Introduction

Medication errors are considered a crucial problem in nursing. Moreover, they can result in hazards for patients, since they affect patient safety significantly and the treatment costs become a burden to their families. The most significant responsibility of nurses may be giving medicine to patients, since the results of wrong dose of medication may have serious repercussion to the patient. Negative outcomes can occur, such as increased hospitalization time, high mortality rate and high medical expenses (Aspden et al., 2006). However, medication errors caused by nurses or health care team members seem common. Many errors arise from the natural process of behavioral and cognitive adaptations, which originate from the correct behavioral skills. Execution of medical orders is an essential part of patient care and healing process. Moreover, it is the main component in the evaluation of nursing performance and it has an outstanding responsibility in patients well-being (Wayne, 2005). The fact that nurses perform most of the medical orders and spend less of their time in the hospital administering medicines increases the risk of medication error in patients treatment. Obtaining statistics of medication errors can be difficult, since nurses delay in reporting their errors in order to protect themselves from patients reactions and possible penalties from administration (Swansburg, 2002). Studies have indicated that despite the myriad advantages and the moral basis for detection, errors reporting has not yet improved in nursing (Green, 2004).

The rates of wrong medication dose in nursing are high in both developed and developing countries. According to research, most of the medicinal complications are due to medication errors. Previous research has shown that annually, thousands of people die due to such errors. The financial costs that arise from medical complications have been increasing every year. Drugs taken inappropriately can impose additional hospitalization costs due to negative medicinal effects and failure to receive the required medication. Lack of proper archiving, reporting systems and absence of registration data system makes it hard for the third world country to keep an accurate number of medication errors (Green, 2004). Determining the type of error gives the first step in errors prevention. From nurses point of view, evaluation of cause and types of medication error is important.

Sources of Errors

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Wrong dose of medication and adverse drug reactions can occur from multiple sources (Wayne, 2005). They may be related to order communication, professional practice, health care methods, products and systems, including prescribing, dispensing, product packaging, labeling and nomenclature, administration, distribution, patient education, as well as health care professional, compounding and monitoring of use (Aspdenet al., 2006). Most medication errors result in death or permanent harm. Some causes are either preventable adverse drug events or potential adverse drug events depending on whether there was the injury (Green, 2004).

Reasons for Underreporting of Medication Errors

The nurses inability to recognize errors occurs due to disagreement over error definition. Nurses also believe that errors do not warrant reporting as a result of fear for their reputation. Moreover, they fear disciplinary actions and embarrassment. Wrong reporting time and confusing reporting mechanism, methods and policies also play a significant role in medication errors.

Factors Contributing to Errors

It is critical to identify common factors that contribute to wrong medication for the development of viable solutions aimed at improving patient safety in healthcare. Moreover, fundamental flaws and design faults should be taken into account.

Organizational responses to address these contributing factors in healthcare have been occurring slowly. According to Aspen et al.(2006), medication errors can be reduced through various ways, they include ensuring proper trading, patient engagement, standard operating procedures and guidelines, medication safety and effective communication. Other contributing factors that are likely to be ignored include fatigue, anxiety, negligence and haste.

Classifying and understanding these contributing factors can be a complex task (Green, 2004). The final study needs to be made available to experts, as well as to all healthcare workers. High risk organizations accept that errors can and will occur, so they have internal systems that are ready to deal with the errors. They know when to promote the culture that does not accept error, when to request for outside assistance and also realize that the first impression in any error is often misleading.

Communication

The key to patient safety is an effective communication. A suggestion in the cause analyses review is that a wrong dose of medication is a result of poor communication. Therefore, effective communication is essential to managing an incident, once it has occurred. There are the following two types of communication in the healthcare setting: the one between the patient (and family member) and a healthcare worker and the other is between one healthcare worker and the other. Each has different elements that can result in medical errors (Aspdenet al.,2006).

Fishbone Diagram of Wrong Dose of Medication

The fishbone technique is one of the tools used in cause effect analysis.

