Risk Management Within a Healthcare Environment Medication errors and falls are among the top events that can cause harm to patients, and consequently, increase the costs of hospitalization. In a healthcare environment, a professional nurse can be liable for damages if her conduct is below the standard of care, which cause injuries to patients. This paper explores the concept of falls, medication errors, and nursing liability. The study recommends how nurses can promote a culture safety within a healthcare environment.

Falls

A fall is an unintentional, and sudden slip that leads to a change in position. A fall is one of the common adverse effects in a hospital setting where more than 37.3 million of the case globally occurs annually. WHO (2012) reveals falls result to more than 424,000 deaths globally each year, and over 80% of the case are in developing countries. In the United States, the fall rates are between 3.31 and 11.5 per 1000 patients. However, Hitcho, Krauss, Birge, et al. (2004) point out that rate of falls is between 2.3 and 7 per 1000 patients per day in the United States. However, fall rates are highest among neuroscience patients with a record between 6.12 and 8.83 per 1000 patients per day. Typically, nearly 30% of inpatients associated falls result in injuries where between 4% and 6% result in a serious injury, and fall-related injuries include subdural hematomas, fractures, excessive bleeding and sometimes death. In the United States, fall associated injuries increase healthcare costs and patients who sustain injuries because of falls incur $4,200 in healthcare costs higher than hospitalized patients who do not sustain falls. The risk factors associated with falls include depression, increasing age, impaired cognition, visual impairment as well as the use of certain medications such as sedatives, antipsychotics, and benzodiazepines.

Currie, (2008) argues that a fall prevention continues to be a considerable challenge to healthcare organizations because unintentional falls are common among people 65 years of age and older. This age group falls at least once a year, and the event is frequent among female patients than male patients. In the United States, fall-related injuries are the cause of accidental death among people over 65 years age resulting in 41 fall-related deaths yearly out of 1000 people. Moreover, mortality and injury rates increase dramatically among people 85 years of age and above. The sequelae associated with falls are costly, and fall-related injuries result to more than 15% re-hospitalization after patients are discharged from hospitals. In 2000, total estimated costs that arise from falls were between $16 billion and $19 billion, and fall-related costs are $170 million dollars. Moreover, injuries associated with falls are between 6 and 44% for acute inpatient falls. Serious injuries from falls are between 2 and 8% resulting in 90,000 serious injuries in the United States. Fall-related deaths are approximately 11,000 across the United States.

Medication Errors

Errors are defined as a kind of mistake that may cause the adverse event to patients in the process administering drugs. A medication error is defined as an unintended failure in the drug prescription and treatment leading to harms to patients. In other words, medication errors are the type of preventable event, which could cause a harm to patients, and inappropriate medication use of medication can also cause harm to patients or consumers. Events that may lead to medication errors include poor in order communication, healthcare procedure, packaging, dispensing, administration and distribution. Mistakes in drug dispensing, prescribing, preparation, storing, and administration can also lead to adverse events leading to a public health burden. Bad medication management can have an adverse drug event. BNF (British National Formulary) identifies the healthcare specializations with top medication errors:

1. analgesics 9.7%;

2. antibacterial drugs 6.2%;

3. bronchodilators 5.7%;

4. anti-anginal drugs 5.3%; and Mcgreevey, (2015) point out that a medication error occurs in one out two surgeries in the United States leading to adverse harm to patients. The most obvious medication errors are incorrect dosage, a mistake in labeling, and documentation errors. Hughes, (2008) identifies poor communication as one of the factors that can lead to medication errors, which can have negative effects on patients' outcomes. In the United States, more than 1.3 million people sustain injuries from medication errors. The FDA (Federal Drug Administration) points out that common cause of medication errors include an improper dose of the drug, and the health consequence of medication errors occur in people aged 60 years and above showing that the older people face the greatest risks from medication errors.

Cheragi et al. (2013) reveal that medication errors are rampant across the healthcare environment resulting in significant financial...

For example, the error rate in anesthesia is approximately one error out 5 anesthetics carried out. Other categories of medication error include lapses, slips, and deliberate violations. Similar to patients' falls, Cheragi et al. (2013) argue that drug errors continue to incur additional high costs for both patients and healthcare organizations.
Nursing Liability

Nursing liability is a nurse's negligence or medical malpractice that may cause harm to patients. In a healthcare environment, negligence and medical malpractice can lead to medication errors and patient falls, which may consequently lead to nursing liability. Under state law, nurses can be liable for medical liability if they are negligent in their professional conduct that can cause harm to patients. Moreover,

"a patient may pursue a civil claim against nurses or other health care providers, called medical malpractice or medical liability if the health care provider causes injury or death to the patient through omission or a negligent act." (NCSL, 2014 p 1).

To recover the damage, the patient must be able to establish that the nurses owe a duty to the patient and the nurse violated the standard of care. A violation of the standard of care can cause an injury or harms to patients. Under the California legislation in the Nursing Practice Act, nursing practitioners should perform their duties in accordance with the laid down regulation and violation of these acts is a crime. Shinn, (2001) remind nurses that they can be sued for a wrongful act, however, the author maintains that nurses confront hundreds of events that can give rise to lawsuits. For example, mislabeled prescription can lead to a medication error. Despite a high number of events that may give rise to lawsuits, fortunately, only a few of these events can actually cause injury to patients.

Health Law Firm (2015) in their argument reveals that a breach of duty can lead to nursing liability where the nurses perform care that is below "an acceptable standard of care." (Health Law Firm, 2015 p 1). In the United States, the standard of care is the legal concept showing an acceptable and expected health care that nurses should perform. Typically, the concept of standard of care reveals that nurses should act professionally, and incorporate a knowledge and skills during their professional practice. Moreover, nurses are expected to apply their education, good judgment, training to deliver high-quality care to patients. However, nursing care that is below an acceptable or appropriate standard of care can lead to a lawsuit against the nurse.

Role of Professional Nurses in promoting Culture of Safety

To avoid nursing liability during a professional practice, licensed nurses should follow an acceptable standard of practice in their professional conducts that should prevent medication errors or patients' falls. Moreover, a nursing organization should draw a comprehensive policy that all nurses should follow, which should provide a guideline for a good conduct during a professional practice. This paper recommends that all nurses should update their knowledge through continuous education to promote a culture of safety within the clinical practice to avoid nursing liability. Moreover, nurses should update their knowledge of the legislation guiding their practice about the strategy to prevent medication errors. In the United States, many nurses are not aware of the legislations guiding their professional practice. Some nurses fail in their professional practice because of ignorance of the law guiding their practice.

Effective communication within the healthcare environment is another strategy to promote a culture of safety within a healthcare environment. Douglas, Pierce, Rosenkoetter, et al. (2011) point out that nurses should establish an open communication with patients in order to respect and listen to cultural practices and beliefs. Moreover, nurses should conduct assessment about clients' psychological, physical and cultural attributes to assist in planning as well assisting in prioritizing care. Moreover, healthcare organizations should provide training and education workshop to help nurses developing their skills and knowledge about appropriate drug labeling and dosages which will assist in preventing medication errors and deliver the quality of care for patients. Moreover, healthcare organizations should enhance nurse's knowledge about diverse ethical groups to enhance effective cross-cultural practice. (Hughes, 2008).

Hughes (2008) recommends that a health care organization should promote cultures of safety to reduce medication errors that can lead to a nursing liability. A culture of safety is defined as

"the product of the individual and group values, attitudes, competencies and patterns of behavior that determine the commitment to, and the style and proficiency of, an organization's health and safety" (Gadd, Collin1993,p. 2).

Organizations that promote…