Safety Quality Issue Pertaining to Medication Administration
Medication errors negatively affect the safety and quality of care patients receive. A patient came to the hospital with high blood pressure and complained of muscle spasms, weakness, and numbness. The patient was frail and wheeled in on a stretcher. Auscultation revealed pulses, and the patient was barely conscious. The patient has a history of heart failure and was on chlorothiazide.
A blood workup revealed severe hypokalaemia (2.0mEq), and the doctor stopped the hydrochlorothiazide and put him on spironolactone. He also ordered a potassium infusion with potassium chloride 20mEq/h in 24 hours for two. Potassium chloride was out of stock, and the nurse changed over shifts before its procurement. After observing the patient’s condition, the incoming nurse infused the drug as a bolus and ran it for two hours.
The patient developed severe diarrheal and cardiac arrhythmia, complained of severe chest pain, and soon lost consciousness. The doctors were called in, and they tried resuscitation. After three unsuccessful attempts, they declared the patient dead. This essay evaluates the factors leading to safety and quality issues, strategies to mitigate safety, and quality errors related to medication administration.
Factors leading to the Safety and Quality Issue
Several factors could have contributed to the problem. The nurse had limited knowledge of drug dosing, route, and frequency of potassium, leading to the fatal error. In addition, there are possible miscommunication errors between shift handovers. Failure to emphasize the importance of frequency and flow rates in potassium and other drug administration could have contributed to the problem. The unavailability of drug administration technologies that ensure correct dosage and frequency contributes to the problem. These factors could have led to the medication error event that led to a loss of life.
The emergency department has a haste nature, making it easy to overlook details before administering drugs. Di Simone et al. (2018) note that despite enough knowledge and training, the urgent nature of conditions can lead to errors as nurses attempt to save lives. It is easy to overlook details such as doses, frequencies, and names, hence identification, dosage, drug, and frequency medication errors.
Strategies to Improve Quality and Safe Care in Medication Administration
Medication administration companions are an evidence-based strategy for reducing medication errors. Drug administration companions help confirm patient and medication information details. They help ensure the drug dose, route, frequency, and person are correct before administering drugs. Nurse companions also help unearth other errors, such as prescription errors with wrong doses or wrong-drug errors in medication administration. However, the strategy remains underutilized due to the global staff shortage. However, nurses should ensure that they countercheck the drugs before administering them.
Another strategy is introducing drug and fluid administration pumps in the emergency department. The department is laden with emergency conditions that make it easy to make errors. The department is busy, and it’s easy to make efforts, especially with infusion drugs with different frequencies and doses. These automated pumps regulate the amounts and allow nurses to dispense drugs with maximum precision hence their relevance.
A study by Guiliano et al. (2018) revealed that smart IV drug pumps reduce medication errors significantly through regulated dosing, unlike regular drip stands, which present significant risks. Smart IV infusion pumps are standard in critical and acute care settings where accuracy and precision are of great importance.
Staff education is an integral step in ensuring patient safety. Most staff in the emergency department do not have specialized training in the area. The specialists in trauma and emergency care are few; hence registered nurses in the department are common. Staff education and training workshops help sensitize these nurses on various issues in the emergency department. Mieiro et al. (2019) note that trained staff is associated with medication errors, deliver quality care, and act promptly on patient conditions, promoting better patient outcomes.
Training of emergency department staff focuses on issues such as increasing staff awareness of errors, use of emergency response information systems, and new guidelines and updates in emergency care. Staff training can also encompass common emergency conditions such as torrential hemorrhage, head and neck injuries, asthma, and hypoglycemia. Mieiro et al. (2019) note that training staff increases their vigilance and confidence in care delivery. It thus increases their efficiency while maintaining quality and safe care delivery. These evidence-based strategies have effectively reduced medical errors in various hospitals.
Another strategy steadily gaining familiarity is the healthcare dashboards. Healthcare dashboards are vital to promoting care quality and patient safety through performance benchmarking (Bersani et al., 2020). Nurses and other healthcare providers can access information on the institution’s performance. These dashboards remind staff of the recommended guidelines and keep them on their toes in achieving benchmarks set forth by the organization and at the local, state, and federal levels.
Nurses’ Roles in Care Coordination and Improving Safety Related to Medication Errors
Nurses significantly promote care coordination, increase patient safety, and reduce costs secondary to medication administration errors. Nurses are patient advocates supported by the ANA code of ethics provisions. They require the nurse to promote quality, safe, and affordable care that is equitable to all (ANA, n.d.). In addition, nurses develop, implement, evaluate, and improve care coordination and patient safety policies. Policies and acts regulating information sharing, such as HIPAA, impact care coordination positively or negatively.
Nurses participate in their making to ensure they do not negatively impact care coordination and improve the accuracy and effectiveness of care coordination (Anders, 2021). Nurses also evaluate these policies to ensure they do not relay more harm than good. They present their knowledge and experiences to these teams, making decisions that improve care outcomes.
Nurses also participate in evaluating and selecting healthcare technologies that improve care coordination. Electronic health records and smartphone apps are technologies that improve care coordination (Archibald & Barnard, 2018). These technologies promote information access and reduce common errors such as poor and illegible handwriting and lost records.
