Critical Analysis of Medication Errors - Case Study Example

Introduction The case of a 55 year-old patient with heart failure in the community is not unique. Medication error has been presented as a significant challenge among healthcare practitioners and paramedic practice is not exceptional to the issue. The family, the patient, and the paramedic are now affected by the consequences of medication errors. As the practice and scope of paramedic practices becomes wider so does the instances of a possible medication error. A paramedic mistakenly pushing 4 milligrams of intravenous norepinephrine instead of the intended lookalike vial of 1 milligram of bumetanide shows that there is need for development of proactive strategy to alleviate such incidences. Central to this point is to ascertain three critical aspects. First, the essay evaluates quality system perspective to the specific error committed by the paramedic. Secondly, there is need to assess medication errors from the standpoint of the contributing system and human errors within the premise of the case provided. At the moment, studies such as Vilke et al. (2007) recognize that medication errors involve route, dose, concentration, medication and treatment. Based on these parameters, the assessment provides a need for paramedics to be aware of their self-guided commitment when it comes to clinical practices so that drug delivery, contraindications, dosage calculations and drug administration can be done accurately. Errors made by the paramedic in the scenario The scenario presents a case where the paramedic engaged in a number of errors. It is apparent that what was presented to the paramedic was look-alike confusion between norepinephrine injection vials and bumetanide injection vials. The paramedic without checking committed first error by administering wrong drug. Rittenberger, Beck and Paris (2005) note that practicing paramedics often carry a large number of drugs some which look-alike. Ampoules for instance, are often difficult to distinguish. It is for this reason that wrong vial was taken and administered. LeBlanc et al. (2005) discussed these system factors in their field research where paramedics conducted their operations and concluded that 20 percent of self-reported errors occurred as a result of wrong drug administration which was attributed to look-alike situations. While wrong drug administration can occur as a result of factors such as labeling errors or syringe swap, the scenarion was a case where the paramedic offered wrong drug as a result of incorrect ampoule. Secondly, the case presents a situation where the paramedic made an error in administering the drug by the wrong route. Lammers, Willoughby-Byrwa and Fales (2014) found that in most cases, it is expected that paramedics will administer medications via a number of routes such as nebulized, oral, sublingual, endotracheal tube, intramuscular, interosseus, intravenous and intranasal. However, we have to recognize that the drugs in question (norepinephrine and bumetanide) may often be indicated for use through different routes. The paramedic in this scenario ought to have noted that the choice of route was to depend on how a 55 year-old patient with heart failure in the community presented himself. Pushing 4 milligrams of intravenous norepinephrine instead of vial of 1 milligram of bumetanide conceptualizes a case where paramedics administer drugs by wrong route. Research on administrations of drugs by the wrong route has been conducted indicating how prevalent this error is among paramedics. While researching on 3,273 paramedic operations in different parts of United States and Australia Mostafaei et al. (2014) noted that errors related to administration of drugs via the wrong route account for about 10 percent to 15 percent of the total errors paramedics make. This finding indicates that what the paramedic did in this scenario remains uncommon errors among other errors likely to be committed. However, Mostafaei et al. (2014) indicated that drugs that paramedics are supposed to be administering via multiple routes are likely to be involved in route related errors. Contributing human and system error factors in the scenario Basing on recent data released by American National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP), one of the contributing human error as well as system error factor is medication package labeling misreading or failure to read labels especially when drugs are packaged in look-alike containers (Cousins and Heath, 2008). Summers (2013) took a case study on 30 different cases attended by paramedics from different organisations and noted that labeling misreading or failure to read labels of look-alike containers accounted for at least 45 percent of all human contributing error factors. The fact that Summers (2013) reported that 9 out of 30 patients died as a result of this error indicates how prevalent the factor has been contributing to instances of medication errors. Another research conducted in Malta investigated paramedics’ perception regarding medication errors (Chan et al. 2015). The finding showed that 41 percent of the sample attributed package labeling misreading or failure to read labels as factor behind the error. This is contributing human error factor that is linked to this case. There is clearly look-alike confusion between norepinephrine injection vials and bumetanide injection vials not because both drugs have been made by Bedford Laboratories but because they can easily confuse practicing paramedic especially those working under stress or exhaustion. It is for this reason that the paramedic in this scenario mistakenly pushed 4 milligrams of intravenous norepinephrine instead of bumetanide. This situation also amounts to system error as the paramedic was