Disclosure of adverse medication events to the patient - Essay Example

Disclosure of Adverse Medication Events Dispensing medicines is a risky task and medication errors are common in nursing profession, especially in critical care nursing. 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, especially when the event has to be disclosed to the patient and his family.

It is often difficult to quantify medication administration errors which are the most common medical errors in any health care set up. However, only less than 5 percent are reported (Trieber and Jones, 2010). The Institute of Medicine (cited in Trieber and Jones, 2010) has recognized medication 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.

According to CNO (2008), "nurses are accountable for ensuring the accuracy, appropriateness and completeness of a client’s plan of care in regards to medication order(s), and for communicating concerns about the treatment plan to other members of the health care team. 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).

According to a study by Treiber and Jones (2010), nurses are willing 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 demands, high work load, multiple medications and useless and complicating technologies. Nurses make sense of their errors and reflect upon such incidents which contributes to learning beyond rumination. Thus, though nurses are accountable for the medication errors done by them, the errors occur due to work load and other factors.

They however find it an emotional turmoil to disclose aspects related to medication errors. References Bates, D.W. (2007). Preventing medication errors: A summary. Am J Health Syst Pharm ., 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. CNO. (2008). Medication, Revised. Retrieved on 16th May, 2011 from http://www.cno.org/docs/prac/41007_Medication.pdf . 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.