Medication Errors - from the Nursing Perspective - Research Paper Example

?Medication errors - from the nursing perspective Introduction and Purposes “Medication errors are typically defined as the deviations from a physician order.” (Mayo and Ducan, 2004). There are many sources which are identified as the major triggers of medication errors. These include illegibly written prescriptions, dispensing errors, calculation errors, etc. Among the above cited errors, some of the errors are considered to be most crucial and they have considerable impact on the patients, for example, the monitoring errors and the administering errors. To compress in a nut shell, it can be described as the wrong medication to the patients. This is where the role of nurses comes under scrutiny, as nurses could act as a major contributing factor for the occurrence of medication errors. Generally diagnoses of the diseases are carried out by the physicians with the aid of other medical personnel, including lab technicians. Monitoring the status of the patients and providing them with the right medicine as prescribed by the physicians at the right time frames is the basic and the essential task of the nurses. Moreover the medication errors are nurse-oriented, as they attend to each and every need of the patients, and are in direct contact with the patients, everyday. Hence they need to have accurate details about the medication given as well as the timings of drug delivery and perfect monitoring of the patients. When they fail to perform their duties in relation to drug delivery, it could end up in medication errors. Some of the major medication errors that will be focused in this paper include the following, Over dosage of the medicine, or the route of administration Failure to prescribe or administer the exact drug to the patients Lack of observation – failure to observe the correct time of administration, this may be due to the difficulties in understanding the prescription and confusion about the different drugs which has similar names. These are some of the errors which can cause lethal effects to the patients such as drastic physical complications affecting various parts of the body, and in extreme cases coma or even death in some patients. Recent studies reveal that “Ten to 18 percent of all reported hospital injuries have been attributed to medication errors.” (Mayo and Duncan, 2004). “Of the approximately 44,000 –98,000 patient deaths reported each year because of medical errors, 7,000 were attributed to medication” errors. (Stratton et al., 2004). These statistical data would back up the fact of the lethal effects caused by medication errors caused by the nurses. Hence, this paper will discuss the issues related to the medication errors, which are issues related to nursing, direct and indirect impacts on the health care policy, statistical data to support the issue and other implications for future nursing practices. Medication errors related to nursing A patient who comes to a healthcare facility can be treated optimally only if proper diagnosis is made, and importantly correct drug therapy is prescribed and carried out. However, “drug therapy cannot be successful unless, and until, both the prescribing and medication delivery processes are conducted correctly.” (Flynn et al., 2002). During this prescribing and delivery process, there are many chances of error creeping in, with all the healthcare personnel including physicians, technicians, nurses, etc., liable for it. They could do some minor or even major error, and that could contribute to major problems for the patient, themselves and to the healthcare facility. However, the issue with these medication errors is that many errors go undocumented and unreported. This perspective was validated by Flynn et al. (2002), who stated “errors resulting in serious harm are reported because they are easy to identify and hard to conceal, yet they represent the "tip of the iceberg",” with many errors intentionally or unintentionally concealed by various players. Among the various players or healthcare personnel involved, the nurses have high chances of committing medication errors. “Every step in patient care for a nursing professional involves a potential for error and some degree of risks to patient safety.” (Bailey et al.,). In general most of the medication errors are associated with nursing. As already discussed, nurses directly deal with the patients, and they attend to the day to day activities of the patients than the physicians and other technicians. Preparing of the drug delivery and the administration of the medicines are the two major processes, during which the nurses play a sizable part and during which only medication errors can occur. This perspective was validated by Stratton et al. (2004) who stated, “medication errors occurs more commonly in the early stages of medication processing (prescription and preparation), whereas errors originating in later stages of the process (administration) have fewer system checks and are at a greater risk for remaining undetected”. During both these processes, medication errors can occur due to various reasons or mistakes on the part of the nurses. Firstly, the nurses could misunderstand or miscalculate in regards to the prescription documents. This reason was pointed out by Deans (2005) who stated, errors could occur when nurses misunderstand abbreviations, misplace decimal point, misread and misinterpret written orders. Stratton et al. (2004) adds some other nurse centric mistakes that could lead to medication errors and they are “distractions and interruptions during medication administration, illegible medication orders, incorrect dosage calculations, and similar drug names and packaging health.” Thus lack of proper understanding about the medicines on the part of the nurses can lead improper treatment and tragic repercussions. From the above focus on the medication errors, it is obvious that nurses forms the crux in medication errors. When the factors that cause the nurses to commit these mistakes and the related medication errors are focused, it provides varied perspectives. The key factors that makes or even pushes the nurses to commit the medication errors is their lack of knowledge and importantly impaired mental state caused by stressing work schedules. This