Introduction
In the present day, patient safety remains a highly disturbing health care issue, and medication errors relate to the most typical causes of damage to life or health. According to Yousef and Yousef (2017), “6–7% of hospital admissions are due to medication errors” (p. 2). In the United States, 450,000 medication errors that could be prevented are reported every year (Hayes, et al., 2015). At the same time, in addition to these reported errors, one or two medication administration errors per patient remain unreported daily (Hayes, et al., 2015). The purpose of this paper is to analyze the issue of medication errors to find and evaluate potential solutions.
Background
In general, a medication administration error may be defined as “a preventable event related to medication which results in a failure in the treatment process that leads to, or has the potential to lead to, harm to the patient” (Cloete, 2015, p. 50). Patients of general and acute hospitals, mental health services, community medical and therapy services, learning disabilities services, general practice, community pharmacies, and ambulance or dental services are substantially vulnerable to medication errors (Cloete, 2015). Under certain circumstances, in these medical settings, the operation loads of nurse practitioners, medical assistants, and physicians and communication difficulties between staff and patients may lead to medical errors. From a personal perspective, the comprehensive examination of medication errors is highly essential as it helps to analyze this issue to find potential solutions for its reduction and prevention.
Types of Medication Errors
Medication administration errors are substantively harmful events that not only have a highly negative impact on patient safety but traditionally place a considerable financial burden on the health care industry as well. Personal and organizational costs resulting in these errors traditionally include readmissions, increased periods of stay, post-discharge disability, and patient mortality (Hayes, et al., 2015). In addition to the financial losses of hospitals and medical centers, errors inevitably lead to the emotional, psychological, and physical affection of individual patients. In general, as medication errors may occur in any stage of the treatment process, they are traditionally classified according to these stages and include prescribing, administration, dispensing, and monitoring errors (Yousef & Yousef, 2017).
Prescribing errors include medication errors made by physicians in the prescription writing process, such as incorrect drug selection, dosage form, or the frequency of administration, wrong-patient errors, or the violation of drug interactions (Yousef & Yousef, 2017). Administration errors imply the deviation “from the physician’s order according to what is written in the patient’s chart”: unlicensed drug, missing dose, wrong dose, overdose, and the wrong time, technique, or administration form (Yousef & Yousef, 2017, p. 2). In turn, dispensing errors are made by the pharmacy staff during the distribution of medications to nursing practitioners or patients in ambulatory settings. Finally, monitoring errors occur when clinicians “fail to review a prescribed therapeutic plan for appropriateness and detection of problems” and do not use appropriate patient data to predict the outcomes of the therapy (Yousef & Yousef, 2017, p. 2). In general, the most common medication administration errors are medication omission without any acceptable clinical reason and wrong time of administration.
Causes of Medication Errors
Multiple studies are dedicated to factors that may potentially contribute to the occurrence of medication errors. Traditionally, all causes of these errors are divided into the patient, system, and personal factors (Cloete, 2015). Patient factors related to the attributes and individual characteristics of patients may lead to medication errors. They generally include:
- Poor communication (language difficulties and barriers, unconscious or confused state, small children);
- Multiple medication use (multiple health problems, complex disease process, more than one physician who prescribes medications);
- Passive involvement (patient’s passive involvement and the absence of interest in the treatment process determined by his or her culture or typical behavioral patterns);
- Complications with drug calculation (weight0based or titrated medications) (Cloete, 2015).
In turn, system and personal factors that may lead to medication errors are directly connected with the characteristics of medical institutions or individual practitioners (Cloete, 2015). For instance, system factors imply the organization’s safety culture, management, leadership, and workplace policies, communication, and procedures. If the staff’s educational needs are not addressed, and succinct, step-by-step algorithms, guidelines, and protocols for equipment and operations are not available in medical settings, medication errors will be inevitable. Finally, personal factors include the practitioner’s situational awareness, cognitive abilities and skills, decision-making, and personal resources, such as responses to fatigue and stress.
Potential Solutions for the Prevention of Medication Errors
In general, for the prevention of medication administration errors, there are multiple potential solutions. The ignorance of the issue will lead to an increased number of errors that may threaten the welfare of patients. The absence of personal responsibility and nurses’ high workloads due to modern requirements in the health care industry and a substantial number of patients may result in unintentional inaccuracy. They may be theoretically divided into three categories related to individual professionals, health care teams, and medical organizations (Härkänen, et al., 2017). The category of professionals includes the personal responsibility of health care providers to prevent medication errors, their accuracy and preciseness, following all necessary guidelines, and verification (Härkänen, et al., 2017). The category of team implies collective responsibility, appropriate distribution of work, the cooperation of all team members, the absence of workforce conflicts, and the proper documentation and marking of information concerning medications (Härkänen, et al., 2017). The organization-related category includes a healthy work environment and the availability of resources, professional training, and comprehensive guidelines.