 

Communication Between Healthcare Workers and Patients

The interaction of patient and healthcare worker is complex. The complexity is caused by change in expectations. Traditionally, patients were accustomed to a healthcare worker as to paternalistic and dogmatic. Nowadays, patients usually look to their nurses to help them navigate through a complicated system and expect information to be based on shared decision-making. However, the model is correct at all times. The appropriate information model depends wholly on the particular situation.

Various forms of communication may be used during an interaction between a patient and a nurse. In nonverbal communication, healthcare workers body language to the patient has been considered important in the way the patients interpret the information they are given (Swansburg, 2002).Verbal communication, on the other hand, shows the differences between how patients perceive the transfer of information and how healthcare workers assume their communication. There are several factors that contribute to communication significantly. One is the ability of patients and nurses to communicate in similar language. Providing patients with interpreters is not only better for them but also cost-effective. Professional interpreters are accurate in passing information. However, they are costly and not always available. Patients would rather have family members as a second-best, whereas nurses seem to prefer using telephone interpretation (Aspden et al., 2006). Communication plays an imperative role in medication error preventing. Enhancing the quality of communication among nurses and between patients and nurses can help prevent errors. Secondly, good communication is necessary when dealing with errors, which have occurred.

Patient Engagement

Patients expect and hope that nurses will provide them with appropriate and safe care. Providing and receiving health care is an act of partnership and trust between patients and nurses. Involving patients in their care process is one of the ways of providing safer care. Involving individual patients to prevent errors should be encouraged and organizational patient engagement should be done to reduce errors and help understand the causes of harm (Green, 2004). The uniqueness of patients perspective is formed due to the fact that the whole pathway of care providing is seen by patients and, for this reason, it is important, in which way care is delivered and communicated to them. Patients can become involved in making health care safer in many ways (Green, 2004). First of all, such patients are those who are better informed about their condition and treatment through the provision of information on their diagnosis and the treatment options available. Patients and their families should be supported to report safety concerns whenever they occur, by talking to dedicated and trained staff or through formal reporting systems (Wayne, 2005). Having a relative or friend present, can support patients in understanding the decisions made and realizing who can be an advocate for safety on their behalf if they are anxious, unwell or confused. Patient advocacy and patients rights organizations are set up to work with healthcare organizations to promote safer care.

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Barriers to Patient Support

Patients are often reluctant to participate because they feel unauthorized to do so. Patients are often not aware of the health care dangers and, as a result, greater awareness of patients security is needed at international, national and institutional levels. Errors can occur in the healthcare setting and patients should be informed that their support can help reduce hazards (Aspdenet al., 2006). However, the most effective way to educate patients remains to be determined. It will probably necessitate a combination of verbal and written information, reminders and incentives. Patients are becoming engaged with local healthcare organizations, nationally and globally. Promoting open and honest relationships between healthcare workers and patients will create forums for dialogs and effective mechanisms to build safer healthcare systems. Healthcare workers must embrace the concept of patient engagement. Each caregiver and the whole healthcare system must openly support and encourage their participation (Swansburg, 2002).

Ensuring Proper Training

Patient safety as a topic is largely absent from healthcare education, demonstrating the low priority given to safe patient care. Safe care for patients can only be optimized if healthcare workers receive the right training and are helped to keep up-to-date with knowledge (Swansburg, 2002). Such situation represents a deeper system failure, which has two main components: failure to address patient safety education in training, as well as a failure to ensure the competence of healthcare workers through regular and up-to-date training and assessment (Wayne, 2005)

Patient Safety Education

Among other high-risk industries, rigorous security procedures and hundreds of training hours are established to prevent harm to human life. The implementation and development of patient safety as a core curricular matter would result to provision of a framework for secure practice during a clinicians professional presence (Green, 2004).

Human factors

The field of human factors concerns the interaction between humans and the system, in which they operate. Training in non-technical skills has been shown to be vital to reducing errors in other industries. However, human factors training, which exists within medical education and validation of competency are critical components to improve patient safety (Aspden et al.,2006). All healthcare workers must be competent to deliver safe care and their organization must have mechanisms to check it. Education needs to be broadened to include explicit patient safety topics, such as social factors and methods and simulation designed to create a generation of healthcare workers.

Medication Safety

Harm from negative drug events occurs all over the world. It is believed to account a quarter of all medical errors.

