Dispensing Medicines Is a Risky Task - Essay Example

Medication Errors: Devastatingly Human Dispensing medicines is a risky task and medication errors are common in nursing profession. Camire et al (2009) opined that medication errors are the most common errors in nursing profession and they account for 78 percent of serious medical errors in the critical care unit. The technicality, complexity and the chaotic working atmosphere of nurses make nurses more amenable to medication errors. Nurses are taught that administration of medication is an individual responsibility and that the blame for administering wrong medication is on the individual who has administered the drug. According to Camire et al (2009), "given the large body of literature about patient safety, the limited evidence available to guide clinicians in selecting strategies to prevent and disclose medication errors in critically ill patients is surprising. Nevertheless, patient safety is a first step in providing high-quality health care, and ensuring the safety of patients is everyone’s responsibility and challenge." Since administration of accurate medication is the most embedded principle of nursing; any event of medication error jeopardizes the livelihood and identity of the professional self. Trieber and Jones (2010) analysed the medication error accounts of registered nurses through direct interview with them in order to facilitate better understanding of the perceives error of medication administration errors and to understand strategies employed by the nurses to deal with them. It is often difficult to quantify medication administration errors which are the most common medical errors in the United States. However, only less than 5 percent are reported (Trieber and Jones, 2010). The Institute of Medicine or IOM has recognized medication administration error as an important target task and has attempted to study and analyze various aspects of environment of the nurses which contribute to errors. This included work design, organizational management and organizational culture. However, the institute failed to include certain aspects of nursing profession like perfectionism, self-sacrifice and duty and also issues related to gender and recent technologies. The institute also did not include the perceptions of nurses who are the frontliners in administration of medication to hospitalized people. This is important because; it is these nurses who are involved in both preventing medication errors and committing medication errors and nurses are emotionally affected when they commit a medication error. The main strategy to prevent medication error is by following the basic principle of "five rights"; right patient, right time, right route, right medication and right dose (Bates, 2007). There is no consensus on the definition of medication error and as to when the error must notified. While most nurses opine that giving wrong medication to a patient is wrong, only a few agree that giving the medication late is also wrong. Thus, discrepancies exist in the definition. Thus, if the rights definition is applied, the number of medication errors would actually escalate more than the estimated number (Trieber and Jones, 2010). Several error reduction technologies have come up which are said to help in decreasing medication errors. These include patient charting through computers, arm-bands that are bar coded, and dispensing cabinets that are automated (Bates, 2007). Other strategies to reduce medication errors include decrease in the number of medicine which look alike or sound alike and application of read back and confirm strategy for orders that were delivered verbally (Trieber and Jones, 2010). There is still controversy as to whether these strategies and procedures introduced to reduce medication errors actually help in reduction or errors or complicated the problem. Some researchers like Koppel et al (2008; cited in Trieber and Jones, 2010) are of the opinion that these recent gadgets actually confuse the nurses and worsen medication errors. Infact, in their study, they found that computerized order entry worsened error chances. In another study by Murray et al (2001; cited in Trieber and Jones, 2010), automated dispensing systems made nurses wait in line for medications and wasted their time. Thus, the recent technologies just relocated the source of error and did nothing to decrease the error and made nurse dependent on technologies for error prevention; thereby becoming less careful themselves unintendedly (Trieber and Jones, 2010). Several other researchers opine that technology is indeed one of the potential solutions to medication errors, but with problems. This is because; technology comes in between patient and nurse. Also, nurses feel that their labor is controlled by technology. Also, since many technologies are actually high tech and need skilled labor to operate them, it has resulted in discordance between nurses, gender and technology. This is because nursing is a predominant female discipline and females do not much embrace technology (Trieber and Jones, 2010). Two important strategies which have been used to improve scientific efficiency are taylorism and scientific management, but many researchers consider these as double-edge swords. While on one side, these liberate the nurses from the drudgery of menial tasks and allow them to focus on professional aspect of patient care; on the other side, they can make health care work like industrial shop floor with less professional judgement. Technology is actually considered as an inefficient substitute for discretion and knowledge (Trieber and Jones, 2010). This is a retrospective study of descriptive nature. The analysis mainly aimed in this study is the thematic analysis. This is suitable for the purpose of the study. The study was based on the responses that came from the open-ended survey questions which were mailed to a random sample of registered nurses of the state. The basic survey included demographics of the respondent and 20 multiple open-ended survey questions which were administered to the nurses. At the end of the survey, th nurses was asked if she made an administration error. If the answer to this question was "yes", the nurse was directed to another set of questions. The study was conducted after gaining approval from the University concerned. Consent to participate was determined by the return of survey. Even online answering option was provided. The names of the participants was kept confidential. From the responses to the questions and descriptions of the experiences provided by the nurses, transcribtion of the handwritten accounts was made using word processor program The analysis of data was made based on Benners interpretive model. Data analysis was based on identified key themes that were identified systematically. Finally, the data was converted to common themes in the accounts. The response rate to the survey was 8.2 percent. 6 symbolic themes were identified from the nursing accounts provided. In the study by Treiber and Jones (2010), nurses were asked to to share their perceptions of medication errors committed by them. The study was conducted in the form of open-ended survey questions which were mailed to some registered nurses selected through randomization. From the results of the study, six common themes were noted based on the accounts made by the nurses. In the first theme, nurses admitted to taking responsibility for medication errors, but they identified extraneous contributing factors simultaneously. In the second theme, the theme was mainly related to inexperience of the nurse which caused the medication error. In the third theme, irrelevant to the severity of the error, the reponses from the nurses were emotionally devastating and this theme was infact common. In the fourth theme, fear was present. In the fifth theme, nurses opined about frustration pertaining to regulations and technologies. In the final theme, nurses accounted "lessons learnt" from the medication error committed and developed their own personal rules to prevent recurrence of such errors. Based on these themes and accounts of nurses who have committed medication errors, the researchers suggested improvement in nursing practice, education and health care quality (Trieber and Jones, 2010). The researchers of the study concluded that nurses are williong to be responsible for the medication errors committed by them. However, several concurring circumstances make them prone to commit such errors. Such such circumstances include multiple demnds, high work load, multiple medications and useless and complicating technologies. Based on these facts, the authors concluded that nurses make sense of their errors and reflect upon such incidents which contributes to learning beyond rumination. Because of this, the nurses were able to account for their errors and continue to nurse. Thus, knowledge of the various accounts of medication errors can help prepare the nurses for threat of their identity and professionalism. References Bates, D.W. (2007). Preventing medication errors: A summary. Am J Health Syst Pharm July 15, 2007 64:, S3-S9. Camire, E., Moyen, E., and Stelfox, H.T. (2009). Medication errors in critical care: risk factors, prevention and disclosure. CMAJ, 180 (9), 45-52. Treiber, L.A., and Jones, J.H. (2010). Devastatingly Human: An Analysis of Registered Nurses Medication Error Accounts. Qualitative Health Research, 20(10), 1327- 1342. Read More