Any Type of Medication Errors - Essay Example

Medication Errors Introduction: Bohomol and Ramos, 2006, define medication or drug errors as a blanket term that covers “any type of error in the prescription, transcription, dispensing and administration process, which lead to serious consequences or not”. In the United States of America it is estimated that medication or drug errors is responsible for mortality in seven thousand patients every year. Nursing professionals are mainly and deeply involved in the administration process, and as such are involved in medication or drug errors. Medication errors are not restricted to administration requiring higher skills like the intravenous route, but occur even when medications are administered through the simpler non-intravenous route (Ghaleb et al, 2006). Literature Review: Tang, Sheu, Yu, Wei, and Chen, 2007, report that among physicians, pharmacists and nurses, who make up the chain of healthcare professionals involved in the use of drugs for therapeutic reasons, the contribution of nursing professionals to medication errors is high, even though they are only involved in the administration of the drugs. They fall back on a multidisciplinary committee analysis of 441 medication errors in a hospital in the United Kingdom. The report of the committee showed that nurses were responsible for twenty-two percent of these errors and that twenty-five percent of these errors were medication errors. The authors provide additional information on the background of the nursing professionals involved in medication errors. More than ninety percent of medication errors occurred after graduation from a nursing school, with more than thirty percent of the errors occurring in nursing professionals, who had graduated in the previous year. The average length of work experience was found to be 2.2 years with a plus or minus error of 0.7. More than half of these errors occur in large teaching hospitals or medical centers, while 36.1% of the errors occurred in regional hospitals and 12.5% in local hospitals. The more significant medication errors within a hospital were the intensive care units and the medical wards. Data on the break up of the types of errors is also provided. Wrong dose makes up the highest percentage of medication errors at 36.1%, followed by wrong drug at 26.4%. The other types of medication errors involved were wrong time at 18.1%, wrong patient at 11.1%, wrong route 8.3%. Wrong administration of antibiotics made up 38.9% of the medication errors. The medication errors regarding the administering of electrolytes were 8.4%, analgesics 6.9%, anti-diabetics 6.9% and all other drugs 38.9% (Tang, Sheu, Yu, Wei & Chen, 2007). The frequency of medication errors as a result of administration errors by themselves are alarming, and it becomes even more critical, when consideration is given to the fact that drug administration errors are under reported. Thus a true picture of the involvement of nursing professionals in medication errors cannot be made in a proper sense. This is more so because most drug administration errors are recorded mostly in inpatient hospital settings. There is not much recording and relevance given to medication errors that occur in other settings like outpatient clinics, nursing homes, ambulatory surgical centers, and home health care. However, there are indications of this from the figures of 3 to 50 adverse drug events for every thousand patients in outpatient settings. Yet another fact that tends to reduce the incidence of drug administration errors and the involvement of nursing professionals is that recording of medication errors concentrates on acts of commission, which is wrong doing, but not in acts of omission by not providing the required medication to the patient, when it has been ordered by the physician. Such acts of omission can have fatal consequences particularly in emergency settings, where failure to provide the required beneficial effects of the required drug could lead to severe morbidity or mortality. Even so there is seldom recording of acts of commission. Thus a more comprehensive list of drug administering errors includes the lack of administering of the required drug in addition to the acts of commission through wrong drug, wrong dose, wrong patient, wrong regimen (frequency of administration, timing of administration and duration), wrong route of administration, allergic reaction, drug interaction (with another drug, with food given and with other therapies), failure to follow appropriate drug administration policies, and failure to follow instructions specific to the drug administered (Hughes and Ortiz, 2005). A recent study by Maricle, Whitehead, and Rhodes, 2007, provides a more precise and detailed account of medication errors from a nursing perspective. The study was based on direct observation after informing the nurses and assuring them of confidentiality. In this manner administration of 1514 doses of medication was directly observed across three units, consisting of a medical intensive care unit (MICU), a cardiac step-down unit and a behavioral health unit, during both day and night shifts. The overall rate of drug administration errors was 4.9%, with an almost even spread of errors across