Medication Error Analysis

Patient centered care and patient safety are the most important roles in nursing. “Serious medication errors are common in hospitals and often occur during order transcription or administration of medication” (Poon et al., 2010. p. 1). One important aspect of nursing is drug administration. It is a multidisciplinary task including doctors, pharmacist and nurses. This paper will show evidence that using electronic medication systems instead of paper based systems to administer medication will reduce medication errors.

An error is one of the vital parts of human life. Hospitals are areas with very chaotic systems and as health care is growing more steadily, it is becoming complex in nature and more sophisticated technologically. Therefore, medical errors are bound to happen. Administrators, physicians, and nurses, are advocates of patient safety and safety is one of the highest priorities during the provision of care. A report from Institute of Medicine (IOM) claims that between 44,000 and 98,000 die annually due to medical errors (Alexander, Cheryl Ann 2014). Medication errors can lead to adverse outcomes such as increased mortality, extended period of hospitalization, and amplified medical expenses. Although the health care team can cause medication errors, nursing medication errors are the most common. Moreover the workload of the nurses combined with more prescription

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.

As it is mentioned earlier, medication administration includes various steps and an interdisciplinary team. Undoubtedly, nurses play a vital role in the medication administration process. Since patient safety is the priority to all health care professionals, it is important for the nurses to effectively communicate and collaborate with an interdisciplinary team if he or she is unsure about any medication prescription to prevent any adverse events. In addition, patient education is another component of safe administration. A patient must be educated on medications they are taking, the reason for taking them, the dosage, a route, potential side effects, and interactions. Nurses should perform “six rights” of the medication each time. Before administering

Patient information, drug instruction, communication amongst medical staff member, drug labels, patient literacy and the nurses knowledge of the medication are just to name a few. It only takes one of these aspects to be incorrect for a medication error to harm a patient, causing life changing or even life threating complications. Other circumstances that may contribute to medication errors include fatigue and staffing shortage. Nurses reported that fatigue, stress and understaffing increased the risk of making a medication error. Anderson, (2010). Majority of clinical staff work 12 hours shifts. Due to patient acuity and inadequate staffing, workload and hours many times are increased. sleep deprivation has been shown to be a major factor in medication errors. The diminished hours of sleep effect clarity of thought causing room for errors. Novice nursing has also been a component of many medication errors. Unexperienced nurses are overwhelmed with the increased workload and new responsibilities, which places them in danger of making these dangerous inaccuracies. While rushing to pass meds in a timely manner, critical medication errors reportedly made. Actively adhering to the five rights of medication administration measures while distributing patient medication can inherently cut down on errors made in the nursing

Medication errors are the leading cause of morbidity and preventable death in hospitals (Adams). In fact, approximately 1.5 million Americans are injured each year as a result of medication errors in hospitals (Foote). Not only are medication errors harmful to patients but medication errors are very expensive for hospitals. Medication errors cost America’s health care system 3.5 billion dollars per year (Foote).Errors in medication administration occurs when one of the five rights of medication administration is omitted. The five rights are: a) the right dose, b) the right medication, c) the right patient, d) the right route of administration, and e) the right time of delivery (Adams). Medication administration is an essential part of

One of the critical core components of Skilled Nursing Facility is medication administration. As cited by Tenhunen, Tanner, and Dahlen (2014), they stated that 88% of the residents living in the nursing homes are aged 65 years old and older. They discussed that every five of administered medications in nursing home has one probability of error. This means that about half of the residents have the possibility of two or more medication errors daily. This applies to the Pasadena Care Center (PCC) because its residents are mostly older adults who require medications on a daily basis. Moreover, residents are prescribed with multiple medications, which make them vulnerable to medication errors. The staff at PCC is trying their best to ensure safe medication administration, however, it still in need of a major change. The goal of the proposed change is to decrease the medication errors in this organization to ensure patient safety.

Medication errors are among the most significant cause of patient injury in all types of medical errors (Johnson, Carlson, Tucker, & Willette, n.d). In the nursing profession, medication administration errors occur 34% of the time, second only to physician ordering errors (Gooder, 2011). The introduction of information technology, such as the Bar Code Medication Administration (BCMA), offers new opportunities for reducing medication administration errors. BCMA was developed by the Veteran’s Affairs Medical Center in 1998 to help improve the documentation of medication administration, decrease medication errors and provide

Safe medication practices are key to every nurse since it results to safe medication administration. When medication is not administered correctly it results to adverse drug event which refers to harm to the patient that includes mental harm, physical harm, or loss of function which is as a result of a medication error (practices, 2017). Medication errors occur when a mistake is committed by a person administering medication and in order to avoid these errors safe medication practices need to be adhered to. Some of these

McComas, Riingenm and Kim (2014), conducted a study that investigated the occurrence of medication errors and the efficiency of medication administration following the implementing an eMAR system. The study was conducted in an appropriate setting and all observed nurses volunteered for the study. Before implementing the eMARs mandatory class were provided and nurses were evaluated for competency. Data was collected by observation and nurses were randomly followed throughout a medication pass. Collected data consisted of medication errors, distractions during medication pass and amount of time spent administering medications.

As a leader in the workplace, medication errors mostly occur when the workplace is understaffed with a patient load of full nursing cares that require more attention and care than patients who are independent. Due to being understaffed with a patient load of 13 to 2 nurses, medication errors occur more often as nurses are being rushed to finish all cares within their work timeframe. To decrease medication errors it is important to implement more staff during medication rounds, thus giving nurses additional time to concentrate and assure that the correct medication and dose is being given to the right patient ( ). The 6 medication rights are important to implement into every workplace as it decreases the chances of administrating medication to the wrong patients ( ). The medication right include; ______________________________________________________________ ( ). Medication errors have important implications for patient safety and in improving clinical practice errors to prevent any adverse events (

The FDA suggests that all medication should be labeled with bar codes (FDA, 2015). Much like the bar code in the supermarkets. The scanning devices scan the bar codes, which generate information such as drug, drug dosage, administration of drug, and patient receiving the drug (FDA, 2015, p.2). Also, patients receive wristbands with bar codes, upon admittance to the hospital, as well (FDA, 2015). The hospital computer system contains information such as patient’s medications. Before nurses administer medications, they scan the bar code. Computer system generate patient’s name, drug, and drug dosage that particular patient is to receive. If any errors are present, a warning message appears. The Department of Veterans Affairs hospitals’ implemented the bar code method and medication errors reduced significantly (FDA, 2015). One hospital reported an 86 percent decrease in medication error rate “over a nine-year period” (FDA,

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.

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).

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