Prescribing, Transcribing, Dispensing, and Administering of Medications - Literature review Example

The processes of prescribing, transcribing, dispensing, and administering of medications are essential parts in the provision of health care. Drugs and other types of medications must be delivered efficiently and effectively so that people seeking for medical care will be provided relief and be liberated from their medical condition they are suffering with. Nevertheless, each one of the involved processes is prone to several gaps and lapses in between which make them more vulnerable to medication errors (MEs). These events in turn eventually result to patients’ unnecessary deaths and injuries which should not be. MEs, indeed, comprise one of the negative issues overwhelming the medical world today. It is not new anymore but is still uncontrollably happening—which had urged and is continually urging many to uncover some facts that surround it through research. Such researches have heralded attention not only from the people engaged in the provision of care but also from its recipients and from the rest of the world to see whether proposed actions by the researchers can be efficiently applied and make used of. The research paper done by Bohomol, Ramos, and D’Innocenzo (2009) entitled “Medication errors in an intensive care unit” is one of those researches focused in the subject of medication errors in a specialized unit—the intensive care unit (ICU). In this paper, their research will be subjected to fair evaluation to enable analysis of its applicability and practicability to the medical field and work. Specifically, the paper will assess the research’s effectiveness based on its research design, data collection, validity, reliability, data analysis, certain ethical considerations and other important matters that will give rise to its importance or worthlessness. With due respect to the researchers’ capability to conduct thorough research process, this paper will also try review the research’s outcome competency in relation to the goals that the researchers have formulated. As reported by Creswell (2003), the purpose statement of a research “establishes the direction for the research” (p. 87). Hence, it is from the purpose statement that researchers formulate key points that must be considered throughout the study. Bohomol et al. (2009) clearly iterated their research rationale by simply stating that the research was done to investigate the “incidence types and causes of medication errors and the consequences for patients” (p. 1259). It was straightforward and direct to the point; it will be able to give its readers the idea on what to expect and what can be learned after reading the paper. The background of the study was likewise clear. Utilizing the research design chosen, the study was founded well on significant literature sources. The presentation and arrangement of the review of literature that they have done was systematic as the researchers first concentrated on wide-scale knowledge and then narrowed it down to their scope of interest. They did so by presenting how health care provision was affected by MEs both inside and outside Brazil since the first time the data of the consequences of MEs was established, what their effects were, and how they would have been easily prevented. In the later part, the researchers then focused on the records of studies about MEs occurring in ICUs and why such areas have become more prone to MEs. The researchers were indeed resourceful in using reliable studies and sources conducted in the past. On the contrary, the facts were not as comprehensive so as to present related issues and identify the gaps that are not yet known. There was also, in contrast to its importance, notable absence of theoretical framework that the researches supposedly must have used of in determining “essential concepts and gaps in the literature that will help drive the research design and show the importance of the research” and to outline a more organized process that they should have had been able to follow (Slack & Parent, 2006, p. 20). The researchers used an exploratory, quantitative survey design in the making of the research paper. This design was rooted from two separate yet somehow frequently-used together designs: the exploratory research design and the quantitative survey design. Berkowitz (2004) described the exploratory research as a design that allows researchers to see the basic idea and viewpoint that the problem presents to be able to understand what is at hand (p. 137). It puts a subject under thorough investigation to establish a more workable concept from a complex one (Dorf, 1999, pp. 12-78). According to Mertler (2006), conversely, a quantitative survey design “involves acquiring information from individuals representing one or more groups—perhaps about their opinions, attitudes, or characteristic—by specifically asking the questions and then tabulating their responses” (pp. 71-72). It enables the researchers to explain the facts about the subject by collecting, analyzing and interpreting the numerical data. The utilization of an exploratory research design in the conduction of the study was deemed useful as the research paper was able to present the nature and impact of medication errors in the practice of medicine throughout all the areas. There, the influences and effects of MEs in hospital cases in the past as what others have observed and have conducted researches with were presented in addition to what has been found out after the whole course of the study. Based on the information presented by the past research papers, the researchers were able to find out that there are only “few conducted researches in Brazil about MEs in the ICUs” (Bohomol et al., 2009, p. 1260). The quantitative survey design, on the other hand, provided valuable assistance to the researchers as they had been able to collect relevant data needed in determining cases of medication errors in the ICU. However, even though the research was able to obtain and present ample data on the number of medication errors the ICU patients have had to experience in the duration of their hospital stay, there still seems to lack important aspects of the conflict that were not catered as the survey only yielded results from a limited scope of sources. In a book, Rabbie (2010) indicated that the “distinction between quantitative and qualitative data in social research is essentially the distinction between numerical and non-numerical data” (p. 23). Basically, it is much easier if the basis was just this. However, this assumption can occasionally be misleading. As emphasized by de Vaus (2002), this statement is not applicable at all times (p. 6). Non-numerical ways of gathering information such as surveys in the form of interviews which most of the time gives a narrative or written form can also give researchers access to numerical data (Mertler, 2006, p. 103); in the same way, quantitative data can also become “measures of some quality” (Rabbie, 2010, p. 24). In research, data collection strategies will be considered useless without the use of proper sampling method which must be both valid and practical for the researchers and the type of research done. Sampling, to Lake and Harper (1987), is a “systematic selection procedure and in most cases requires obtaining a list which covers the population” (p. 68) that needs to be considered in a research procedure. Samples are selected through various ways as research theories project. At the same time, the data from the chosen samples are also collected in various ways. It is made possible through observation, written or narrative questionnaires, and further research on literatures available in