Medication errors are one of the most common causes of patient morbidity and mortality. Then there is the financial burden on the institution and the legal ramifications. While the impact varies from no harm to advanced side effects and death, the issue deserves lots of attention because it can be prevented. Over the years, the individual effort has carried the weight, but recent evidence proves that medication errors are complex and multifactorial. The role of allied health and healthcare professionals in enabling medication errors is increasingly becoming known, indicating the need to improve those fields in the fight against the issue. Often, a medication error is irreversible. If the error happened in a vulnerable patient population, such as those in ICU or undergoing surgery, then its impact may not be realized until it is too late. Therefore, everyone involved in medication errors, from the manufacturer to the bodies regulating the entry of pharmaceuticals in healthcare, pharmacists, doctors, nurses, and the organizational culture needs to play their role in preventing the issue. Otherwise, playing blame games will only enhance the problem, which is against the purpose in which healthcare facilities were created— to provide safe, high-quality, and appropriate care.
Keywords: medication errors, medication safety, medication administration
Annotated Bibliography: Medication Errors
The identified healthcare problem is medication errors. This issue is significant because it negatively affects nurses. The institute of medicine (IOM) reports: To Err is Human and Crossing the Quality Chasm, established that medication errors are a severe issue in healthcare. While the causes are multifactorial, the two reports indicated that nurses are responsible for optimal patient safety because they are bedside care providers where most medication errors occur. More so, patient and clinical outcomes reflect the nursing practice within that organization. Because medication errors are one of the leading causes of deaths in the US, it, therefore, follows that nurses need to step up and find effective ways of managing the issue. I have also heard some of my practicing friends talk about near misses and how medication errors exacerbated certain conditions to near death. Therefore, I would also like to enhance my knowledge of medication errors; hence, the purpose of conducting this research.
Search Criteria
The databases used in this study was PubMed. Settings were adjusted to 2015/09/25 to 2019/12/31 and free full text. The keywords, medication errors AND medication safety, AND Medication administration were used. The search returned 355 results out of which three were selected. A similar search was conducted on Wolters Kluwer database for the fourth article where 170 results were obtained. Only the most relevant article was chosen.
Selection Criteria
Peer-Reviewed
All articles must be peer-reviewed and published in a credible journal. In peer-reviewed journal articles, experts in the field review the studies before publication to ensure that the investigation is scientifically valid, the methodology quality is high, and there are reasonable conclusions. Peer-reviewed articles have a Digital Object Identifier (DOI) that shows the material has been standardized as per the International Organization for Standardization (ISO).
Purpose of the Article/Study Population
The goal of my research was to explore medication errors. However, there are numerous studies in the field, but very few studies focus on a particular study population or niche. Therefore, the purpose of the scholarly study was the primary inclusion and exclusion criteria. The objective must be unique, with defined outcome measures, justifiable sample sizes, and tools. For instance, the study by Dhawan, Tewari, Sehgal, and Sinha (2017) focused on medical errors in anesthesia, which is very different from Schmidt, Taylor, and Pearson’s (2017) focus on IV and other fluid medications. It is widely known that most medication errors occur at the administration site where bedside nurse work. Therefore, there was a need for a study that focused on nurses’ side of the story concerning medication administration errors, hence the inclusion of Armstrong, Dietrich, Norman, Barnsteiner, and Mion (2017). These differences allowed me to explore the expanse of medication errors without over considering one aspect and disregarding the other.
There was also a need for an article that studied the root of medication of errors often disregarded by most researchers. I felt it would be essential to include a study that removed the blame from the nurses, precisely one that spanned other causes of medication errors. Cohen (2016) was a perfect fit. The credibility of his work lies in the source of information—report errors, close calls, and hazardous conditions, as reported to the Institute for Safe Medication Practices (ISMP).
The Credibility of the Authors
After passing the first two requirements, the next step was to assess the reliability of the writers. Accredited practitioners or educators with PhDs and other doctorate degrees, in addition to experience with the issue at hand, was a desirable quality. Authors writing in association with accredited departments or bodies such as a hospital, medical center, and university were also helpful because the associations increased the credibility of the study, particularly data collection. All the studies included in this bibliography satisfied this need. For instance, Cohen is the president of ISMP, Dhawan works with the Department of Anesthesia, PGIMER, Chandigarh, India, and Armstrong is an associate professor and at the University of Colorado College of Nursing.