Causation of Errors

Doctors handwriting can be awful (Green, 2004). Sometimes written medical records are the only means healthcare workers have to communicate with each other. Medical records need to be clear and unambiguous. They need to provide an accurate way of conveying important information. When the written information concerns drug dosages it is very significant (Wayne, 2005). Changes in delivery timings and modifications of the current regime occur often as well. But medical records are not kept up-to-date and in addition to illegibility, transcription can also be problematic. These are the causes of many adverse drug events (Aspdenet al.,2006).

Medication reconciliation seeks to establish what medications a patient should receive in a formal record to prevent communication breakdowns. At the local level WHO recommends that a complete list of medications is kept for each patient, which is provided at every care transfer and includes hospital and over the counter medications, specifies the timing, dose and route and matches the patients actual habits.

It is likely that involvement of the patient in the medication reconciliation process would help reduce adverse drug events significantly.

The high prevalence of adverse drug events, the extent of harm and the presence of viable solutions, all make the reduction of injury in this area imperative and urgent goal. Strategies of medication reconciliation at the local level and organizational policy implementation, regarding procurement another drug-related issues, should remain high on the agenda. The most pressing issues of the patient safety agenda are the medication safety.

Standard Operating Guidelines and Procedures

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A standard operating procedure (SOP) can be defined as protocols that give details on how a certain procedure should be performed every time it is carried out. SOPs are a daily feature of many high-risk industries. Often, there has been resistance to the adoption of SOPs and their uptake in medicine has been disappointingly slow. Barriers to SOP use include the fear that clinical autonomy will be reduced and it will cause lack of familiarity with guidelines, not believing that they will help, and lack of motivation to change practice. Yet, SOPs provide a real opportunity to make care significantly safer (Swansburg, 2002). A common criticism of SOPs deals with reduction of clinical decision-making. SOPs are not designed to turn health care into a production line. Instead, SOPs provide a stable basis, particularly suited to high-risk practices and areas, on which clinical excellence may flourish. It has been demonstrated that following SOPs are not linked to error. Harm caused by committing the wrong action or omitting to perform the necessary action can be reduced by the presence of SOPs. SOPs give patients the opportunity to identify their care pathways and to play a part in areas, such as medication safety. Moreover, it aids in learning and contributing to the daily functioning of high quality healthcare system (Green, 2004). Good leadership and the development of systems to support SOPs are needed to help for their implementation.

Root Cause Analysis

When error occurs, the customary focuses on blaming the individual caregiver overlooking the conditions, in which the error occurred. The opportunity for the organization to learn how to make its environment safer is missed. Human error cannot be eliminated from the clinical setting. Systems can be designed to help individuals avoid errors and minimize their harmful effect (Green, 2004).

The cause analysis is the analysis of all the factors that have a potential to prevent systematic errors. It can be applied to incidents, in which harm was caused to the patient (Aspden et al., 2006). Organizations can use cause analysis both to explain how the incident occurred and to design mechanisms to prevent it from happening again.

Technique Used in Problem Solving

Hospital can customize medication error tracking form in conjunction with other resources to highlight particular medication safety issues. It helps to facilitate the collection of data on medication errors in an organization. It can be used in ordering, dispensing and administering medication. To ensure that medication errors are categorized and tracked uniformly, the forms should be reviewed by people who understand the medication process. Such people should be chosen from quality assurance, pharmacy, hospitals risk management, therapeutic committee or pharmacy department delegated for summarizing data to the oversight committee (Swansburg, 2002). The data collected through medical tracking form can be used to implement the intervention to prevent medication errors. The tracking form should be an ongoing process for improvement of hospitals performance or continuous quality improving activities. The organization will be equipped to identify and monitor errors and prevent them.

Conclusion

The supportive culture and approach, which is patient-centered, will motivate healthcare professionals to report medication errors timely. Moreover, on-going incident of reporting schemes, implementation of error reduction strategies and rewards to nurses who report errors should be encouraged. Severity index should be used for categorization of the medication errors. The point prevalence as per medication usage tools and use of software programs for medication tracking will promote patient safety and allow a reduced error rate (Wayne, 2005).

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