Medication Administration Error

Introduction

Medication administration error refers to an incident where some drugs prescribed to a patient are used wrongly or cause harm to the patient. Such incidents are usually avoidable. According to Bankhead (2010), medication administration errors may occur even once per day. The rate is rather high and in most cases, the reasons for the medication errors are the interruptions. Delivery of quality health services calls for all pharmacists and nurses to avoid medication administration errors at all levels. Many health care providers and academicians have laid down strategies to minimize the occurrence of medication administration errors. However, these errors still occur, according to Stoppler (2005) roughly 1.3 million persons suffer adverse health problems due to medication administration errors and related cases. Medication errors occur at different levels which include labeling, administration, distribution, dispensing, use, and packaging. Errors that occur at any of these points are eventually channeled to the end-user who is always the patient. Factors that lead to medication errors are classified into two categories the first category is factors that occur as a result of system error. The second categories are those caused by health care providers. Percentages of medication errors reported in different hospitals are not representative since some nurses do not report medication errors. These nurses fear that their colleagues may question their competency (Terzibanjana, 2008). Different interventions have been explored which involve computerizing of health systems, education, and application of double check by health care providers before dispensing and administration of drugs. The involvement of technical innovations in the problem-solving process may lead to safe medication (Schneider et al, 2006). Furthermore, the ethical side of the problem is also significant (Armitage, 2005). The essay seeks to explore medication administration errors and their effect on health care systems.

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Question

What are some of the factors that lead health care providers to make medication administration errors? Some incidences of medication errors are a result of poor communication between health care providers and patients. For instance, a case of a 48-year woman who was obese suffered from diabetes and sleep apnea. The woman was taking some medicines- nasal CPAP- every night before an operation which was to be done later. During her assessment two days before the operation, the woman reported sporadic shortness of breath and cough. Her heartbeats were within the standard limits and no major changes were recorded. The patient was found to be suffering from acute bronchitis. As a solution to counter it, the doctor prescribed antibiotics and a bronchodilator. The two were aimed at controlling the shortness of breath and healing the problem. The physician also handed the patient’s preoperative report to the patient’s surgeon and discussed with him all-important findings. Since her operation procedure was arranged as a day operation the doctor did not bother to request post-op CPAP (Case Study, 2009). As the anesthesiologist was preparing the patient for surgery he discovered that she had acute bronchitis and sleep apnea but no respiratory evaluation was documented. Surgery was carried out without complications and she was to be admitted throughout the night for observation. The patient’s condition stabilized within a short period and she showed no characteristics of sleep apnea. At 7:00 am there was a shift change and new health care providers took over. The new healthcare providers gave her Demerol (PO) following some complaints that she experienced some pain in the eyes. The medicine that was first administered did not work efficiently. A request to the nurse to contact the doctor to avoid complications did not work. She assumed the request and administered a dose of Demerol (IM) to treat the pain in the eyes. As the pain was perceived, the nurse contacted the doctor who prescribed pain relievers and other antiemetics. After taking this medication the patient appeared more comfortable, one hour later the patient became lethargic this was managed with a glass of juice. The conditions of the patients continued to worsen and she was transferred to an ICU in a neighboring hospital. She was later pronounced dead (Case Study, 2009). If all health care providers had maintained a good communication channel the lady could have most probably survived (Wakefield, Uden-Holman, & Wakefield, 2005).

