Introduction
Drug errors are the mistakes that occur in the administration of drugs to patients. It is possible to assume that only nurses are involved in this occurrence but the truth is that numerous medical professionals are involved in drug administration and therefore it is not professionally sound to blame nurses only. But this essay will specifically deal with the connection between nurses and drug errors. The position of nurses in patient care places them in a very strategic position as far as drug administration is concerned. Once prescription has been done, the nurses are responsible for the administration of the drugs to the patients as per the instructions given by the physician. What happens when the nurse fails to follow the instructions of the physician?
The response to this question is obvious. The exercise ends up in error whereby the patient is given the wrong drugs or the wrong instructions as far as drug usage is concerned. What happens after a nurse has given a patient the wrong drugs? The results range from absence of any effect to death of the patient. This means that drug error is a serious issue that needs to be looked into. What is responsible for this behavior from nurses? What can be done to ensure that nurse behavior is of the best standard; since this is the only way to avoid drug error? In this essay, the findings of other researchers will be examined in an organized literature review so as to try and provide viable answers to these questions. The role played by nurses in patient care cannot be underestimated and therefore any idea that can make it even better is something that should be highly encouraged.
The Literature Reviewed and the Findings
Amy Edmondson carried out a thorough research whose target was to establish the group and organizational influences on the detection and correction of human error in drug administration (Edmonson1996, pp.5-8). In this seminal work, she came to the same conclusion that is made in the conclusion to this essay that drug errors in medical institutions are not to be blamed on nurses alone. In demonstrating this fact, Edmondson gives the case of a patient who left the operation room and instead of heparin that was meant to halt any chances of blood clotting; a heart stabilizer named lidocaine was administered. It was by God’s grace that this particular drug, lidocaine had no adverse effect on the patient. Otherwise the outcome would have been fatal. Edmondson lists more than four professionals who had the chance to correct the mistake but all of them, including the subject of this essay, the nurses, failed to correct it for a long time. The nurse who reported to duty at 7.00am the next day after the surgery is the one who noticed the error (Edmondson 1996, pp.7).
Besides the system analysis that Edmondson’s study is mainly concerned with, a number of points are clear as far as nurses and drug errors are concerned. First, the errors are more frequent than it is generally thought (Gladstone 1994, pp.628-629). The outcome of these errors ranges from absence of an effect especially when the drug that is administered by mistake is of no effect to the patient to death, when the drug that is administered by mistake is of adverse effect to the system of the patient. Another point that emerges from the study by Edmondson is that in most cases, the drug errors that are done by nurses are due to carelessness and system traditions. The fact that the two or three nurses who handled the patient were not able to detect the anomaly shows that they did not bother to investigate whether the patient was receiving the right medication. Were they tired? We cannot tell. But it is a professional requirement that when a nurse or any other medical professional is not in a position to work due to either sickness or fatigue, he or she takes a break.
There is also the fact that the system within which nurses work operates without an established tradition of always reminding nurses to ensure that they have properly checked the medication that their patients are given so as to make sure that it is not only of the right quantity but also quality and type. This is why all the professionals who handled the patient from the time the percussionist made the mistake of using the lidocaine bag instead of the heparin bag did not take the trouble to check whether the patient was actually on heparin and not something else. This is where the study connects with the subject of Edmondson’s study; which is basically the organizational influence on drug errors. Is there anything wrong with Edmondson’s study? The study carried out by Edmond is too wide in spectrum in that it focuses on the wider organizational setting as well as the various individuals who operate there in relation to the errors that occur. This makes the attention paid to the connection between nurses and errors slightly narrow. It is possible that if the study had been focused on nurses only, more details would have been availed.
What strengths are present in Edmondson’s research? Edmondson’s work is strong in a number of ways. To begin with; the study takes a broad view of errors. This is because of the focus that is given to the entire organization as well as the individual role in errors. Also, the psychological inclination of the study provides the more satisfying explanation as to how most individuals make errors. The issue of the schema theory (Edmonson 1996, pp.8) makes it clear that once people take a certain perception and complete a particular frame, the existing reality is made to fit into the formed frame. Thus the actual is replaced with the expected. This is pointed out as one of the ways in which physicians make most errors while working with patients. Another notable strength of the Edmondson study is the variety of literature that has been incorporated in the study. The best way to have a balance in any sensible study is to gather the opinions of other scholars and researchers on the subject. This is what Edmondson has done. Strength in this work is that it is basically a primary source since it is the outcome of an experiment. All the data that is analyzed was collected by the author and the reference made to other sources is for support purposes.
