Patient Safety Quality Improvement Project- Medication Errors in the Emergency Department
Medication errors in the emergency department (ED) are a significant health issue in contemporary medical practice. Medication errors in the ED are pretty common due to the setting and activities in the ED. Such errors lead to increased healthcare costs, poor quality care, patient dissatisfaction, and high morbidity and mortality rates.
Each year, the healthcare sector incurs over $4 billion due to medication errors in the ED (Walsh et al., 2018). Written and verbal communication is integral in the reduction of medication errors. This essay focuses on a patient safety improvement project aiming to reduce medication errors and related consequences in the emergency department.
Poor communication and missing links are significant causes of patient safety issues. The hasty nature of ED activities increases the prevalence of medication errors. Medication errors in the ED are caused by dosage errors, failure to follow set guidelines, the emergency nature of the ED, poor communication, and increased workload (Di Simone et al., 2018).
The project’s main aim is to reduce medication errors, improve medication error reporting, and decrease the healthcare costs related to medication errors by improving communication between the nurses and other healthcare providers in three months. Another aim is to promote/ enhance effective communication during the medication administration process.
Another aim is to enhance competence and efficiency during medication administration to the patient. In addition, the project aims to improve medication administration reporting in the emergency department. These aims/ objectives will inform the medication administration process and the evaluation process.
Doctors or advanced practice registered nurses prescribe drugs for the patient. These drugs are generally available in the department store, and the nurses administer them as per the prescription. In some instances, nurses administer drugs directly, bypassing written prescriptions to save lives. Most prescriptions are handwritten, thus prone to poor illegible handwriting and missing files (Hassan, 2018). Transcription in the ER is hastily done also, which increases the risk for errors.
Medication errors in the ED also arise after failure to sort drugs, especially LASA drugs, due to the haste common in the emergency departments (Martyn, Palliadeli, & Perry, 2019). Drugs are then administered to the patients using the prescription sheets. The nurses on duty are responsible for administering these drugs, and patient handing over occurs after every shift at the nursing desk.
Poor reporting of medication errors in the ED is attributed to stern measures taken against nurses involved in medication errors (Dirik et al., 2019). These current practices have many areas for improvement which require addressing.
Figure 1. Current practices in drug administration.
Solutions/ Change Ideas for Medication Errors
Poor communication is a major cause of medication errors in the ED. Various evidence-based interventions help enhance the communication process. One intervention is bedside patient handing-over using the ISBAR method (Marmor & Li, 2017).
This method is critical because the patients’ movement rate is relatively high compared to other departments because they are moved to other relevant departments to create space for other patients. Thus, there is a need to pay attention to every patient’s details (Di Simone et al., 2018). Using this intervention, nurses familiarize themselves with the patients, and during each shift, they evaluate the patient’s status and the medications for possible changes and necessary adjustments.
Effective communication at the bedside helps eliminate transcription errors during this step (Marmor & Li, 2017). The method also helps avoid confusion and forgetfulness common when nurses hand over patients at the nursing desk. The documented success rate of this intervention is high, and it is an excellent strategy to reduce medication errors.
Written communication is prone to errors such as illegibility and transcription errors. Avoiding these errors is by using electronic health records, which help in ordering, transcription, and documentation in the medication administration process (Ratwani et al., 2018).
The information is also available in the systems for confirmation and reflection at any moment. These systems provide formality at the workplace and are easier and more effective than traditional methods (Patient files). Electronic health records also increase accountability through accurate documentation, knowing the information is visible to all healthcare providers, and help trace medication errors in the ED (Alotaibi & Federico, 2017). Medication errors recorded help in hospital statistics, and follow-up is also possible to ensure errors do not occur in the future.
Another effective strategy in minimizing drug administration errors is using an assistant or medication administration companion. Medication administration errors form the most significant percentage of medication errors (Gomes et al., 2021).
The errors are more prevalent in the emergency department than in other departments due to time pressure. When administering drugs alone, one can overlook errors but checking with a companion; often, a qualified and experienced nurse ensures compliance to drug administration rights. The use of companions increases the efficacy and safety of drug administration (Douglas et al., 2018).
Confusions such as LASA (Look-alike sound-alike) drugs do not occur while using a companion. It also allows mitigation of other errors that might have occurred during the ordering and transcription. The intervention significantly decreases drug administration errors compared to administration by one nurse. The mentioned interventions will be integral in the change project by enhancing communication, improving accuracy and efficacy, and improving reporting of medication errors in the ED.
Evaluation of the Project
The project objective will inform its evaluation. As mentioned earlier, the project aims to reduce the incidences of medication errors in the ED. According to Parasrampuria and Henry (2019), hospital data/records analysis is the most accurate and relevant method to evaluate the effectiveness of the project.
The hospital records provide data such as the average incidences of medication errors in the ED and mortality and morbidity rates related to medication errors. An analysis of this information would directly reflect on the effect of the proposed project. Moreover, patient self-reported satisfaction report analysis will give a clear picture of the effectiveness of the change ideas.
The cost-benefit analysis will be an integral evaluation tool for this project. The cost-benefit analysis involves weighing the costs incurred during the project implementation against the project’s benefits (Mishan & Quah, 2020). The benefits must outweigh the costs for the project to be considered.
The project involves high healthcare costs such as training healthcare workers and installing healthcare information systems. The benefit of the project is reducing mortality and morbidity rates and decreasing healthcare costs associated with medication errors. Analysis of these costs and benefits provides a basis for decision-making regarding the process implementation.
Nursing is a dynamic profession requiring change and interventions. Medication errors in nursing practice threaten quality care and patient safety, especially in the emergency department. They are also a significant cause of increased healthcare costs. Nurses must identify current practices and flaws in the systems to inform the development of effective strategies to mitigate medication errors and other significant challenges in nursing practice.
In addition, technological advances are integral in informing practice. When implementing projects, pre-and post-implementation evaluations are vital. An evaluation helps determine the applicability and benefits of a project, thus saving on costs.
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Ratwani, R. M., Savage, E., Will, A., Arnold, R., Khairat, S., Miller, K., Fairbanks, R. J., Hodgkins, M., & Hettinger, A. Z. (2018). A usability and safety analysis of electronic health records: a multi-center study. Journal of the American Medical Informatics Association, 25(9), 1197-1201. https://doi.org/10.1093/jamia/ocy088
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