. Several studies have supported that computerized provider order entry (CPOE) reduces medication errors. How does it accomplish this? A CPOE enables a clinician to electronically write orders, keep an online medication administration record, and review and make changes if an error occurs (Srinivasamurthy et al., 2021).
A CPOE has an alert-based warning, or an alarm, that detects incorrect dosages, frequencies, routes, and patient information, reducing the possibility of administering medication to the wrong patient (Srinivasamurthy et al., 2021). Minimizing medication error incidences reduces the costs that the hospital and individuals would incur in treating medication-related problems.
Medication reviews constitute a process that evaluates patients’ medications to detect any errors that may have occurred during the medication use process and to improve health outcomes. Pharmacists conduct the most successful medication review interventions. Chiu et al. (2018) conducted a prospective controlled study in a geriatric unit of a regional hospital in Hong Kong to assess the efficacy of a pharmacist-led medication review program. Two hundred twelve patients were eligible for the study, with 108 receiving the pharmacist-led intervention and 104 receiving routine care (control patients).
According to the study’s findings, 51.9% of intervention patients and 58.7% of control patients had at least one medication error. The unintentional discrepancy occurred in 19.4% of intervention patients, with omissions accounting for 90.7% of the cases. Following the pharmacist-led review, 60 of 93 medication reviews and 32 of 41 medication reconciliations were accepted and implemented by physicians.
Medication error in the intervention group was significantly lower than in the control group at the end of the study (28% vs. 56.4%, p<0.001), data that supports a pharmacist-led medication review and reconciliation as an effective intervention in resolving medication errors. When the interventions are supplemented with medication education for both the patient and the care provider, the rate of medication errors in hospitals and health costs are dramatically reduced.
Contribution of Nurses to the Patient Safety During Medication Administration
Nurses, who comprise most of the healthcare workforce, are highly valued in the care delivery process. Nurses are frequently the first people patients encounter when seeking care in hospitals. Nurses engage in various patient safety measures throughout the nursing process, which includes assessment, diagnosis, planning, implementation, and evaluation.
At the assessment level, nurses obtain the patients’ subjective history, including medication history and comorbidity history. At this level, a patient’s history, such as an allergy to sulfa medications, may be life-saving, and a history of a previous drug reaction to a specific drug will lead to the prescription of an alternative (Tai et al., 2022).
At the diagnosis level, nurses refer to the most recent North American Nursing Diagnosis Association (NANDA) list of nursing diagnoses. This avoids making an incorrect diagnosis, which could lead to the prescription of incorrect medications, worsening the patient’s situation. Nurses assist in developing an appropriate care plan for the patient, which may include close monitoring of patients on high-risk medications, to prevent any adverse event or error that may occur (Tai et al., 2022).
The implementation process necessitates the execution of nursing interventions and actions, such as the administration of the appropriate medication to the appropriate patient. Nurses reassess patients during the evaluation stage to ensure that the desired outcomes are met. If the nurse suspects an inappropriate medication event, they may request that the patient’s care plan be revised.
Stakeholders with whom Nurses coordinate to enhance Quality and Safety
` An adage goes, “alone we can do so little, together we can do so much.” This is particularly relevant in the context of healthcare, where interdisciplinary collaboration is highly valued. Nurses require assistance in carrying out their duties, as do physicians, pharmacists, and the tech-savvy group. When asked about the newly opened COVID19-ward in a university hospital in Copenhagen’s urban area, one of the nurses said, “Don’t try to be a hero, always involve others” (Halberg et al., 2021).
This is simply to emphasize the significance of collaboration. Physicians, pharmacists, the healthcare informatics group, the hospital’s leadership and management team, patients and their family members, and caregivers at home who continue patient care after discharge from the hospital are all part of the team required in the process and efforts to reduce medication errors. Working in unison, the goals of achieving patient quality and safety can be achieved in the smoothest possible way.
It is sometimes only fair to acknowledge that caregivers are human and prone to making mistakes. Medication error is a preventable action in healthcare. While care providers play a role, the vast majority of medication errors are caused by distractions in the health environment, which may influence the care providers’ actions to commit a medication error.
Various approaches to reducing medication errors have been tried, including pharmacy-led reviews and reconciliations, computerized information systems, and education. No study, however, supports a single method as the most effective in reducing medication errors, necessitating the concurrent implementation of multiple interventions.
Because of the increased use of technology in healthcare, it is recommended that healthcare providers expand their knowledge of information technology to facilitate the operation of systems aimed at reducing medication errors.
Chiu, P. K. C., Geriatric Medical Unit, Grantham Hospital, Wong Chuk Hang, Hong Kong, Lee, A. W. K., See, T. Y. W., & Chan, F. H. W. (2018). Effectiveness of a pharmacist-led medication review program on medication appropriateness and hospital readmissions among geriatric in-patients in Hong Kong. Xianggang Yi Xue Za Zhi [Hong Kong Medical Journal]. https://doi.org/10.12809/hkmj176871
Germack, H. D. (2021). States should remove barriers to advanced practice registered nurse prescriptive authority to increase access to treatment for opioid use disorder. Policy, Politics & Nursing Practice, 22(2), 85–92. https://doi.org/10.1177/1527154420978720
Halberg, N., Jensen, P. S., & Larsen, T. S. (2021). We are not heroes-The flipside of the hero narrative amidst the COVID19-pandemic: A Danish hospital ethnography. Journal of Advanced Nursing, 77(5), 2429–2436. https://doi.org/10.1111/jan.14811
National Coordinating Council for Medication Error Reporting and Prevention. (2021, July 18). About medication errors. NCC MERP. https://www.nccmerp.org/about-medication-errors
Parekh, N., Ali, K., Davies, K., & Rajkumar, C. (2018). Can supporting health literacy reduce medication-related harm in older adults? Therapeutic Advances in Drug Safety, 9(3), 167–170. https://doi.org/10.1177/2042098618754482
Srinivasamurthy, S. K., Ashokkumar, R., Kodidela, S., Howard, S. C., Samer, C. F., & Chakradhara Rao, U. S. (2021). Impact of computerized physician order entry (CPOE) on the incidence of chemotherapy-related medication errors: a systematic review. European Journal of Clinical Pharmacology, 77(8), 1123–1131. https://doi.org/10.1007/s00228-021-03099-9
Tai J.-F., Wang C., Lin L.-Y., & Tang P.-L. (2022). Validity and reliability of a Nursing Process Scale. Hu li za Zhi The Journal of Nursing, 69(3), 31–40. https://doi.org/10.6224/JN.202206_69(3).06
Tariq, R. A., Vashisht, R., Sinha, A., & Scherbak, Y. (2022). Medication dispensing errors and prevention. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK519065/