Medication safety
- Introduction
Enhancing medication safety is among the most significant nursing practices. Medication safety is critical in clinical practices since medication errors in Australian health care are prevalent, adverse, and costly (Smeulers et al., 2015; Koyama et al., 2020). According to Smeulers et al. (2015), a medical error, “is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer” (para. 1). In every clinical setup, the medication process faces a critical vulnerability and error status since it engages a five-phased complex and detailed process that encompasses “prescribing, verifying, dispensing, administration, and monitoring” (Roughead, Semple, & Rosenfield, 2014, p.22).
Medication errors arise from any of the phases; however, Koyama et al. (2020) provide that the errors arise extensively in administration. Based on an Australian systematic review, prescription-related errors are 21%, delivery-related errors are 22%, while medication administration ones can range up to 33% (Berdot et al., 2013). While errors associated with prescribing practices are obstructed like medical instruction prior drug administering (Wheeler et al., 2018), obtrusion to mitigate errors during drug administration are utmost critical since administering serves as the final stage before an individual can receive the medication (Koyama et al., 2020).
Medication administration as the last stage has been insufficiently reviewed in literature and practice, despite the clinical urgency emanating from the practice. Findings from Australian-based data across various reviews on medication safety indicate that the patient is adversely affected, and the morbidity arising from these errors is not only health-threatening but expensive to the hospital and patient(Roughead, Semple &Rosenfield, 2016). According to Roughead and colleagues, present data shows that the number of hospital admissions which are drug-related range between two to three per cent (2016). Statistics indicated that these admissions arise from two significant errors. Extensive studies investigating the proportion of prescribing mistakes in substantial clinics provide oversight into the mistake’s prevalence, suggesting that there is an average of one error per every patient (Westbrook et al., 2015). Crucial evidence-based research provided that medication administration errors occur to up to nine per cent of the patients.
Specific strategies have been installed and actualized in clinical practices to reduce the probability of medication administration errors. These strategies are grounded on the National Safety and Quality Health Standards (NSQHS). This paper focuses on medication administration that is addressed in the Medication Safety Standard, under the criterion of the medication management process.
According to this standard, medicines are commonly used in clinical practices; thus, there are more likely to predict numerous errors than other clinical subjectivities. Most of the medication-derived adversities are expensive in morbidity, clinical resources, and mortality, but about 50% of such events are avoidable (Roughead, Semple & Rosenfield, 2013).
2.1 Factual Description
A graduate nurse was once responsible for administering an incorrect dose to a child. At that time, she was on her first rotation, practicing in one of the hospitals. In one of the night shifts, she was assigned to the pediatric ward. A day before, a girl, five-months-old, had been admitted after been rushed to the emergency room by the mother. The girl had been diagnosed with acute community-acquired pneumonia (CAP). The doctor’s instructions entailed ensuring a consistent saline administration to maintain a desirable fluid status, regular subjective assessment, and antibiotic administration.
The doctor had prescribed a 190mg of IV Azithromycin for the patient, and she had been given a dose of 10mg/kg on her first day. The graduate nurse had never handled a similar pediatric case before. Consequently, she confirmed the doctor’s instruction with the supervising nurse to ensure that she had correctly assessed the patient’s vital signs before she administered the drug. She confirmed the assessments with the supervising nurse and proceed with drug administration. Since the chart indicated that patient had previously received 10mg/kg, and the graduate nurse had been advised by the supervising nurse to give the drug, gradnursepresumed that she had to be consistent with the dosage. After giving the drug and ensuring that the girl was comfortable, she left the patient to rest until the next hourly observation.
Thirty minutes later, she decided to read more on the case, and she realized that the antibiotic dose needed to be reduced on the patient’s second administration. She called in the supervising nurse and doctor to explain the situation. The doctor confirmed that for CAP patients under six months, they are required to get 10mg/kg on the first day, and half the dose during their two-five days of treatment. As a result, she filled in a Riskman form and the mother was informed. The doctor advised that we observe her for at least thirty minutes to identify any drug reactions. Fortunately, the girl did not demonstrate the expected side effects, and she established a recommendablerecovery.
2.2 Description (Feelings)
The encounter was the long run. Throughout the week, junior nurse had been assigned exhaustive night shifts. The pediatric ward was busy and had only three-night nurses that worked inter-changeably to handle the patient load. Besides the large number of patients that she had to attend, the girl was in pain and young – which made the junior nurse experience significant clinical pressure.
Before the case, she had never single-handedly handled a critical pediatric case; hence she felt responsible for demonstrating her learning and leadership skills. Besides, the doctor’s beep kept him busy with incoming patients, so she felt liable to help ease the busy clinical state.
2.3 Evaluation
Throughout the patient’s observation, none of the staff reacted adversely towards the situation. The girl’s mother was quite understanding and tolerable. She kept giving the graduate nurse a pitiful gesture that, to some extent, made her empathetic of the burden she had added on the mother’s list of worries—the doctor recommendedthe graduate nurse on her quick response and ability to own up to her own mistakes. The doctor and supervising nurse were embarrassed that they did not clarify the drug’s administration script.
2.4 Analysis
Based on the process recommended for medication management, health care professionals are required to document appropriate information on medication pathways. The incidence was disheartening and an indication of the medication management irregularities. For this case, the junior nurse had adhered to the present documentation without applying any evidence-based practices.
Until today,she does not know what made her desire to fully understand the patient’s diagnosis by doing a deep reading. However, sheis grateful that she reacted to her clinical instincts. After assessing the situation, she confirmed that the error arose from obscure clinical management systems and under-staffing.