Annotated Bibliography
Armstrong, G. E., Dietrich, M., Norman, L., Barnsteiner, J., & Mion, L. (2017). Nurses’ Perceived Skills and Attitudes about Updated Safety Concepts: Impact on Medication Administration Errors and Practices. Journal of Nursing Care Quality, 32(3), 226–233. doi:10.1097/NCQ.0000000000000226
This study evaluates the perceived skills and attitudes of bedside nurses’ concerning updated safety concepts and their impact on medication administration errors (MAEs) and adherence to safe medication administration practices. Therefore, the study covers MAEs and the human factors enabling or preventing the mistakes from occurring. Findings indicated that MAEs are an interplay of system, unit, and nurse-level factors. The researchers established a relationship between reporting errors with the ability to analyze one’s mistake, discussing it, and reporting at the microsystem level. The researchers also found that the level of perceived skills needed to implement updated safety practices was directly related to the accuracy of medication administration. The higher the interpersonal belief, the higher the efficiency. The researchers concluded that there is a need for more expanded assessment of nurses’ perceived skills and attitudes in safety practices to identify result-giving strategies on reducing MAEs and improving adherence to established practices.
This study will inform on the medication errors occurring at the bedside due to nurses’ errors. For years, nurses have carried the burden of medication errors. This study will help the researcher understand why this is so, and what can be done to improve nurses’ role in facilitating safe medication practices.
Cohen, M. (2016). Medication errors (miscellaneous). Nursing, 46(2), 72. doi: 10.1097/01.NURSE.0000476239.09094.06
The purpose of this article is to discuss the most common yet disregarded sources of medication errors and how they can be resolved. The covered areas include the roles of seals, labeling, and packaging in enabling medication errors. The authors start by establishing the manufacturer’s seal as a source. Healthcare providers are advised to always confirm the integrity of the seal before dispensing. Pharmaceuticals can also use tamper-resistant stickers to help providers distinguish between used and unused drugs. Another source of medication errors is the pharmacist’s label that conceals the bar code, thus preventing the information from being read and confirmed during drug processing. This oversight facilitates the wrong drug to the right patient type of error. The authors also establish that look-alike drugs can confuse providers, leading to medication errors. Therefore, healthcare facilities should isolate such products and find a different manufacturer for one of them. Pharmaceutical companies also facilitate medication errors through difficult to read drug labels. The FDA should ensure that drugs reaching the healthcare facilities have proper labelling.
Few studies focus on these seemingly small aspects of medication errors. Therefore, this article will establish that medication errors are multifactorial. While the dispensing provider is responsible for asserting the right drug, right dosage, right frequency, right channel, and proper patient, allied health and healthcare professionals also have important roles in reducing medication errors.
Dhawan, I., Tewari, A., Sehgal, S., & Sinha, A. C. (2017). Medication errors in anesthesia: unacceptable or unavoidable?. Revista Brasileira de Anestesiologia, 67(2), 184-192. doi: 10.1016/j.bjane.2015.09.006
The purpose of this review was to examine medication safety when administering drugs to anesthesia patients. The topics covered include medication errors, incidence and history, and practices that counter their occurrence in the identified population. Findings indicate that anesthesia medication errors have an incidence level of 0.33% to 0.73% for fifteen years. Results on the history of medication errors show that wrong medication was the most prevalent (48%), tailed by overdose (38%), and incorrect administration route (8%). Syringe swap resulted in 42% of the administration route errors, medication ampoule swap (33%), and wrong drug choice (17%). Dose misunderstanding or preconceptions resulted in 53% of a drug overdose.
Another aspect covered was the legal ramifications of preventable medication errors. Preventable medication errors are the number three killer in the USA, claiming 400,000 lives annually. From 1995-2007, the healthcare system lost about £4,915,450 in cases filed under anesthesia directly related to errors in drug administration, including allergic reactions. A further £4,283,677 was from alleged medication administration errors. In all claims where human error was the cause, alleged or otherwise, the researchers found that the double-checking process could have prevented less than 50%. Several operations were provided to counter medication errors at the system, unit, and individual level with the integration of electronic methods as the most recommended game changer. For instance, every anesthetizing location needs to have a barcode reader to identify the medications before drawing up or administering, and an automated information system to provide feedback and support on medication. The study concludes by positing that its high-time digital concepts were implemented to reduce medication errors in anesthesia patients.
