Medication Errors

Medication error is a failure in the treatment process that causes, or has the potential of causing harm to the patient. These errors may be experienced when making the decision on the medicine and the dosage regimen to use. Monitoring errors may also occur due to failure of changing the therapy when required or making incorrect alterations (WHO, 2016). Medication errors are amongst the major health threatening mistakes that affect patient care. These mistakes have been indicated as global problems that hikes the mortality rates, length of hospital stay, and other medical related costs. While the medication error may be caused by any member of the healthcare team, nursing medication errors are the most prevalent. The reason behind this is due to the fact that the nurses are responsible of executing the medical order and approximately 40% of their time in spent administering the drugs (Cheragi, Manoocheri, Mohammadnejad, & Ehsani, 2013).

Causes of Medication Errors

Among the most common causes of medication errors is unsafe acts. These are actions related to individual acting without adhering to the established framework. The unsafe acts may include slips, lapses, mistakes, and violations. Slips and lapses are the most common. Slips mainly relate to the misidentification of the medication or a patient (Keers, Williams, Cooke, & Ashcroft, 2013). Other commonly experienced slips and lapses include misreading of either medication label, prescription, or other medical documentation. It has been observed that staff at time confuses the look-a-like or sound-a-like medication names, patient names and medication packages thereby leading to medication errors. The slip and lapses may occur as a result of mental status such as lack of concentration, complacency, and carelessness (Keer et al. 2013). The slips and lapses may also be associated with work issues such as being busy or distracted, heavy workload, or job-related pressure. The other form of unsafe acts includes the knowledge and rule-based mistakes. These are experienced when the staff fail to understand the information about the medication that they were administering, the infusion pump being used, or about the patient being administered to. Violations that commonly cause medication errors include situational violation that emerge due to poorly designed protocol or lack of staff. The violations are caused by factors such as trusting senior colleagues, acting on the patients’ interest through seeking to avoid harm or optimize treatment, poor supervision, intentional administering of medication either early or late (Keer et al. 2013).

The medication error may also be caused by factors related to the patient. These include logistical issues related with delivery of the medication caused by lack of, difficulty with, or delays waiting for intravenous access(Keer et al. 2013). This in most cases leads to wrong route being used, deterioration of medication, omission, wrong time, or compatibility issues.

Medication errors may also be caused by ward-based equipment which are used to facilitate the drug administration. the factors considered here may include insufficient equipment, malfunctioning equipment, ambiguous equipment’s. Other factors that may be related to equipment either directly or indirectly may include problems with the drug charts due to their inaccessibility or distractions in the workplace environment (Keer et al. 2013). 

Effects of Medication Errors on the Lives of Patients and Healthcare Providers

Medication errors affects the patient safety to a large extent. These errors often lead to preventable adverse drug event. The occurrence of medication errors is increased by the fact that medication is carried out by human beings who are vulnerable to error and thereby inevitable to total avoid mistakes. Medication related errors have been noted as the most common source of morbidity and mortality among the patients. The occurrence of the medication error increases the economic burden due to increased length of stay and accumulated healthcare cost (Walsh, Hansen, Sahm, Kearney, Doherty, & Bradley, 2017). The patient’s health may deteriorate due to the effect of medication errors. 

When medication errors occur, the healthcare providers involved are the second victims. These providers may experience shame, guilt, and self-doubt. The second-victim syndrome among the providers may be life-threatening from the guilt, emotional burnout, and psychological distress experienced from the event. These reason makes some providers fail to inform the patients of the occurrence of the medication errors. Pham et al, in a study found out that only about 3% of healthcare professionals informed their patients about a medication error (2011). The provider may also face a legal battle for negligent act thereby imposing extra emotional pressure. 

Strategies recommended by ACSQHC to Reduce the Medication Incidents

To reduce the occurrence of the medication errors, the NSQHS standards advocate for the establishment of safety and quality systems that are meant to be adhered to when implementing the policies and procedures for medication management, dealing with potential risks, and training of the appropriate staff on training requirements. In reference to this, the NSQHS recommends that the facilities should apply already established safety and quality systems to support policies and procedures, risk management, and training of medication management, and ensure that the current versions of the appropriate policies and procedures are made available to clinicians for them to refer to where necessary. 

Another strategy that may be used to reduce the medication errors is on clinical performance and effectiveness. Here, healthcare facilities need to ensure that they maintain personal professional skills, competence, and performance. There should be an established framework for monitoring personal clinical performance. Healthcare facilities needs to set up systems for the supervision and management of junior clinicians. There should be a well described framework through which specific performance concerns are reported and responded to promptly. The healthcare facilities should also promote teamwork among the clinical teams  (Australian Commission on Safety and Quality in HealthCare, 2017).

Role of Nurses in Reducing the Occurrence of Medication Errors

The nurses may be engaged in the process of medication review and medication. This is a process where the patients’ medicine is reviewed and evaluated with an aim of improving the health outcomes and mitigate on the drug related issues. The review should include the nurses, pharmacists and other clinicians. It has been indicated that pharmacist-led medication reviews contribute to reduction in hospital admissions (WHO, 2016).

The nurses have a key responsibility in ensuring growth in education. Enhancing education level has been found to lead to an improvement in the prescription and dispensing of medicines. This is likely to have a positive impact on the behavior of the nurse in adherence to the guidelines (Roque, Herdeiro, Soares, Rodrigues, Breitenfeld, & Figures, 2014). 

Conclusion

Medication error is a failure in the treatment process that causes, or has the potential of causing harm to the patient. The most common causes of medication errors include unsafe acts. Such as slips, lapses, mistakes, and violations; patient related factors, and ward-based equipment. The occurrence of the medication error increases the economic burden due to increased length of stay and accumulated healthcare cost. When medication errors occur, the healthcare providers involved are the second victim and may experience shame, guilt, and self-doubt. Strategies to reduce medication errors may include establishing of clinical governance within a healthcare facility and promoting on clinical performance and effectiveness. The nurses have a key responsibility in ensuring reduction of medication errors. They achieve this by continuous education and engaging in medication review.

References 

Australian Commission on Safety and Quality in HealthCare. (2017). Clinical Governnance for Nurses and Midwives. Retrieved from http://nationalstandards.safetyandquality.gov.au/sites/default/files/files/media/Clinical-governance-for-nurses-and-midwives.pdf

Cheragi, M. A., Manoocheri, H., Mohammadnejad, E., & Ehsani, S. R. (2013). Types and causes of medication errors from nurse’s viewpoint. Iranian journal of nursing and midwifery research18(3), 228.

Keers, R. N., Williams, S. D., Cooke, J., & Ashcroft, D. M. (2013). Causes of medication administration errors in hospitals: a systematic review of quantitative and qualitative evidence. Drug safety36(11), 1045-1067.

NSQHS. (n.d.). Medication Safety . Retrieved from http://nationalstandards.safetyandquality.gov.au/4.-medication-safety

Roque, F., Herdeiro, M. T., Soares, S., Rodrigues, A. T., Breitenfeld, L., & Figueiras, A. (2014). Educational interventions to improve prescription and dispensing of antibiotics: a systematic review. BMC public health14(1), 1276.

Walsh, E. K., Hansen, C. R., Sahm, L. J., Kearney, P. M., Doherty, E., & Bradley, C. P. (2017). Economic impact of medication error: a systematic review. Pharmacoepidemiology and drug safety26(5), 481-497.

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