Discussion

Medication errors are said to occur at least in every five different medications administered to the patients. Analysis of these incidences often shows the nurse and pharmacists as individuals who provide unsafe practice. Patients are said to die or their conditions get worse for instance allergic reaction as a result of the wrong prescription. Patients lack confidence in health care providers who happen to commit this error, their response to medication is adversely affected as they are not sure whether they are taking the right medication (Pallarito, 2010). Safe and Quality Use of Medicines (SQUM) a movement that was formed in the 1990s encourages health care providers to review existing strategies of controlling medication administration errors. This was to correct the increasing trend of medication errors that were being observed in medical care centers. New Zealand adopted strategies that were more inclined to patient safety. The method which rates the occurrence of medication error varies greatly depending on the mode of measurement used to evaluate the error rates (McBride-Henry & Foureur, 2005). Nonetheless, examination of practice is deemed as the most accurate manner of rating the occurrence of medical error. Medical administration error for the intravenous drug was identified as greater than other forms of medication. Researchers analyzed both administration and preparation errors, they found the percentage of preparation error to be 26% and administration error 34%. The average of their observation showed that in every five doses of intravenous medication one error either preparation or administration occurred (Stoppler, 2005).

Drug administration procedure is a complicated sub-sector in a medical care center. The whole process relies on procedures meant to make sure that patients receive the right treatment (Schelbred & Nord, 2007). Nonetheless, if a mishap occurs at any point of the process it is most likely that the patient will not get the correct treatment. Hence each process requires a high level of accuracy in prescription, dispensing, and administration of drugs. Schelbred & Nord (2007) assert that researchers use standardized criteria in exploring different methods in which errors happen. These criteria address wrong dosage, faulty calculations, and errant dosage. Research confirms that a high rate of medication error occurs in intravenous medication as a result of wrong IV push rates, roughly 88 out of 100 dosages are wrongly administered. Nurses are charged with the responsibilities of medication administration as well as supervising the prescription behaviors of other health care providers. They are referred to as the gatekeepers, ensuring active scrutiny over the procedure on a continuous basis. However, this may instill fear and guilt in nurses, their effort to give the right medication to the patient is coupled with fear rather than patient safety. This may force nurses to accept medication errors made by other professionals in the medication chain (WHO, 2005, 12). Nurses spend most of their time with the patient as opposed to clinicians; therefore they should be well equipped to provide the best services notably in medication. Nurses address the issue of medication from a point of having the right information. They are considered to have skills which aid in the detection of prescribing errors. A study which was carried out in Australia showed that nurses are always careful of offering the best and most safe form of patient care. They are always walking on a tight rope between upholding policies and offering receptive patient-oriented care. The result of the study emphasized the significance of creating awareness to nurses on proper medication practices. This is likely to encourage nurses to develop a nursing-focused strategy that would offer meaningful promotion of medical administration and other related decision-making strategies. Researchers claim that if nurses became competent enough in medication administration the burden of medication errors would be significantly reduced. Nurses are the key professional in the management of patients until their health is fully restored (Joanna Brigs Institute, 2005).

Causes of medication errors

Extensive studies have been carried out in medical centers to identify major causes of medication administration errors. Results of a study done in the United States showed that poor communication between health care providers and patients leads to at least 23% of medication errors. Patients who fail to express themselves adequately to medical professionals for instance informing them of an allergic reaction to certain medications may lead to medical error. Inadequate communication between health care providers is also considered to contribute to significant levels of medication error. When changing shift doctors nurses are supposed to brief those taking over on important medical issues of the patient that need attention during medication (Bankhead, 2010). A study conducted in the United States showed that this mistake may contribute to approximately 19% of medication errors observed in 11 medical centers. Hurried patient history taking may lead to incorrect diagnosis thus wrong medication. The study showed that errors also occur when patients have similar names, nursed may administer wrong medication. Medication errors may occur as a result of poor preparation methods, some drugs need to be diluted before administration. Observation of accurate measurement is fundamental to ensure that the end dosage represents the right medication. The research conducted by Biron, Lavoie-Tremblay, and Loiselle (2009) measured the interruptions of the nurses while the preparation procedure and its influence on its quality.

