Medication Errors Have Serious Direct and Indirect

Medication errors have serious direct and indirect results, and are usually the consequence of breakdowns in a system of care…Ten to 18% of all reported hospital injuries have been attributed to medication errors" (Mayo & Duncan 2004: 209). One of the most common reasons that errors in medical administration transpire is miscommunication. On a staff level, errors may occur in terms of the paperwork associated with the patient. The hospital pharmacist may misread the strength or even the name of the pill or the frequency of the dose and release the patient with an incorrect pill or orders. Or, within the hospital a nurse may misread the patient's orders and administer treatment incorrectly. If a nurse, within the environment of the hospital, is pressed for time or overtired, risks of medication errors increase.

When a patient is discharged with orders, miscommunication can also occur if the nurse does not stress the seriousness of taking medications as the right time (some medications must be taken with food, some without food, some must be coupled with certain types of food, such as antibiotics with yogurt, to reduce digestive distress, some foods may need to be avoided). Correct dosage, such as tablespoons vs. teaspoons, or the need to split pills, must also be explained. Asking the patient to repeat directions can be a simple way to reinforce these principles. Particularly if the patient is elderly, does not have a high level of literacy, or speaks English as a second language, it is essential that the nurse tailor her responses to the individual patient. The nurse must also recognize that some medications may be more intimidating to administer for patients at home, such as insulin injections, or that some home environments may be less supportive of a regular schedule of dosages.

Team, task, environment, individual and patient will all influence the likelihood of both hospital professionals and patients to administer the correct dosage. Miscommunication between team members can result in incorrect dosing. Difficulties inherent to the task or an environment that is not conducive to focus and concentration can likewise result in incorrect or misread dosages. The nurse's own mental state (one of experience with the drug, culture of the patient, and level of tiredness) can affect the transmission of knowledge, as can the patient's (or caregiver's) level of literacy and understanding. One survey of nurses themselves found that nurses "cited illegible physician handwriting and being distracted or tired as the primary causes for drug errors" (Clinical rounds, 2004, Nursing).

The six 'rights' of drug administration are: 1. Right Patient 2. Right drug 3. Right Dose 4. Right Route 5. Right Time 6. Right to refuse must be upheld, regardless of the challenges of the situation (Bullock & Manias 2011). Only effective communication can ensure that they are followed at all times. Healthcare providers on the same treatment team must communicate with one another, and carefully review drug orders if something seems amiss, rather than obeying by rote. Nurses must know how to listen to patients to assess the patient's level of comprehension in an effective manner, and become aware of patient incomprehension. It is not enough to merely say the correct words -- the information must be communicated in a manner that is comprehensible to the patient, at his or her level of understanding.

Q2. Mrs. Dorrie Smith is a 70-year-old patient in your ward who has recently been prescribed the medication Warfarin. Using adult learning principles outline the information you would provide Ms Smith in an education session. The aim of this session is to ensure she uses her medication safely. (300 words)

When communicating with Mrs. Smith, having an active dialogue in which both parties participate is essential. It is not enough to merely tell Mrs. Smith how she should take Warfarin, a drug which requires a strict diet and careful monitoring of potentially serious side effects (Warfarin, 2011, NIH). The nurse must ask Mrs. Smith to restate what Mrs. Smith understands, even if Mrs. Smith says that she comprehends what the nurse is saying. Because of her age, Mrs. Smith may fear seeming foolish. While it may seem obvious to the nurse that Mrs. Smith has a strong motivation to learn to preserve her health, an older person may feel depressed if socially disconnected and be less proactive about being careful about dosage and treatment.

Mrs. Smith may also not see herself as 'sick' even if she is. Mrs. Smith's prior experience with taking medication, monitoring side effects and being aware of contraindicated activities and medicine will also influence her receptivity and seriousness with which she takes her medication and her emotional readiness to comply. If at all possible, Mrs. Smith's close family members should be involved in the session, although if Mrs. Smith wishes to speak with the nurses alone, this should be respected if she is competent to do so.