point was put forward by Deans (2005), who states “several human factors were attributed to potential causes of medication errors, including: stress, fatigue, knowledge and skill deficits.” In addition, the recent studies have revealed the fact that the quality of the nursing education could also be a factor in medication errors. The other factors like “training deficiencies, undue time pressure and nursing shortages” also contribute to medication nurses on the part of the nurses. (Bailey et al., n.d). Lack of training to the nurses regarding the new drugs and also about the old drugs could also lead to medication errors. This point was validated by Deans (2005) who stated that “further training in medication administration would positively impact on their nursing practice.” Thus, the quality of the syllabus and the duration of the training are the root causes which can lead the nurses to commit the medication errors. “Direct results include patient harm as well as increased health care cost.” (Mayo and Duncan, 2004). From the above statement it is obvious that a wrong medication given to a patient can lead to further inflation of the health care costs including their personal costs, which will ultimately add more burdens to the patients. More than the costs, when viewed from the perspective of the patients, it can lead to can cause further physical and mental complications, which will deteriorate their health. On the other hand, the indirect effects can be explained in relation to the nurses, as their professional status and their career path can be disturbed due to these sorts of blunders on their part. They could loose their source of livelihood, their self confidence, could even become mentally depressed and unfortunately can be made legally liable for any tragic eventualities. “Decisions made in situations of medication errors have moral implications at personal, institutional, and professional levels.” (Amdt 1994). Implications of the future nursing practices “All nurses in an organization may need help in identifying what is a medication error, when to report it, and to whom.” (Mayo and Duncan, 2004). This implies that nurses irrespective of their experience level need to focus on maintaining the safety of the patients, by reporting all the unintentional as well as intentional medication errors. Above all, most of the hospitals are emerging with the patient safety program which includes the error-reporting component. This allows the nurses to report their mistakes on time so that corrective measures can be taken as early as possible. The other health care policies related to the issues would encompass the system –oriented and the critical thinking aspects that are being implemented in most of the hospitals all throughout the world. The results of various studies “indicate the need to improve the accuracy of medication error reporting by nurses and to provide a hospital environment conducive to preventing medication errors from occurring.” (Stratton et al., 2004). Under this concept all the errors made by the nurse should be submitted to the higher level so that the organizations have an opportunity to improve their patient’s safety programs effectively. As mentioned earlier, the other issue is how the external factors like distractions and interruptions could disrupt the nurses to correctly administer the drugs, leading to medication errors. In those scenarios, it is left to the hospital managers and other administrators to review the work environment, and optimize it. “Designing safe work environments at the unit level that reduces environmental stressors such as noise and lighting while improving overall structural organization of the unit” can surely facilitate better output by the nurses. (Stratton et al., 2004). Some of the technologies that can be utilized to overcome the medication errors includes the following “Computerized Physician order entry (CPOE), automated dispensing machines (ADMs), bar coding, and computerized medication administration records.(CMARs).” (Oren, Shaffer & Guglielmo, 2003). Summary and Conclusion The issue of medication errors has been prevalent from the days, when the field of pharmacology developed and with the development of various drugs. Dosage of the medicine, route of administration and the monitoring of the patients are some of the vital roles played by the nurses. Right medicine at the right time in a right way should be the main responsibility of the nurses. When they fail to perform this role promptly, it ends up in health complications for the patients, problems for the physicians and the hospital management and importantly major problems for the nurses themselves. Moreover, they should be able to admit their mistakes and inform the physicians, so that they can initiate the corrective measures to save the lives of the patients. Thus, if the nurses exhibit optimal responsibility and take utmost care while delivering the drugs to the patients, with the aiding role played by the hospital management, then the medication errors can be totally eliminated or even minimized appreciably. Reference: Amdt, M. (1994). Nurses' Medication errors. Journal of Advanced Nursing 19 (3): 519-526. Bailey, G. C., Engel, S. B., Luescher, N. J. & Taylor, L. M. Medication Errors In Relation To Education And Medication Errors In Relation To Years of Nursing Experience. Volume 3. Retrieved from: http://www2.lagrange.edu/resources/pdf/citations/nursing/Medication%20Error s.pdf. Deans, C. (2005). Medication errors and professional practice of registered nurses. Collegian 12 (1): 29-33 Flynn, E. A., Barker, K. A., Pepper, G. A., Bates, D. W. & Mikeal, R. L. (2002). Comparison of Methods for Detecting Medication Errors in 36 Hospitals and Skilled-Nursing Facilities. American Journal of Health-System Pharmacy 59 (5). Mayo, A.M. & Duncan, D. (2004). Nurse Perceptions of Medication Errors: What We Need to Know for Patient Safety. Journal of Nursing Care Quality 19 (3): 209- 217. Oren, E., Shaffer, B & Guglielmo, B.J. (2003). Impact of Emerging Technologies on Medication Errors and Adverse Drug Events. American Journal of Health- system Pharmacy. 60(14):1447-58 Stratton, K. M., Blegen, M. A., Pepper, G and Vaughn, T. (2004). Reporting of Medication Errors by Pediatric Nurses. Journal of Pediatric Nursing 19 (6): 385-392. Read More