print or non-print sources. This sample then provides “statistical data on an extensive range of subjects” (Kalton, 1993, p. 5). The researchers identified all the inpatients of the intensive care unit during the study as the participants of this survey-type research. They additionally noted the participation of staff nurses, nursing aides, physicians, and medical transcriptionists—all of whom have direct control and dealing on what and how drug reaches the bodily systems of all the patients in the ICU. Notably, the researchers did not exactly point out specific sampling method used in choosing the participants and samples for the paper. Based on the available facts, though, it can be assumed that they have chosen to use convenience sampling method. As suggested by the name, it is a method of selecting samples by which a researcher “selects participants on the basis of proximity, ease-of-access, and willingness to participate” (Urdan, 2005, p. 3). Additionally, the researchers identified three strategies of collecting the data needed which may give insights about the medication errors that have been and are being committed while the study is being conducted. They pointed out the use of anonymous self-reports, staff interviews and review of patient records. Anonymous self-reports were collected through a box that serves as the bank for the nursing staff’s accounts of medication errors. Staff interviews, on one hand, were done daily along with reviewing the patients’ medications and prescription records. In the end, the nurse investigators put altogether all the collected data into analyzable form and made appropriate interpretations from it. All of these processes enabled the researchers to collect quantitative data related to the identified purpose of the study. Essentially, every research paper must achieve maximal reliability and validity to serve its purpose. Key (1997) defined validity and reliability as “the degree to which a test measures what it is supposed to measure” and “the extent to which the instrument yields the same results on repeated trials” respectively. Due to the research design and limited data collection methods and strategies used, the result of the research paper conducted by Bohomol, Ramos and D’Innocenzo may be biased—which can actually affect its reliability and validity. As what Curwin and Slater (2008) had stated, bias can be a result of inappropriate or “stereotyped” statements, and survey design (p. 659). The use of convenience sampling in the research paper in question may add up to its unreliability and invalidity simply because of the fact that not all of the people involved in each of the process of prescribing, transcribing, dispensing and administering of medications to the patients contributed to the research. It is to be noted that the investigators emphasized that only the nursing staff—which deals primarily in the process of medication administration--has played much role in reporting the committed medication errors. The population included in the study does not in actuality stand for all the significant population that affects the delivery of medications. Hence, the errors in prescribing, transcribing and dispensing of the medications are not known. This further proves the inadequacy of the research paper to represent the totality of medication errors in the intensive care unit in that studied hospital. Yet, the research cannot be judged as null and void since it still paved way to the realization that in conducting researches, data collection must use more consistent method and be improved to prevent underreporting of any mishap incidents. Also, there must be multidisciplinary collaboration from the different department staff to gain a fuller and clearer picture of the true situation in the practice of medicine with regard to medication errors (Bohomol et al., 2009, p. 1266). It is undeniable that ethical issues still continue to exist in the making of research papers concerning any population despite presence of research ethics committees. These committees primarily exist to provide protocols to prevent and control minute or most importantly, substantial dilemmas concerning ethical issues in the different field of research studies. For this reason, the researchers and investigators must put to mind the importance of bearing the basic ethical principles of autonomy, beneficence, and justice in every aspect of the research process (Streubert Speziale, & Carpenter, 2007, p. 62). Autonomy, as defined by the Merriam-Webster Online Dictionary, is the “quality of being self-governing” and having “moral independence (“Autonomy,” 2010); and justice is the “quality of being just, fair and impartial” (“Justice,” 2010). Beneficence, moreover, is the “act of doing good or kindness” and doing no harm (“Beneficence,” 2003). As per mentioned in the study, the “appropriate ethics and governance committees” were able to give their approval for the researchers to undergo all the research process that were needed to complete the paper (Bohomol et al., 2009, p. 1261). This further demonstrates that the ethical and governance committees saw no deficiency in the reported research process that can result to harm and unequal treatment of individuals involved that will be requested to collaborate with the researchers before the study was even started. In spite the absence of stated potential risks [or maybe they just really did not see any potential risk], the agencies and committees in the area and the institution involved supported the conduction of the study. The investigators additionally stressed that proper consent were asked by letting the participants sign the informed consent forms together with the action taken to orient the several departments of the hospital about the steps of the investigation (Bohomol et al., 2009, p. 1261) and had maintained the anonymity of the participants by not mentioning their name. They also promoted the principle “do no harm” by preventing probable harmful situations that came across their awareness throughout the duration of the study. Finally, this research promotes better practice of the medicine and nursing profession by making the errors known. With this knowledge, the medical and nursing staff, the pharmacists and all of those have the “say” on the delivery of the correct drugs to the patients not only in the institution involved but for other concerned populations too are encouraged to improve their services that they provide to those who need it. Although the study of Bohomol, Ramos and D’Innocenzo only include a single institution in Brazil, it does however still benefit others by pointing out what can be done to improve the state of medication errors in the field of health care. Errors in medication is one vital aspect that can put the medical, nursing and other related professions into potentially substantial threat as they likely harm instead of giving relief to those who depend on them. Bearing in mind the fundamental features of what a research should be, research has an unquestionable positive effect in the improvement of professional health care practice by applying and making use of newly discovered facts. References Autonomy. (2010). In Merriam-Webster Online Dictionary. Retrieved from http://www.merriam-webster.com/dictionary/autonomy Beneficence. (2003). In Collins English Dictionary—Complete and Unabridged. London: HarperCollins. Berkowitz, E. N. (2004). Essentials of health care marketing. Sudbury, MA: Jones & Bartlett Publishers, Inc. Bohomol, E., Ramos, L. H., & D’Innocenzo, M. (2009). Medication errors in an intensive care unit. Journal of Advanced Nursing, 65 (6), 1259-1267. Creswell, J. W. (2003). 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