Introduction
Nursing homes are continually improving their organizational processes to provide comfort and high-quality care to their patients, who are more vulnerable due to their age. Even with advancements, medical administration errors continue to threaten residents’ health and well-being. Administration involves giving patients the drugs they need for their condition, and following established guidelines and regulations is critical to therapeutic action.
However, the lack of standardization of the Medical Administration Record (MAR), high workloads, and problems in supervision and communication can lead to errors in the process. The Centers for Medicare & Medicaid Services (CMS) recommends ensuring clarity in instructions and adherence to the five rights of the process: patient, drug, route, dose, and time (Ernstmeyer & Christman, 2020). Nevertheless, various organizations may have contrasting causes of errors requiring investigation.
Problem
The problem studied in the current paper is medical administration errors among geriatric patients in a nursing home. Errors are considered events and incidents when an action was taken incorrectly during the administration process, leading to non-compliance with the instructions for using the medicine. Nurses, doctors, or medical assistants with the appropriate authority to give medications are involved in this procedure, and patients are most affected. Due to health conditions that worsen with age, care home residents are more vulnerable to medication errors, and 16-27% of them suffer from errors every year (Shelton, 2023). The administration occurs during direct patient drug administration in the Community Living Center (CLC) setting at the Hampton, VA Medical Center nursing home.
The study of administrative processes in the CLC provided grounds for highlighting statistics, patterns, and obstacles that cause errors. The data collected from the reports showed that, out of 1,828 cases of medication transmission, 219 errors (12%) occurred, of which 42% occurred during administration. Employee surveys suggested that unclear MRA, lack of time, weak support for supervisors and mentors, and the complexity of drug regimens due to polypharmacy, pharmacokinetics, and pharmacodynamics among geriatric patients are the primary reasons for these mistakes. Although there is no national rate for errors, each institution sets its own standards (Comprehensive Pharmacy Services, Inc., 2020). A discussion at Hampton VA Medical Center found that the current mistake rate does not meet the needs of employees and administration, and reducing it is an important goal.
Root Causes
Observations and employee surveys helped delve into the root causes of medication errors. Eight employees cited time constraints due to high workload as the most discussed cause of the errors. Five team members complained about difficulties in understanding the MRA instructions. Two trainees pointed out that when confused during the administration process, they did not know how to ask supervisors for help or where to find them. Finally, many employees mentioned that the organization rarely discusses errors and their reasons, that there was an opportunity to address them, and also noted polypharmacy, which complicates the process.
Lack of Standardization in MAR Documentation
The difficulties employees had in understanding instructions arose from problems with standardization. The language used in the documents was ambiguous, for example, when indicating the amount of medication but not the frequency of use.
High Workload and Time Constraints
The nurse-to-patient ratio in the nursing home does not meet recommended standards, resulting in increased employee workload. At the same time, administration often requires accuracy, attention, and an extended study of instructions. With MAR problems, staff rely on experience and knowledge to get through the process faster, leading to mistakes and inattention.
Unestablished Mentorship and Supervision Policies and Procedures
The CLC staff includes several trainees who have begun their careers. It is common for new employees to lack the skills and experience to complete tasks accurately (Wondmieneh et al., 2020). Such a reason is relevant for CLC, but at the same time, new employees do not receive supervision or support when they encounter heavy workloads.
Communication Inefficiency
Discussion and reporting of emerging issues are essential measures for finding a solution. However, CLC employees noted a lack of communication, which prevented improvement of existing procedures.
Polypharmacy and Modified Pharmacokinetics and Pharmacodynamics
A unique feature of working with geriatric patients is their need for many drugs and altered pharmacodynamics and pharmacokinetics. Consequently, composing the accept mode to achieve the best effect and reduce side effects is challenging.
Population and Setting
CLC is included in the Hampton VA Medical Center in Virginia and provides long-term care for geriatric patients. Medical staff involved in care include nursing managers, registered nurses, nursing assistants, licensed nurses, and physicians. The institution’s workflows are regulated and require staff to report to managers. The effort aims to support more than 30 older patients, who include men and women, Caucasians and African Americans.
The Medical Centre works with veterans, and its residents receive government support to provide insurance. There is not enough funding, which is why there is a shortage of employees, leading to difficulties and problems at work. The main health problems and needs are renal failure, lung cancer, dementia, hospice, or rehab. Therefore, patients need careful care, management of multiple conditions, and socialization opportunities.
Significance
Medication errors have implications for several stakeholders involved in the problem. They can affect the health of residents by causing negative consequences, up to death, which also impacts the families of patients. For employees and organizations, mistakes lead to a decrease in wards’s trust and a deterioration in public image. Moreover, such incidents have financial consequences, resulting in annual losses of $20 billion nationwide (Ahsani-Estahbanati et al., 2022). As a result, the problem must be addressed to improve service quality and ensure that patients in nursing homes have comfortable conditions.
References
Ahsani-Estahbanati, E., Doshmangir, L., Najafi, B., Akbari Sari, A., & Sergeevich Gordeev, V. (2022). Incidence rate and financial burden of medical errors and policy interventions to address them: A multi-method study protocol. Health Services and Outcomes Research Methodology, 22(2), 244-252.
Comprehensive Pharmacy Services, Inc. (2020). Medication error rates.
Ernstmeyer, K., & Christman, E., (2020). Nursing pharmacology. Chippewa Valley Technical College.
Shelton, P. (2023). Medication errors in nursing homes. Nursing Home Abuse.com.
Wondmieneh, A., Alemu, W., Tadele, N., & Demis, A. (2020). Medication administration errors and contributing factors among nurses: A cross sectional study in tertiary hospitals, Addis Ababa, Ethiopia. BMC Nursing, 19(1), 1-9.