Intervention

Intervention measures have been explored to eliminate or reduce incidences of medication errors. These intervention measures include the installation of a computerized system that provides an alert of possible medication errors, allows barcoding and automatic dispensing. A study in the United States indicated that nurses who used barcoding reduced medication errors from 0.17% to 0.05%. Education to both health care providers and patients on the importance of medication is considered to create awareness to both parties on practices that promote proper medication. It has been proven that the use of nursing care models for example double-checking of medication before administration/ dispensation greatly reduces the occurrence of medication error. Changing health care systems to ensure that practices promote proper medication is also considered as an intervention of medication error (Roy, Gupta & Srivastave, 2007).

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Recommendation

Computerization of health care system to ensure that patient’s information is in the database. This lowers the risk of misinterpreting medication orders. Medical centers should adopt personal medication supplies. Nurses and pharmacists should always double-check medications before giving them to the patients. Double-checking gives health care surety that they have provided the patient with right the right medication. The proper explanation should be given to a patient who practicing self-administration. Educating patients on medication promotes them to seek and practice the right medication (Flynn, 2010).

Conclusion

Drug administration procedure is a complicated sub-sector in a medical care center. The whole process relies on procedures meant to make sure that patients receive the right treatment. Nonetheless, if a mishap occurs at any point of the process it is most likely that the patient will not get the correct treatment. Hence each process requires a high level of accuracy in prescription, dispensing, and administration of drugs. Medication administration errors compromise the welfare of patients. The practice causes preventable morbidity and mortality of patients. Medication errors are mostly observed in the administration of intravenous medication as opposed to other forms of medication. Medication errors occur at two levels, the first one is whereby the error occurs during the preparation of drugs. The second category occurs during administration, nurses may either give the wrong dosage or incorrect medication. This may be due to poor communication between health care providers and patients or among medical professionals. Medication errors are prevented by the promotion of computerized systems which allow automatic dispensing of drugs, double-checking of drugs before dispensing or administration.

Reference List

Armitage, G. (2005). Drug errors, qualitative research and some reflections on ethics. Journal of Clinical Nursing 14, 869–875.

Bankhead, C. (2010). Interruptions Risk Medication Errors by Nurses. MedPageToday. Web.

Biron, A. D., Lavoie-Tremblay, M., & Loiselle, C. G. (2009). Characteristics of Work Interruptions During Medication. Journal of Nursing Scholarship 41(4), 330–336.

Case Study. (2009). Failed Physician-Nurse Communication, Post-Op Sleep Apnea, Death. Texas Hospitals: Case in point. Web.

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Flynn, E. A., Barker, K., & Barker, B. (2010). Medication-administration errors in an emergency department. American Journal of Health-System Pharmacy, 67 (5): 347-348.

Joanna Briggs Institute. (2005). Strategies to reduce medication errors with reference to older adults, Best practice 9(4). Web.

McBride-Henry,K., & Foureur,M. (2005). Medication administration errors: understanding the issues. Australian Journal of Advanced Nursing 23(3). Web.

Pallarito, K. (2010). Interrupting a Nurse Makes Medication Errors More Likely. HealthDay Reporter. Web.

Roy, V., Gupta, P., & Srivastave, S. (2007). Medication errors: causes & prevention. Health Administrator XIX (1): 60-64. Web.

Schelbred, A., & Nord, R. (2007). Nurses’ experiences of drug administration errors. Journal of Advanced Nursing 60(3), 317-324.

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Schneider, P. J. et al. (2006). Improving the Safety of Medication Administration Using an Interactive CD-ROM Program. American Journal of Health-System Pharmacy 63(1), 59-64.

Stoppler, M. C. (2005).The most common medication errors. Doctor’s View. Web.

Terzibanjana, A. (2008). Medication error reporting systems-lesson learnt. Executive summary of the finding. Web.

Wakefield, B.J., Uden-Holman, T., & Wakefield, D. S. (2005). Development and validation of the medication administration error reporting survey. Advances in Patient Safety 4. Web.

World Health Organisation. (2005). Collaborating centre for patient safety and high 5s initiative. Web.

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