Reducing Medication Errors In Nursing

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.

The pharmacy, nursing, and informatics department were required to be involved in implementing the bar-code-assisted medication administration (BCMA) patient safety initiative. The involvement of the informatics department was required for planning and coordination of the electronic medication administration record and the scanning devices. The nurses were administering the medications so they were required to undergo training on BCMA methods and the importance of BCMA implementation. Pharmacists were needed to assist nurses in case if a scanning error occurred. Pharmacy, nursing, and informatics staff members were responsible for evaluation of the BCMA system upon implementation.

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

The following articles were reviewed for the purpose of addressing bar code scanning in medication administration. Nursing requires the critical skill of accurate medication administration. The use of electronic medication administration has brought about many changes in the healthcare field. The article,” What Determines Successful Implementation of Inpatient Information Technology Systems” (Spetz et al 2012), was reviewed to address the above question. Computerized patients records and bar-code medication systems continue to gain favor in healthcare. This idea spread across the nation in all VA sites (Spetz et al., 2012, p. 157), providing a safer environment for patient care.

Medication reconciliation is defined as a “formal process of obtaining a complete and accurate list of each patient’s current home medications – including name, dosage, frequency, and route – comparing the physician’s admission, transfer, and discharge orders to the list.” (Meguerditchian N, Krotneva, Reidel, Huang, & Tamblyn, 2013). There have been several studies performed across the world to try to comprise a system that will successfully accomplish medication reconciliation. Some of these studies have been successful and others have failed to find a solution. There have been studies that have utilized a pharmacy technician in the emergency department to facilitate the input of patient’s medication reconciliation prior to admission. Other studies have relied on the pharmacist to obtain the information. Most studies involved the primary nurse providing care to the patient to obtain the medication reconciliation information. There have been several forms of documentation tried on trial bases. These forms of documentation range from a paper medication administration record (MAR) to an electronic medication administration record (EMAR) that utilizes today’s technology.

This integrative review sought to identify and understand the impact of information technology in on medication errors. The review of 14 papers shows that the implementation of medication management systems, which include CPOE, BCMA and automated dispensing machines has successfully reduced medication errors and adverse medication events significantly, particularly the two most susceptible stages of prescription and administration of drugs (Armada et al., 2014).

The John Hopkins Nursing Evidence-Based Practice Model describes how practice, education and research are the foundation for professional nursing. Practice is first, nurses need to question the basis of their practice and utilize an evidenced based approach to validate or change their current practice. Next is education, nurses’ education is basic in the beginning however with ongoing education nurses are able to gain new knowledge and skills throughout their careers. Finally is research, research generates new information for the nursing profession and allows for improvement of practice based on scientific evidence and research. (Dearholt & Dang 2012, p. 34-40).

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.

Safety is a priority to delivering healthcare, however, medication errors have been identified as a safety issue in healthcare. The Institute of Medicine (IOM) has released two landmark reports that identify adverse outcomes that occur yearly from medication errors (Kohn, Corrigan, Donaldson, 2000; Institute of Medicine [IOM], 2001). Because nurses are intimately involved in providing patient care and medications, as a result of these reports attention was directed at the nursing profession to improve the mathematical competence of nurses. Therefore, it is imperative that nursing students are competent in converting between measurement systems, identifying common pharmacological abbreviations, methods of medication administration, reading medication labels, and calculating medication dosages in order to provide safe care. In the article, Teaching the Culture of Safety, the American Nurses Association (ANA) affirms that pre-licensure programs should include education on patient safety and system vulnerabilities that is expanded on throughout all nursing education and practice to promote a culture of safety (Barnsteiner, 2011). Therefore, the implementation of early medication calculation in a nursing program helps establish fundamental nursing mathematical skills to help nursing students become competent in medication calculation skills and combat medication errors and promote the delivery of safe nursing care (Newton, Harris, Pittilgio, & Moore, 2009).

The John Hopkins Nursing Evidence Based Practice Model (JHNEBP) has three phases that describe the practice question, evidence and translation (PET) for determining the practice problem finding evidence that supports change in current practice and than translating the new information into practice (Newhouse, Dearholt, Poe, Pugh, & White, 2012). The first phase, practice question, is developed used to develop an answerable evidence-based practice question that derived from the PICO mnemonic (Newhouse et al., 2012). The second phase of is conducting the research and finding the evidence to be used in implementation for change of practice. The PET process finds the evidence, makes an appraisal of the findings and provides recommendations for change in practice (Newhouse et al., 2012). The final phase is to determine if the information obtained in research is appropriate for implementing change in the current practice. The PET process within the JHNEBP Model can be used as a means for finding evidence, evaluating and synthesizing the information from the research and evaluating

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).

Electronic-prescribing, often referred to as e-prescribing, is a fairly new, innovative way for physicians and other medical personnel to prescribe medications and keep track of patients’ medical history. Not only has e-prescribing enabled prescribers to electronically send a prescription to the patients’ pharmacy of choice, in the short amount of time it has been available, it has significantly reduced health care costs, not only for the patient, but for the medical facilities as well. In 2003, e-prescribing was included in the Medicare Modernization Act (MMA) which jumpstarted the role of e-prescribing in healthcare. It has proven to significantly reduce the yearly number medication errors and prescription fraud, and its widespread

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