Physicians, nurse practitioners, pharmacists, and medical assistants should administer medications with a strong sense of responsibility, concentration on a particular task, and high moral awareness. At the same time, the system of health care should help individual providers through the support of effective communication within medical settings and an appropriate work environment. In general, the most appropriate and accessible strategies that may prevent the occurrence of medication administration errors are the following:
- Increased demand for nurse practitioners. Registered nurses may be regarded as the most essential employees for medication administration as they provide the connection between physicians, pharmacists, medical assistants, patients, and their families (Cloete, 2015). To prevent medication errors, health care providers should obtain two fundamental skills – basic computation and mathematical aptitude to calculate drug dosage and the ability to access, understand, and interpret clinical information for correct treatment (Cloete, 2015). In addition, to promote accuracy in medication administration, medical organizations require an increased number of licensed nurses. In turn, the educational system should focus on providing necessary knowledge related to medication administration to future specialists.
- Appropriate working conditions. According to Cloete (2015), “the number of hours nurses work, length of shifts, patient acuity and high workloads result in nurse fatigue” that leads to a lack of concentration and medication errors (p. 54). While nurses are bound by organizational policies and statutory requirements, the official regulation of working shifts and the limitation of their length will help them to execute safe practices. The establishment of appropriate working conditions requires the reevaluation of existing conditions for their correction if necessary. In addition, the application of principles of transformational leadership may be efficient as well as leaders aim to be aware of their employees’ needs and suggestions. If nurses express considerable dissatisfaction with their job, changes in the policy of a medical setting should be initiated.
- Prevention of confusion. The prescriber’s poor handwriting in medication orders or on medication charts frequently leads to confusion and errors (Cloete, 2015). That is why physicians, nurse professionals, and pharmacists should be certain that their handwritings are understandable.
- Double-check system. This system implies the check of all activities related to medication administration by a second person (Yousef & Yousef, 2017). The strategy requires the change of the organization’s policy that records this regulation. A second person or a group of people with an appropriate professional level will be responsible for the check of other nurses’ activities to prevent medication errors.
With the development of information technologies, the strategies for the prevention of medication errors may be implemented with the help of computer systems. The establishment and development of computerized medication records in medical settings may be regarded as one of the most effective ways the reduction of medication errors and the prevention of new cases. The successful implementation of computer systems requires the purchase or rent of hardware, system adjustment by IT specialists, and training for health care providers who are unfamiliar with technologies. This practice is highly efficient as it helps to avoid the consequences of poor communication between clinicians as they will put all information concerning medication administration in a system. For instance, when health care providers finish their shift, they will know that their colleagues will receive all data concerning the patients’ medication in an electronic format that excludes any misunderstanding typical for handwriting. However, health records may be considered vulnerable to cybersecurity breaches.
Concerning the ethical implications of this solution, electronic health records have both advantages and disadvantages. On the one hand, patients will exercise their right to awareness concerning their health condition and treatment as they will receive full access to their medication records. In this case, the implementation of health care records will correspond with the ethical principles of veracity, right to knowledge, beneficence, and nonmaleficence. On the other hand, ethical issues related to the patients’ privacy may occur as their data will be available for a substantial number of health care providers who are not involved in the treatment process personally. In addition, the same ethical issue may occur in the case of the double-check system’s implementation when medication administration is checked by external specialists. In turn, the improvement of working conditions will help nurses to focus on patients and their needs to form solid relationships based on mutual trust and respect.
References
Cloete, L. (2015). Reducing medication errors in nursing practice. Nursing Standard, 29(20), 50-59. Web.
Härkänen, M., Saano, S., & Vehviläinen-Julkunen, K. (2017). Using incident reports to inform the prevention of medication administration errors. Journal of Clinical Nursing, 26(21-22), 3486-3499.
Hayes, C., Jackson, D., Davidson, P. M., & Power, T. (2015). Medication errors in hospitals: A literature review of disruptions to nursing practice during medication administration. Journal of Clinical Nursing, 24(21-22), 3063-3076.
Yousef, N., & Yousef, F. (2017). Using total quality management approach to improve patient safety by preventing medication error incidences. BMC Health Services Research, 17(621), 1-16.