The study is critical because of its unique anesthetized patient population. These patients are the most vulnerable owing to the fact they might not be able to report or respond to medication errors until it’s too late. Therefore, the study is vital in understanding how such a population should be dealt with for safe medication administration.
Schmidt, K., Taylor, A., & Pearson, A. (2017). Reduction of medication errors: a unique approach. Journal of Nursing Care Quality, 32(2), 150-156. doi: 10.1097/NCQ.0000000000000217
The purpose of this study was to identify the critical steps needed to reduce medication errors without significantly changing the nursing practice. The areas covered were the intravenous (IV) and other fluid medications. The sociotechnical probabilistic risk assessment (ST-PRA) tool was used to review five years of reports on medication errors. The researchers also used a focus group to study the disparities between organizational policies and actual policies, system vulnerabilities, and medication processes. The findings provided 11 recommendations, five of which were most significant. These are, verifying steps in the EHR, double-checking, using better armbands and bar code scanning, reducing clamped lines, and simplifying the medication administrations for consistency and adherence. From the results, the 3Cs, connection, clamps, and confirming clamps were identified.
Upon implementation of the 3Cs in a follow-up pilot study, the 3Cs reduced medication errors by 22%. Researchers concluded that more research is needed on the effectiveness of 3Cs. However, their preliminary study showed positive results indicating that nurses can try the 3Cs to reduce errors associated with administering IV and other fluid medications. Relatively few studies focus on IV medication errors and how they can be prevented. Therefore, this article will provide knowledge of why and how IV medication errors occur, and the role of human error on the same.
Summary
In recent years, nurses have received much of the blame concerning medication errors. The assumption is understandable because they are the most primary care providers at the bedside, where most medication errors occur. However, one of the most remarkable point the studies have established is that medication errors are complex and multifactorial. There are human errors, system aspects, such as active channels of reporting errors, and the individual personality. Then, is the role of allied professions and professionals, such as pharmaceuticals and pharmacy, in enabling these errors. According to my Cohen (2016), medication error often starts from the manufacturer and FDA to pharmacists and prescribing nurses. Therefore, preventing medication should be corrected in all facets that impact their occurrence.
Another interesting finding was the nurses’ personality in preventing or enabling medication errors. According to Armstrong, Dietrich, Norman, Barnsteiner, and Mion (2017), nurses with perceived skills implement safety practices better than those who do not believe in their capabilities. This indicates that confidence plays a significant role in healthcare delivery. Therefore, I will endeavor to practice with confidence because my thoughts impact my actions. The wheel on error reporting in the review article has also helped me visualize and understand medication errors (Dhawan, Tewari, Sehgal, & Sinha, 2017). This knowledge is critical because of lack of clarity on what medication errors constitute and their reporting is a significant problem in healthcare (Armstrong et al., 2017; Dhawan et al., 2017; Schmidt, Taylor, & Pearson, 2017).
References
Armstrong, G. E., Dietrich, M., Norman, L., Barnsteiner, J., & Mion, L. (2017). Nurses’ Perceived Skills and Attitudes about Updated Safety Concepts: Impact on Medication Administration Errors and Practices. Journal of Nursing Care Quality, 32(3), 226–233. doi:10.1097/NCQ.0000000000000226
Cohen, M. (2016). Medication errors (miscellaneous). Nursing, 46(2), 72. doi: 10.1097/01.NURSE.0000476239.09094.06
Dhawan, I., Tewari, A., Sehgal, S., & Sinha, A. C. (2017). Medication errors in anesthesia: unacceptable or unavoidable?. Revista Brasileira de Anestesiologia, 67(2), 184-192. doi: 10.1016/j.bjane.2015.09.006
Schmidt, K., Taylor, A., & Pearson, A. (2017). Reduction of medication errors: a unique approach. Journal of Nursing Care Quality, 32(2), 150-156. doi: 10.1097/NCQ.0000000000000217