Apart from Edmondson, Laurie Barclay, a medical doctor writing for Medscape makes a number of assertions in her study. To begin with, she accepts that the frequency of drug errors by nurses has been on the rise. But she also admits that the causes are clear and can therefore be eliminated. The major cause of drug errors by nurses are interruptions (Barclay 2010, para.1). She cites relevant research which indicates that when a nurse is interrupted in the middle of a medical duty such as drug administration, her concentration on administering the drug reduces and chances of error multiply. Barclay’s work has figures showing the procedural and clinical errors that occur by percentage during an interruption. A study that she cites indicates that for each interruption that a nurse got while administering medicine to a patient, chances of making a procedural mistake rose by 12.1% whereas those of making a clinical mistake rose by 12.7 %. This is a terrifyingly high percentage given that fact that in most cases, the administration of the wrong drug means death to the patient or an adverse outcome such as a permanent deformity. Nurses are known to avoid reporting these errors do to fear of being treated badly (Osborne, Blais & Hayes 1999, pp.33).
The Barclay work’s weakness is that it is a secondary source. This is because it relies heavily on other researcher’s works. The strengths of this work include the fact that it is purely focused on nurses unlike the Edmondson work that was broad. It also has data that is direct and therefore easily understandable. For example, she clearly points out the fact that 12.1 % increase in procedural errors was witnessed if a nurse was interrupted while 12.7 % rise in clinical errors was observed if a nurse was interrupted.
Another study on nurses and drug errors is by Ingrid Torjesen. Torjesen is very categorical that the number of drug errors is on the rise (Torjesen 2008, para.1). He proceeds by identifying the fact that a method such as double checking which is being used frequently by nurses as well as other medical professionals as a way of avoiding errors in drug administration actually lead to more drug errors. In this work, Torjesen goes straight to the point by outlining the ways in which drug errors can be avoided by nurses. These methods include administering drugs separately if they are to be administered separately, administering drugs to patients on time, reporting all misses, and ensuring that drugs are administered to the right patients through compliance with such patient marks as hand bands. Also, he says that it pays to question other staff members on issues pertaining to drug administration regardless of their position. Even senior members of staff need to be questioned as a way of avoiding drug errors. This study by Torjesen is strong through its directness, primary nature and relative depth. The weakness it has is that it lacks wide scholarly reference.
Besides the above, a study by Karen Pallarito of the Bloomberg Business week concurred with the Laurie study covered above. Her verdict is the same as the one reached by Barclay. She clearly points out that just like a pilot can make a critical error if interrupted while landing, a nurse can make a critical error if interrupted while administering drugs (Pallarito 2010, para.1). Her study is strong due to the wide reference she has done. The fact that the work is brief means that some details have been left out thus making the work slightly weak.
The final study covered in this literature review is the work of Susan Starkings. Her recommendation is straightforward that nursing students who excel in mathematics will have higher chances of making better nurses in terms of avoiding drug errors (Starkings 2000,para.1-2).This is especially true if these errors are related with calculation of drug concentrations. This study is strong in its comprehensiveness on the area of mathematics for nursing. It is however weak in that it ignores other elements that cause drug errors such as system influences and fatigue.
Conclusion
In conclusion, drug errors are evidently a common phenomenon. Lack of proper math that is useful in calculations, system influences and psychological settings such as the schema theory behavior of putting everything to an already known and expected frame are largely responsible. As a result of the drug errors, deaths and other effects arise.
References
Barclay, L. (2010). Interruptions Linked to Medication Errors by Nurses.Medscape Today, Web.
Edmondson,A.(1996).Learning From Mistakes Is Easier Said Than Done: Group And Organizational Influences On The Detection And Correction Of Human Error. Journal Of Applied Behavioral Science, (32), 1, pp.5-28.
Gladstone,J.(1994). Drug Administration Errors: A Study Into The Factors Underlying The Occurrence And Reporting Of Drug Errors In A District General Hospital, Journal of Advanced Nursing (22), 4, pp. 628 – 637.
Osborne,J,Blais,K & Hayes,J.(1999).Nurses’ Perceptions: When Is It a Medication Error? Journal of Nursing Administration, (29)4, pp. 33-38.
Pallarito,K.(2010).Interrupting a Nurse Makes Medication Errors More Likely.Bloomberg Businessweek, Web.
Starkings,S.(2000). Drug Calculation and the Mathematics required for Nursing. Web.
Torjesen,I. (2008). How Do We Reduce Drug Errors? Nursing times.net, Web.