Reducing Medication Errors: Nursing Quality and Safety

Introduction

One of the most challenging problems facing nurses practicing in any setting — but most especially in tertiary healthcare facilities — is the occurrence of 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 associated with medication errors are staggering. Current estimates indicate 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. A definition of quality and safety measures for medication errors and an assessment of their relationship and role in nursing science today are followed by a contemporary example of how quality and safety measures for medication errors are applied in nursing practice. Finally, the quality components needed to analyze a healthcare program's outcomes with respect to medication errors are identified, and the paper closes with a summary of key findings.

Defining Quality and Safety Measures for Medication Errors

A strict definition of quality and safety in medication administration is zero tolerance for errors from the pharmacy to the patient. Although this level of acceptance may appear unrealistic given the human factors involved at each stage of delivery, accepting anything short of perfection when it comes to protecting patient safety is tantamount to conceding defeat and sets the bar unnecessarily low. Current estimates indicate that at least 30% of inpatients experience at least one medication discrepancy upon discharge, and many authorities believe the true rate is much higher (Da Silva & Krishnamurthy, 2016).

What is known with certainty is that, as Hayes and Power observe, "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" (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, more aggressive action is urgently needed.

Scope and Trends of Adverse Drug Events

The adverse drug reactions caused by medication errors include a wide range of harmful side effects and allergic reactions, some of which can be fatal (Medication safety basics, 2018). Current estimates from the U.S. Centers for Disease Control and Prevention indicate that:

The number of adverse drug events is likely to grow due to the following factors:

These trends underscore the need for more aggressive approaches by nursing staff to reduce medication errors. While zero tolerance may not be fully achievable given all the human factors involved across an entire healthcare system, it is both possible and desirable for nursing staff to pursue this aspirational objective. In this regard, Hayes and Power note 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).

Conclusion

One of the unfortunate consequences of the human condition is the propensity for making errors. It is reasonable to acknowledge that everyone makes mistakes — perhaps several each day — but the majority of these mistakes do not carry the same life-threatening implications as medication errors. The research shows that in hospital settings, nurses bear primary responsibility for the correct administration of medications and therefore account for a significant share of facility-level medication errors. 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, meaningful 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 Improvement. 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 and Prevention. 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