The importance of studying medication administration errors (MAE) has been highlighted by many researchers, as it is recognized that such errors occur across countries and types of medical facilities bringing considerable risks to the safety of patients (Hughes & Blegen, 2008). Much academic effort has been applied to exploring the causes of MAE, conditions facilitation them, possible innovations, and interventions to reduce their occurrence and the effectiveness of strategies aimed at struggling them. It has been identified that MAE can be related to nursing, patients, pharmacy, and technology. This review will approach five recent studies to explore major themes and proposed solutions in this area.
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Complications associated with identifying medication errors and controlling them were addressed by Hughes (2008) through the perspective of safety, which is the main goal of medication administration. What the author suggested is to reconsider the role of nurses in the context of medication administration. Recommendation for better administration should be built upon recognizing the nurses’ ability to detect and prevent errors that may occur on the prescribing, transcribing, and dispensing stages of the medication administration process. However, Hughes acknowledges that “there isn’t much known about the causes or the effectiveness of proposed solutions” (p. 120) even though administration errors constitute a considerable portion of all errors in medical facilities, which emphasizes the need for further research.
Safety when taking medications
Concerning further research, there is also a growing recognition that new research methods will need to be applied. Keers, Williams, Cooke, Walsh, and Ashcroft (2014) claim that methods should be more standardized, as the previous modes of addressing MAE in actual clinical conditions have been demonstrating a lack of systematic understanding of the causes and effects of administration errors. Therefore, a comprehensive theory of medication administration should be designed to serve as a foundation for various efforts aimed at the detection and prevention of errors. Keers et al. (2014) wrote, “In the future, greater standardization of methods and a more theory-driven approach to the design and implementation of forthcoming interventions to minimize MAEs is needed, whereby knowledge of the range and causes of these errors is used to guide their prevention” (p. 330). The type of intervention they found particularly practical is educational, showing the potential that education of medical staff has to address the issue of MAE.
However, education measures—as any type of interaction—should consider the possibility of resistance and difficulties. The introduction of new technologies or policies may disrupt the work of nurses. Moreover, if nurses do not acknowledge the importance and helpfulness of certain innovations or interventions, they become likely to ignore them in their work, which has several adverse consequences. It has been repeatedly stressed in the relevant literature that one of the main components of addressing the issue of MAE is communicating the way proposed solutions will work and benefit medical facilities to people who will have to face these solutions in their everyday work, and these are primarily nurses. Rack, Dudjak, and Wolf (2012) explored a case of the use of a bar code medication administration system in a hospital and observed that approximately half of the medication operations were done without scanning, i.e. overlooked by the system. To improve this situation, “hospital leaders [should] understand the barriers nurses encounter when using systems that promote safer and more efficient patient care” (Rack et al., p. 238). These barriers are also subject to further research.
The recognition of barriers should not, however, stop the technological advancement in this sphere. Taufiq (2015) found that the use of technology is exactly what will help reduce MAE in the nearest future, as it is concluded in the study that “innovative technology and its role in the identification of MAE and WTMAE [wrong time MAE] are imperative and well supported by the literature” (p. 14). The study by Taufiq (2015) was the first one presenting MAE research results from a third-world country, where it was found that 17 percent of all medical administration operations were associated with errors in one way or another, which illustrates the threats of MAE and the need to prevent them more effectively.
Finally, concerning the nature of MAE and their classification, it has been observed in a systematic review that “primary causes of MAEs…could be attributed to the individual responsible for the error without using an established framework. These were broadly considered as either slips, lapses, mistakes, or violations” (Keers, Williams, Cooke, & Ashcroft, 2013). According to patients’ and health care professionals’ perceptions, most MAE occur because of the fault of individual care providers. However, Keers et al. (2013) demonstrate that there are also systematic causes that should be better understood by today’s researchers and practitioners. For example, policies, established practices and procedures, and overall environments in medical facilities may contribute to the likeliness and frequency of administration errors. Particularly, Keers et al. (2013) list among major influences on MAE such conditions as the unsatisfactory quality of written communication (prescriptions, patient records, and other documents) and issues of supplying and storing medications (dispensing, ward stock, and organization into a manageable system). However, staff issues, such as high perceived workload or health problems (stress, fatigue, depressive moods) should be regarded as possible contributors to MAE as well.
Hughes, R., & Blegen, M. (2008). Medication administration safety. In R. Hughes (Ed.), Patient safety and quality: An evidence-based handbook for nurses (pp. 107-123). Rockville, MD: Agency for Healthcare Research and Quality.
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Keers, R. N., Williams, S. D., Cooke, J., & Ashcroft, D. M. (2013). Causes of medication administration errors in hospitals: A systematic review of quantitative and qualitative evidence. Drug Safety, 36(11), 1045-1067.
Keers, R. N., Williams, S. D., Cooke, J., Walsh, T., & Ashcroft, D. M. (2014). Impact of interventions designed to reduce medication administration errors in hospitals: A systematic review. Drug Safety, 37(5), 317-332.
Rack, L. L., Dudjak, L. A., & Wolf, G. A. (2012). Study of nurse workarounds in a hospital using bar code medication administration system. Journal of Nursing Care Quality, 27(3), 232-239.
Taufiq, S. (2015). Prevalence and causes of wrong time medication administration errors: Experience at a tertiary care hospital in Pakistan. Canadian Journal of Nursing Informatics, 10(1), 1-16.