These technologies also increase prompt access to information to respective professionals because many professionals can access care information simultaneously. Archibald and Barnard (2018) note that nurses evaluate the technologies for compatibility with healthcare institutions and promote their implementation for better care quality and safety.
Nurses have a role in promoting care quality delivery through team play. Nurses participate in interprofessional teams through designated roles, such as proper documentation, comprehensive handing over practices, drug administration companions, and medication prescription review (Dirik et al., 2019). Implementing these roles in the interprofessional team will increase care coordination, promote patient safety, and promote quality care outcomes.
Stakeholders in Improving Care Quality and Safety
There are various stakeholders that nurses can coordinate with to improve patient safety related to medication administration. Healthcare professionals such as doctors and pharmacists are vital professionals. These healthcare providers collaborate with nurses to ensure that prescriptions are reviewed and that prescription is safe (Rodziewicz et al., 2022). Pharmacists are involved in prescription and packaging practices that help reduce packaging and LASA drug errors.
Patients are also essential stakeholders because patient errors significantly contribute to drug administration errors. Patients help confirm their doses of drugs, especially oral doses, and can help reduce errors through learning and understanding their medications. Healthcare leaders are also vital stakeholders. These leaders spearhead improvement projects. They also evaluate interventions to promote better health outcomes. They also provide resources for these programs, promoting their implementation.
According to Billstein-Leber et al. (2018), efforts and interventions endorsed and supported by healthcare leaders have a significantly higher chance of success than those opposed by leaders. Thus, other healthcare providers, leaders, and patients play vital roles in promoting patient safety in medication administration.
Medication errors affect care quality and patient safety. Adverse events resulting from medication errors can result from several factors, such as haste, legibility, and lack of knowledge. Nurses play significant roles in promoting patient safety and increasing care quality. They participate in policy-making, healthcare technologies evaluation and implementation, and interprofessional collaboration.
Nurses must also work with healthcare leaders and other healthcare providers such as pharmacists, doctors, and patients to promote patient safety and outcomes. The various interventions they can leverage to improve care outcomes include healthcare safety dashboards, medication administration companions, and healthcare technologies such as smart IV pumps. These interventions will promote patient safety and enhance quality care delivery.
American Nurses Association (ANA), (n.d.). Code of Ethics for Nurses. https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/
Archibald, M. M., & Barnard, A. (2018). Futurism in nursing: Technology, robotics and the fundamentals of care. Journal of Clinical Nursing, 27(11-12), 2473-2480. https://doi.org/10.1111/jocn.14081
Bersani, K., Fuller, T. E., Garabedian, P., Espares, J., Mlaver, E., Businger, A., Chang, F., Boxer, R. B., Schnock, K. O., Rozenblum, R., Dykes, P. C., Dalal, A. K., Benneyan, J. C., Lehmann, L. S., Gershanik, E. F., Bates, D. W., & Schnipper, J. L. (2020). Use, perceived usability, and barriers to implementation of a patient safety dashboard integrated within a vendor EHR. Applied Clinical Informatics, 11(01), 034-045. https://doi.org/10.1055/s-0039-3402756
Billstein-Leber, M., Carrillo, C. J. D., Cassano, A. T., Moline, K., & Robertson, J. J. (2018). ASHP guidelines on preventing medication errors in hospitals. American Journal of Health-System Pharmacy, 75(19), 1493-1517. https://doi.org/10.2146/ajhp170811
Di Simone, E., Giannetta, N., Auddino, F., Cicotto, A., Grilli, D., & Di Muzio, M. (2018). Medication errors in the emergency department: knowledge, attitude, behavior, and training needs of nurses. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine, 22(5), 346. https://doi.org/10.4103/ijccm.IJCCM_63_18
Anders, R. L. (2021, January). Engaging nurses in health policy in the era of COVID‐19. In Nursing forum (Vol. 56, No. 1, pp. 89-94). https://doi.org/10.1111/nuf.12514
Dirik, H. F., Samur, M., Seren Intepeler, S., & Hewison, A. (2019). Nurses’ identification and reporting of medication errors. Journal of Clinical Nursing, 28(5-6), 931-938. https://doi.org/10.1111/jocn.14716
Giuliano, K. K. (2018). Intravenous smart pumps: usability issues, intravenous medication administration error, and patient safety. Critical Care Nursing Clinics, 30(2), 215-224. https://doi.org/10.1016/j.cnc.2018.02.004
Mieiro, D. B., Oliveira, É. B. C. D., Fonseca, R. E. P. D., Mininel, V. A., Zem-Mascarenhas, S. H., & Machado, R. C. (2019). Strategies to minimize medication errors in emergency units: an integrative review. Revista Brasileira de Enfermagem, 72, 307-314. https://doi.org/10.1590/0034-7167-2017-0658
Rodziewicz, T. L., Houseman, B., & Hipskind, J. E. (2022). Medical error reduction and prevention. StatPearls [Internet].
Safety Quality Issue Pertaining to Medication Administration Instructions
For this assessment, you will develop a 3-5 page paper that examines a safety quality issue pertaining to medication administration in a health care setting. You will analyze the issue and examine potential evidence-based and best-practice solutions from the literature as well as the role of nurses and other stakeholders in addressing the issue.