Bedside Medication Administration: A Case Study

Each year, roughly 1.5 million adverse drug events (ADEs) occur in acute and long-term care settings across America (Institute of Medicine [IOM], 2006). An ADE is succinctly defined as actual or potential patient harm resulting from a medication error. To expound further, while ADEs may result from oversights related to prescribing or dispensing, 26-32% of all erroneous drug interventions occur during the nursing administration and monitoring phases (Anderson & Townsend, 2010). These mollifiable mishaps not only create a formidable financial burden for health care systems, they also carry the potential of imposing irreversible physiological impairment to patients and their families. In an effort to ameliorate cost inflation, undue detriment, and the potential for litigation, a multifactorial approach must be taken to improve patient outcomes. Key components in allaying drug-related errors from a nursing perspective include: implementing safety and quality measures, understanding the roles and responsibilities of the nurse, embracing technological safeguards, incorporating interdisciplinary collaborative efforts, and continued emphasis upon quality control.

According to the Food and Drug Administration (FDA 2009), the wrong route of administrating medication accounts for 1.3 million injuries each year. An article published in September issue of the Journal of Patient Safety estimates there are between 210,000 and 400,000 deaths per year associated with medical errors. This makes medical errors the third leading cause of deaths in the United States, behind that comes heart disease and cancer. To prevent medical errors always follow the Three Checks and most importantly the Rights of Medication Administration. The “Rights of Medication Administration” helps to ensure accuracy when administering medication to a patient. When administering medication the administer should ensure they have the Right Medication, Right Patient, Right Dosage, Right Route, Right Time, Right Route, Right Reason, and Right Documentation. Also remember the patient has the right to refuse, assess patient for pain, and always assess the patient for signs of effects.

Improved patient safety is the most essential advantage of the BCMA system. “On average a hospital patient is subjected to at least one medication error per day (IOM, 2006)”(Foote). BCMA significantly reduces medication errors that cause a compromise in patient safety. The BCMA verifies the five rights of medication administration before a patient receives a medication by the software alerting the nurse if there is a contraindication between the medicine scanned and the patient’s orders. A pilot study conducted at a 300-bed community hospital found that the BCMA system reduced medication errors by 80% (Foote). Fowler et al states that “decrease in errors related to the wrong patient was a direct result of the bar code system (Fowler).”

Hospital acquired infections (HAIs) affect over 1.7 million patients each year, causing almost 100,000 deaths annually in the United States alone (Johnson, 2010). According to the World Health Organization, HAIs are the most frequent adverse event in the healthcare industry. Fortunately, most of these infections can be prevented with one single intervention, proper hand hygiene (“The Evidence,” n.d.). Four out of five pathogens that cause illness are spread by direct contact. Proper hand hygiene eliminates these pathogens and helps to prevent cross-contamination and HAIs (Linton, 2015; “Hand Hygiene,” n.d.). Reduction of cross-contamination and HAIs improves patient outcomes, increases employee wellness, and lowers health care costs. Adherence to proper hand hygiene is the single most important safety measure in the health care setting. However, for many years compliance to proper hand hygiene in the healthcare industry has been dismally low. New and inventive measures must be implemented to increase compliance to proper hand hygiene and lower the rate of hospital-acquired infections.

Non care setting - Medications are often stored and administered in a variety of non-health care settings. These settings include: primary and secondary schools, Child day care centres, Board and care homes, Jails and prisons. In all these settings, employees frequently are responsible for handling and administering prescription and over-the-counter medications to clients or residents. Some organizations may employ licensed health professionals to directly manage the medication administration process. However, many of these settings have no licensed health professionals involved. Where medications are stored and administered to individuals, written policies and procedures should address the following: Acquisition of medications (e.g., from parents, caregivers, pharmacies), Specification of which personnel are allowed access to medications and allowed to administer medications to students, clients or residents, Labelling and packaging of medications managed for students, clients

Administration of medicines is a key element of nursing care. Every day some 7000 doses of medication are administered in a typical NHS hospital (Audit Commission 2002). So throughout this essay I will be evaluating and highlighting the learning that took place whilst on placement at a day unit.

In today’s current fast-paced and demanding field of heath care, medication administration has become complex and time-consuming task. Approximately one-third of the nurses’ time is used in medication administration. There is much potential for error because of the complexity of the medication administration process. Since nurses are the last ones to actually administer the medication to the patient therefore they become responsible for medication administration errors (MAE). Reasons for MAE may include individual factors, organizational factors or system factors. This paper will discuss the root causes analysis of MAE and strategies to prevent them.

Rebecca was threatening to hurt herself and also get loud to wake other clients if she was not given the phone to call her guardians. She started hitting the window, waking other client in the process. Staff tried to redirect her to keep the unit safe, but to no avail. The unit nurse, Peninah Gitonga, RN, obtained orders from the on-call provider, Kat McNeil, NP, to administer IM medication. Rebecca refused to take the medication willingly so she was on physical hold for medication administration. CRU policy and procedures were followed to ensure clients' and staff safety.

