Quality Improvement and Safety in Nursing

Ensuring a safe environment for patients is among the primary concerns for nurses. It could be difficult, as many factors impact safety within the health care setting. One of them is connected with medicine administration, which is an essential part of a nurse’s job. While it may feel routine, the action also involves risks that may threaten the patient’s life. The Evidence-based practice offers several up-to-date solutions to the issue to enhance safety. This paper will discuss the factors surrounding medication administration errors that lead to a patient-safety risk and suggest quality improvement measures.

The factors that affect medication administration are numerous, and some are more prevalent and dangerous than others, but the general picture is homogeneous. A major reason for errors is medicine being out of its packaging with instructions (Hammoudi, Ismaile, & Abu Yahya, 2017). It might or might not be related to another factor: poor communication with doctors, caused either by its quality or shortness (Hammoudi et al., 2017). Increased workload and various interruptions, including unfinished work with another patient, may also cause errors, such as slips and leaps (Thomas, Donohue-Porter, & Stein-Fishbein, 2017). It appears that using barcode technology is also potentially risky due to malfunctions, although its original intent is to improve safety (van der Veen et al., 2018). A nurse’s past experience is also a significant factor that can enhance or reduce safety; in the latter case, if a medication that requires new approaches is introduced (Parry, Barriball, & While, 2015). Considering that such errors are not subject to reimbursement, the nursing staff should avoid them and focus on decreasing the risk factors. Overall, many variables lead to medication administration errors, and they should be tackled.

Some guidelines and practices can assist in mitigating safety risks, including those that occur in medication administration. A system of labeling should be introduced to resolve the issues with packaging, which would remove confusion for the nurses and consequences for the patients (Hammoudi et al., 2017). While the effectiveness of double-checking does not have enough evidence support, it might also be beneficial (Koyama, Maddox, Li, Bucknall, & Westbrook, 2020). Improving the nurses’ work environment and facilitating collaboration between all participants in the system responsible for medication within the hospital setting is essential (Härkänen, Saano, & Vehviläinen-Julkunen, 2017). Diversion strategies and checklists can be used to decrease interruptions, as well as special clothes that signify that a nurse is busy, although their impact requires further studies (Lapkin, Levett-Jones, Chenoweth, & Johnson, 2016). Error reporting also appears to be a contributing factor in lowering safety risks, as they can be further analyzed and avoided, especially if it is something that the administration can resolve (Kavanagh, 2017). Altogether, most of the risk factors can be addressed by applying respective measures that will not burden the budget and adopting a safety culture.

A nurse, regardless of their position, a novice or a leader, can contribute significantly to safety. However, the current strategy is for nurses to unite in teams to support each other and help less experienced colleagues (Choete, 2015). Such assistance can be instrumental in resolving poor communication and the fear of reporting medication administration errors (Choete, 2015). It is also important for a nurse to recognize patients as equal partners worthy of respect, which may enhance the attention and meticulousness with which care is provided (Sherwood & Nickel, 2017). Nurses should also constantly evaluate their performance and use technologies and information to update their knowledge and mitigate safety risks while remembering that some, such as barcode usage, have issues (Sherwood & Nickel, 2017). In conclusion, an individual nurse can do much to enhance safety, although it remains a collective effort of the staff and the system in place.

Sometimes nurses can feel restricted in their actions to tackle safety risks, so they have to cooperate with stakeholders to implement changes. The relevant groups would be the employers and the firms that provide medication. The former’s importance is that they are responsible for systematic improvements and staffing, and the nurses might negotiate their shifts and workload in a way that would decrease distractions and other oversights. Pharmaceutical firms can be instrumental in resolving the issues with packaging and instructions, making the former more distinct and the latter more detailed. The patients can also be considered an important stakeholder group in relation to medication administration, as most issues manifest in nurse-patient situations. Such cooperation allows a nurse to be aware of their opinion and vision of the ways a certain safety risk can be tackled because those directly affect them. Overall, by communicating with such stakeholders as the employers, the pharmaceutical firms, and the patients, a nurse may achieve improved safety results.

In conclusion, the paper described such a safety risk as medication administration errors, the factors that lead to them, and the measures that can enhance safety. Those can be roughly divided into the systematic and individual ones, but they should still apply together. A nurse can contribute considerably to maintaining safety as a team or a single unit, although cooperation with stakeholders is necessary to ensure a safe environment in the health care setting.

References

Cloete, L. (2015). Reducing medication errors in nursing practice. Cancer Nursing Practice, 14(1), 29–36. Web.

Hammoudi, B. M., Ismaile, S., & Abu Yahya, O. (2017). Factors associated with medication administration errors and why nurses fail to report them. Scandinavian Journal of Caring Sciences, 32(3), 1038–1046. 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.

Kavanagh, C. (2017). Medication governance: Preventing errors and promoting patient safety. British Journal of Nursing, 26(3), 159–165.

Koyama, A. K., Maddox, C. S., Li, L., Bucknall, T., & Westbrook, J. I. (2020). Effectiveness of double checking to reduce medication administration errors: a systematic review. BMJ Quality & Safety, 29, 595–603. Web.

Lapkin, S., Levett-Jones, T., Chenoweth, L., & Johnson, M. (2016). The effectiveness of interventions designed to reduce medication administration errors: A synthesis of findings from systematic reviews. Journal of Nursing Management, 24(7), 845–858.

Parry, A. M., Barriball, K. L., & While, A. E. (2015). Factors contributing to Registered Nurse medication administration error: A narrative review. International Journal of Nursing Studies, 52(1), 403–420.

Sherwood, G., & Nickel, B. (2017). Integrating quality and safety competencies to improve outcomes. Journal of Infusion Nursing, 40(2), 116–122. Web.

Thomas, L., Donohue-Porter, P., & Stein-Fishbein, J. (2017). Impact of interruptions, distractions, and cognitive load on procedure failures and medication administration errors. Journal of Nursing Care Quality, 32(4), 309–317. Web.

van der Veen, W., van den Bemt, P. M., Wouters, H., Bates, D. W., Twisk, J. W., de Gier, J. J., & Taxis, K. (2017). Association between workarounds and medication administration errors in bar-code-assisted medication administration in hospitals. Journal of the American Medical Informatics Association, 25(4), 385–392. Web.

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