the three units (MICU 4.7%, cardiac step-down unit 5.2% and behavioral health unit 4.7%). However the study observed a variance in the type of errors that occurred in the three units. The most frequently occurring error in the behavioral health care unit was wrong timing in drug administration, while in the cardiac step-down unit it was wrong technique in administration, and omission or failure to provide the required medication. In the MICU unit the predominant error occurring in the administration of medication was wrong technique. These observations suggest that as the criticality of the unit enhances and the sophistication in drug administration, there is an elevation in the use of wrong technique in drug administration by nurses, which has implications on the more complex drug administration skills of the nursing professionals. Though not statistically significant more errors were observed in the day shift (7.8%) than in the night shift (5.9%), and the authors felt that this aspect needs deeper investigation for better understanding of nursing involvement in medication errors (Maricle, Whitehead & Rhodes, 2007). There are several factors that contribute to medication errors including distractions, the lack of focus, and failure to follow standard protocols in the administration of medications. Pape et al, 2005 examine the factor of distraction on medication errors and the means to address it, as any nursing unit faces the possibility of several interruptions and distractions at critical times of administrating medications that have a negative impact on their working memory and their ability to focus on the task at hand. Modern health care settings is a demanding place for nursing professionals, making them more prone to errors, when we take into consideration the nature of the working environment, and the numerous and complex functions handled by the nursing professionals. More so with the several advances in science and technology that is being witnessed. In such a complex environment it is not easy to predict the course of events and develop a set of controls to address the issue of medication errors, but it is essential to improve the quality of nursing practice and reduce the consequences for patients. The study borrows from the highly technical and demanding environment of the airline industry to create a strategy that employs teamwork, decision for support, and checklists to address the problem of medication errors among nursing professionals. Based on the findings, the study has made recommendations to reduce medication errors in its conclusion that include the need to empower nursing professionals to speak up for themselves and discourage unwanted interruptions in the processes involved in obtaining and administering medications, and the creation of a protocol checklist and signage on nursing units so that there is enhanced focus levels and reduced distractions among the nursing professionals. Such simple strategies are useful among the nursing workforce that is stressed due to staff shortage and helps in reducing medication errors (Pape, et al, 2005). Discussion: The literature review makes it very clear that the involvement of nursing professionals in medication is on the higher side than I had considered earlier. It also shows that the lack of focus on the task at hand has led to errors even in simple drug administrations, like giving oral medications to patients, and not just the more technically complex drug administration routes like intravenous drug administration. However wrong techniques in drug administration increases, as the sophistication in drug administration increases. Several factors are responsible for the high level of medication errors by nursing professionals and not the least the distraction that they face in their work, which can be addressed through empowering nurses to discourage such distractions and the creation of protocol checklists and signage on nursing units. In my opinion the significant factors that also help in reducing medication errors involve an increased knowledge of medications, their pharmaco-dynamics and pharmaco-kinetics, and the skills and techniques required for administering drugs, even when they are sophisticated and require complex administering techniques. Literary References Bohomol, E. & Ramos, L. H. (2006). Perceptions about medication errors: analysis of answers by the nursing team. Revista latino-americana de enfermagem, 14 (6), 887-892. Ghaleb, M. A. Et al. (2006). Systematic Review of Medication Errors in Pediatric Patients. The Annals of Pharmacotherapy, 40 (10), 1766-1776. Hughes, R. G. & Ortiz, E. (2005), Medication Errors: Why they happen, and how they can be prevented. Journal of infusion nursing, 28 (2): 14-24. Maricle, K., Whitehead, L. & Rhodes, M. (2007). Examining Medication Errors in a Tertiary Hospital. Journal of Nursing Care Quality, 22, (1), 20-27. Pape, M. Tess. Et al. (2005). Innovative Approaches to Reducing Nurses’ Distraction During Medication Administration. The Journal of Continuing Education in Nursing, 36 (3), 108-116. Tang, F., Sheu, S, Yu, S., Wei, I. & Chen, C. (2007). Nurses relate the contributing factors involved in medication errors. Journal of Clinical Nursing, 16, 447-457. Read More