Nursing in today?s society involves more than technical skills, critical thinking, and compassion. It also is changing to add the ability to not only understand but be able to utilize technology to impact a patient?s health. There are many technological changes employed in healthcare practices, however, I have chosen to address bar-code medication administration or BCMA. According to an article in the Journal of Patient Safety, ?bar-code medication administration has been shown to be effective in reducing patient medical errors, yet is still only utilized in 5% of the country?s health care facilities? (Sands, Slebodnik, & Young, 2010). Medication errors are common in hospitals and often lead not only to patient harm, but also lengthy hospital stays and law suits. ?One study identified 6.5 adverse events related to medication use per 100 inpatient admissions, more than one fourth of these events were due to errors and were therefore preventable? (Bane, et. al., 2010).

Healthcare associated infections have an impact on patients - how? Can be prevented greatly with compliance to hand hygiene protocols (REF).

"An estimated 2.5 million hospital-acquired infections occur annually in the United States" (Fox et al., 2015). Hospital acquired infections (HAIs) are defined as infections that are associated with interventions, devices or procedures carried out in healthcare facilities (Aziz, 2014). Of these 2.5 million HAIs, 90,000 patient deaths result that were completely preventable (Fox et al., 2015). These infections are considered to be entirely avoidable if health care workers adhere to proper infection control guidelines. One of the most significant ways of preventing infection in a health care setting is proper hand hygiene. Hand hygiene has been accepted as the single most important measure to prevent the spread of infection and is the foundation of most infection prevention and control programs (Grota, Ackiss, & Association for Professionals in Infection Control and Epidemiology, 2014). Nurses are the individuals who interact with patients the most; therefore, it is crucial that nurses follow proper hand hygiene practices in order to prevent the occurrence of HAIs. Although there is an abundance of evidence that HAIs cause a substantial amount of preventable morbidity and mortality, nurses often view them as far less of a threat to patient safety than other adverse events such as falls and medication administration errors. As a result of this mentality, 2.5 million HAIs occur in the United States every year. Proper hand

Medication error is one of the biggest problems in the healthcare field. Patients are dying due to wrong drug or dosage. Medication error is any preventable incident that leads to inappropriate medication use or harms the patient while the medication is in the control of the health care professional,or patient (U.S. Food and Drug Administration, 2015). It is estimated about 44,000 inpatients die each year in the United States due to medication errors which were indeed preventable (Mahmood, Chaudhury, Gaumont & Rust, 2012). There are many factors that contribute to medication error. However, the most common that factors are human factors, right patient information, miscommunication of abbreviations, wrong dosage. Healthcare providers do not intend to make medication errors, but they happen anyways. Therefore, nursing should play a tremendous role to reduce medication error

The need to wash hands has been proven to be beneficial in decreasing Hospital Acquired Infections (HAI) since the time of our foundress, Florence Nightingale was practicing. Though this is widely understood to be beneficial, healthcare providers have consistently scored poorly on studies regarding compliance to hand washing with a rate of 39% on average. In the United States, the healthcare industry has felt an economic burden due to HAI’s which account for the largest rate of morbidity and mortality. HAI prevention is possible with the practice of hand hygiene which is the single most important task healthcare providers can offer. Diegel-Vacek & Ryan, (2016).

According to the Institute for Safe Medication Practices and the Agency for Healthcare Research Quality (AHRQ), there are some recommendations to reduce medication administration. The recommendations surround the use of three techniques, such as unit- dose dispensers, bar-coding medication administration (BCMA) and smart infusion pumps. Such combination strategies are effective against the wrong patient, the wrong medication, as well as incorrect drug dose. Similarly, it may reduce the incidence of medical errors associated with the administration of the drug at the wrong time. However, there are still cases of the medication errors which are related to administering nurse, who lacks knowledge of the drug. Lack of proper drug knowledge is the cause of 10% of mistakes and problems that result from information that the nurse has forgotten or does not use. The actual patient care situation represents 40 % of errors at the administration stage (Moss & Berner, 2015).

Non-compliance of correct hand hygiene can lead to severe life-threatening diseases (Malliarou, et al, 2013). Hand hygiene is one of the most effective, inexpensive and simplest ways to help prevent the spread of healthcare acquired infections (HCAIs) (Malliarou, et al, 2013). It is often recognised by healthcare professionals that they do not comply with hand hygiene as often as necessary or do not follow the correct techniques due to certain factors such as role modelling/social influences, attitude, self efficacy and also due to time constraints and level of knowledge (Wandel, et al, 2010). The effectiveness of a simple hand wash can often be underestimated by healthcare professionals (Kilpatrick, et al, 2013). Failure to comply with appropriate hand hygiene is considered to be the leading cause od healthcare acquired infections and the spread of multi-resistant organisms (Malliarou, et al, 2013). Understanding the importance and performing hand hygiene at the right time and in the correct manner is absolutely crucial to the preventing of easily avoidable healthcare acquired infections (Kilpatrick, et al, 2013). Hospital acquired infections are closely linked to increased morbidity, mortality, increased costs of healthcare and also prolonged hospital stays (Tan & Olivo, 2015).