Medication Errors

Identifying Opportunities to Reduce Medication Error Rates by Nursing Staff
Today, one of the most challenging problems facing nurses practicing in any setting, but most especially tertiary healthcare facilities, is the adverse drug reactions caused by medication errors. Although medication errors can occur at numerous stages of care during hospitalization and outpatient follow-up, nurses are on the front lines in preventing these errors (Da Silva & Krishnamurthy, 2016). This is an important issue because the human and economic costs that are associated with medication errors are staggering, with current estimates indicating that these errors affect more than 7 million patients, cost nearly $21 billion and cause more than one million emergency room visits and three-and-a-half million visits to doctors’ offices each year (Da Silva & Krishnamurthy, 2016). The purpose of this paper is to provide a timely discussion concerning the role of quality and safety in nursing science as they apply to the prevention of medication errors. To this end, a definition of quality and safety measures for medication errors an assessment of their relationship and role in nursing science today are followed by a contemporary example of how quality and safety measures for mediation errors are applied in nursing science. Finally, an identification of the quality and components needed to analyze a health care program's outcomes with respect to medication errors is followed by a summary of the research and key findings concerning this nursing science issue in the conclusion.
Definition of quality and safety measures for medication errors and their relationship and role in nursing science today
A strict definition of quality and safety is zero tolerance for medication errors from the pharmacy to the patient. Although this level of acceptance may appear unrealistic given the human factors that are involved during each of the various stages of delivery, accepting anything short of perfection when it comes to protecting patient safety is tantamount to conceding defeat and sets the bar low. Current estimates indicate that at least 30% of inpatients experience at least one medication discrepancy upon discharge, but many authorities believe that the rate is much higher (Da Silva & Krishnamurthy, 2016). What is known for certain is that, “Medication related incidents and errors continue to be a significant patient safety issue in health care settings internationally and despite decades of research and quality improvement initiatives, we have failed to identify innovative and sustainable solutions” (Hayes & Power, 2014, p. 3). Given the persistently high rate of medication errors and adverse drug reactions that continue to diminish the quality of care and patient safety,
The adverse drug reactions caused by medication errors include various harmful side effects and allergic reactions that can be fatal (Medication safety basics, 2018). Current estimates indicate that:
· The vast majority (82%) of American adults take at least one medication and 29 percent take five or more;
· Adverse drug reactions cause approximately 1.3 million emergency department visits and 350,000 hospitalizations each year;
· $3.5 billion is spent on excess medical costs of adverse drug reactions annually;
· More than 40% of costs related to ambulatory (non-hospital) adverse drug reactions might be preventable;
The numbers of adverse drug events is likely to grow due to:
· Development of new medicines;
· Discovery of new uses for older medicines;
· Aging American population;
· Increased use of medicines for disease treatment and prevention; and,
· Expansion of insurance coverage for prescription medicines (Medication safety basics, 2018).
These trends underscore the need for more aggressive approaches by nursing staff to reduce medication errors. While zero tolerance may not be fully achievable outside the nursing domain given the human factors involved, it is possible and desirable for nursing staff to pursue this lofty and seemingly unachievable objective. In this regard, Hayes and Power add that, “Nurses are not only the largest group of health professionals who administer medications, but are also considered to be in the best position to recognize and prevent medication errors before patient safety is compromised” (2014, p. 4). Some of the most common sentinel events identified by the Joint Commission as being primarily the responsibility of nursing staff that exacerbate current medication error rates include the following:
· Accidental daily dosing of oral methotrexate intended for weekly administration;
· Missing or inaccurate patient weights, and mix-ups between metric and non-metric units when measuring and documenting weight;
· Unintended intravenous administration of oral medications;
· Mix-ups between milliliters and non-metric units when measuring oral liquid medications;
· Accidental topical application of glacial acetic acid;
· Inadvertent administration of neuromuscular blocking agents to patients not receiving proper ventilator assistance;
· Infusion-related errors when administering high-alert intravenous medications;
· Delay in administration or improper use of antidotes, reversal agents, and rescue agents;
· Accidental administration of an intravenous infusion of sterile water;
· Errors during sterile compounding of drugs, especially high-alert medications;
· Inappropriate use of fentaNYL patches to treat acute pain and/or patients who are opioid-naïve;
· Serious tissue injuries and amputations from injectable promethazine use; and,
· Lack of learning from external medication safety risks and errors (Targeted medication safety best practices for hospitals, 2017).
Contemporary example of how quality or safety measures are applied in nursing science
Beyond the sentinel events identified by the Joint Commission, medication errors are also caused by nursing staff mistakes with respect to the so-called and easy-to-remember “five rights” of medication administration:
1. The right patient;
2. The right drug;
3. The right dose;
4. The right route; and,
5. The right time (Federico, 2018).
Therefore, by ensuring that the five Rs as followed, nurses will be far less likely to make a medication error that can have profoundly severe adverse results.
Identification of the quality and/or components needed to analyze a health care program's outcomes
Because the Joint Commission mandates tracking medication errors rates, tertiary healthcare facilities will have access to benchmark data concerning mediation error rates by type, time, ward, and responsible individual. Armed with this data, the outcome of a health care program focused on reducing medication errors can be measured to assess the effectiveness of interventions such as staff education initiatives concerning the importance of reducing medication error rates, posters for nursing units describing the five rights of medication administration and inclusion of medication error rates by nursing unit and shift in the facility’s monthly institution-wide quality assurance summary for multidisciplinary review to identify additional opportunities for improvement..
Conclusion
One of the unfortunate consequences of the human condition is the propensity for making errors. Indeed, it is reasonable to conclude that everyone makes mistakes all the time, perhaps several each day, but the majority of these mistakes do not have the same life-threatening implications as medication errors. The research showed that in hospital settings, nurses carry most of the responsibilities for the correct administration of medications and they therefore account for most of the facility’s medication errors. Therefore, by making reductions in medication errors a high priority and consistently focusing on this problem, nursing leaders and educators can help improve the quality of care and patient safety in measurable ways.
References
Da Silva, B. A., & Krishnamurthy, M. (2016). The alarming reality of medication error: a patient case and review of Pennsylvania and National data. Journal of Community Hospital Internal Medicine Perspectives, 6(4), 10.34.
Federico, F. (2018). The five rights of medication administration. Institute for Healthcare Administration. Retrieved from http://www.ihi.org/resources/Pages/ImprovementStories/ FiveRightsofMedicationAdministration.aspx.
Hayes, C. & Power, T. (2014, April-June). Interruptions and medication: Is 'do not disturb' the answer? Contemporary Nurse: a Journal for the Australian Nursing Profession, 47(1/2), 3-6.
Medication safety basics. (2018). U.S. Centers for Disease Control. Retrieved from https://www.cdc.gov/medicationsafety/basics.html.
Targeted medication safety best practices for hospitals. (2017, December 4). Joint Commission. Retrieved from https://live-ismp.pantheonsite.io/guidelines/best-practices-hospitals.