presented with two confusing medications from manufacturers having the same bottle but different names. Evidence-based researches that have been concerned with pre-hospital paramedic self-reported medication errors have noted that lack of medication calculation skills or poor medication calculations among group of practicing paramedics is a contributing error factor (Mostafaei et al., 2014). While basing their data on Helicopter Emergency Medical Service Paramedic Mostafaei et al. noted that about 20 to 30 percent of paramedics will find the types of computations involved in the calculations to be difficult, not to mention the link between calculation of drugs and different demographic. Mostafaei et al. finding is in tandem with a demographic research survey as well as a twenty-item drug calculation observation that were administered to a convenience study sample of 120 practicing paramedics who represented emergency medical services (EMS) in North Carolina (Cousins and Heath, 2008). The study concluded that at least 30 percent of the total sample pooled recorded errors in their calculations. While this findings is not applicable to this scenario it presents one of such errors that contribute to other scenarios that have been reported before. The process and systems actions to improve patient safety and prevention The first process and system is administration of the right drug. Evidence-based studies have documented that while practicing, paramedics carry a large number of drugs needed for administration and in such settings there comes a situation where these drugs have similar labeling appearance in plastic ampoule form (Cousins and Heath, 2008). While this case represented norepinephrine and bumetanide another example can be a case of atropine as a 1.2mg or a 600mcg presentation. To control such situations introduction of design layout having only the ampoule tips that one can view would be necessary. In such situation, the chances of using incorrect vial for administration will be limited especially when the paramedic is unfamiliar with the layout of the kit or confuses the presented drugs. For general understanding and for prevention of related medication errors, there is need to administer the drug to the right patient. Studies have documented instances where paramedics administer drugs to wrong patients as a result of interruptions, distractions or workload related stress (Summers, 2013). This solution is related to instances where paramedics administer wrong dose. As noted by Chan et al. (2015) administration of the right dose is one way of improving patient safety and preventing a similar error. In as much as this case did not manifest wrong dosage administration, researchers have found that at least 51 percent of paramedics often administer wrong dosage as a result of wrong drug calculations especially under stressful emergency settings. The third process and systems action related to this scenario is administration of drugs by the right route. The choice of route should be made depending on presentations made by the patient, the drug required and prescriptions given about the drug. Conclusion This study sought to critically analyse a clinical scenario to understand different medication errors in paramedic practice and strategies that can be used to improve patient safety and prevent errors presented in the case. Based on research findings, we conclude that medication errors among paramedics will occur; to remedy, there is need to develop system of reporting that entail participation by paramedics as this will be essential in reduction of pre-hospital medication errors. It is important to note that as paramedics’ scope of practice widens evidences that are specific to pre-hospital setting remains elusive. Therefore paramedics will be required to develop their specific self-guided allegiances to clinical practice. It is essential that the central point of their professional performance entail a commitment to reflective personal examination as well as keeping the doctrine of ‘above all, do no harm!’ References Chan, E., Taylor, S., Marriott, J., & Barger, B. (2015). Exploration of attitudes and barriers to bringing patient’s own medications to the Emergency Department: A survey of paramedics. Australasian Journal of Paramedicine, 6(4). Cousins, D. D., & Heath, W. M. (2008). The National Coordinating Council for Medication Error Reporting and Prevention: promoting patient safety and quality through innovation and leadership. Joint Commission journal on quality and patient safety/Joint Commission Resources, 34(12), 700. Lammers, R., Willoughby-Byrwa, M., & Fales, W. (2014). Medication errors in prehospital management of simulated pediatric anaphylaxis. Prehospital Emergency Care, 18(2), 295-304. LeBlanc, V. R., MacDonald, R. D., McArthur, B., King, K., & Lepine, T. (2005). Paramedic performance in calculating drug dosages following stressful scenarios in a human patient simulator. Prehospital Emergency Care, 9(4), 439-444. Mostafaei, D., Marnani, A. B., Esfahani, H. M., Estebsari, F., Shahzaidi, S., Jamshidi, E., & Aghamiri, S. S. (2014). Medication errors of nurses and factors in refusal to report medication errors among nurses in a teaching medical center of Iran in 2012. Iranian Red Crescent Medical Journal, 16(10). Rittenberger, J. C., Beck, P. W., & Paris, P. M. (2005). Errors of omission in the treatment of prehospital chest pain patients. Prehospital Emergency Care, 9(1), 2-7. Summers, A. (2013). Human factors within paramedic practice: the forgotten paradigm. Journal of Paramedic Practice• Vol, 2(9), 425. Vilke, G. M., Tornabene, S. V., Stepanski, B., Shipp, H. E., Ray, L. U., Metz, M. A., ... & Harley, J. (2007). Paramedic self-reported medication errors. Prehospital Emergency Care, 11(1), 80-84. Read More