2.5 Conclusions
The graduate nurse was relieved that the patient recovered without any drug-related morbidity. Nevertheless, the incidence prompted me to evaluate the numerous drug-related events arising from the practitioner’s misplaced actions. Although a health care professional faces significant litigation, the patient suffers adversely in mortality and resources. One crucial question remains, what are hospitals doing to ensure that medication administration errors are minimized? How can hospitals apply clinical governance to enable efficient medication management processes?
2.6 Action
That incidence marked and consistently reminds me of the importance of health quality and safety to a patient. I have learned to apply analytical skills in drug administration. By realizing that every patient is unique in diagnosis and recovery, I have adapted evidence-based practices to ensure that I critically assess every patient before implementing any drug-related procedure.
As my career progresses, I will experience new and challenging clinical cases that demand my utmost attention, critical, and agile abilities. In the normal world, making mistakes is argued as beneficial and crucial in learning, and the quicker you are at making mistakes, the faster you learn. However, from the incidence experienced by other people, I have identified that drug-related mistakes are fatal, and the only way you can learn is adapting risk-management approaches that can prevent the mistake’s occurrence.
3.1 Topic
The Australian Commission on Safety and Quality (2017) launched a global drive to minimize medication errors by 50% by 2024. The drive, sponsored by the World Health Organization (WHO) aims at saving lives that are harmed by drug mix-ups. Via WHO’s universal Patient Safety Challenge, “Medication without Harm,” focuses on supporting different countries by enhancing their health management systems to mitigate medication errors, found to cost the globe about $42 billion per year – with individuals in low-income communities been disparately implicated (WHO, 2017).
According to recent studies, medication errors are critical to Australian’s clinical practice (Westbrook et at., 2015; Roughead, Semple & Rosenfield, 2016; Alanazi et al., 2018). The Australian Commission on Health Safety and Quality estimated that a proportion of about 3% of all nationwide ward admittance is drug-related. Based on the data, about 230,000 admissions in Australia arise when patients take or are given inaccurate drug doses – incurring the Australian government over $1.2 billion (2017).
These errors have been pivotal in enhancing health safety by describing the prevalence of adverse drug events (ADEs) via the evaluation of the interaction between medication errors and ADEs (Patient Safety Primer, 2019). Errors resulting from medication administration arise when the five rights are disregarded: the right patient, time, drug, dose, and application route (Martyn, Paliadelis& Perry, 2019). These misdoings arise from individual-level failures, clinical system-level mishaps like understaffing, software-level failures, process-level failures, and other potential
Medication administration error (MAE) is the negation of the doctor’s medication order, outlined in a patient’s record chart (Berdot et al., 2013). The dependent variable in the MAE occurrence was found to be the Total Opportunity for Errors (TOE) and is investigated based on two definitions that produce similar clinical results (Alomari, 2019). To arrive on the first definition, all doses are summed up with the list of administered but unordered doses. The second definitions consist of the addition of all administered doses together with omission errors. The implication arising from MAEs is assayed using standard systems listed by internationally identified health quality and management systems. Despite extensive reduction strategies – both in process-level and execution of efficient clinical technologies – medical administration errors continually prevail to affect health quality and safety systems.
To access administration errors, clinical observation offers the most effective and reliable results. However, the observation approach can be time-consuming and limited by extensive hours. Hence, specific studies have attempted to evaluate MAEs using systematic approaches. Keers et al. (2013) conducted systematic research on 91 immediate clinical observation investigations. The authors approximated median error probabilities of about 8 to 24%, based on a measurement strategy with and without considering time errors. Intravenous drug administration was found to be significantly error-prone, with an average of 48% to 53%.
Similarly, Roughead, Semple, and Rosenfield reported that a previous study estimated a 70% likelihood of a minimum of one error happening in a single intravenous administration (2014). The study indicated that the most substantial error was administering the drug at an inappropriate period, followed by dose omission, wrong dose, and administration rate.
3.2 Causative Factors
The key to actualizing a viable intervention to cut on medication administration errors (MAE) is to comprehend mechanisms in which the errors arise. Since nurses are potent candidates who find themselves as “the last link in the drug therapy chain,” (Keers et al., 2013, p. 1046) they have been longed held responsible when MAEs occur. Nevertheless, the actuality is that the conditions under which the responsible party operates within, together with strategic approaches put in place by the institution that the individual works for, are often found to be essential determinants (Westbrook &Baysari, 2017)
To evaluate MAE’s causes, one needs to recognize the intentions of the individual liable for the error (Keers et at., 2013). To obtain this result, one could ask the person directly; however, utmost precaution should be present since data derived from this approach could rely more on general clinical ideologies, instead of real-time experiences eminent to the error incidence. So, the true identity and complexity of how various MAEs arise could be obstructed. Essentially, one could observe the causative factors without engaging the person responsible for the error and refraining from researcher’s self-derived opinion on potential causalities. Over the years, researchers have identified direct observation as the most efficient method since it identifies both potential causes and associative variables, that could be unknown to the person (Latimer et al., 2017).
Keers et al. (2013) investigated the causative factors by evaluating 54 different studies. Causalities were grouped via the Reason’s approach. The assay’s results were evaluated to access their significance, highlighting probable causes. They found that the most substantial causes rose from slips and lapses, followed by health literacy-associated disregards and violations. Among the conditions necessitating MAEs included insufficient documentation (Prescriptions and transcriptions), irregularities found in drug supply (pharmacology preparation mistakes and inefficient stock systems), under-staffing, instrument-based failures (accessibility and usability), patient-related problems, staff health issues (fatigue and work-related stress), and interruptions when giving the drugs.
3.3 Potential Solutions
According to Oldland et al. (2020), health quality and safety is likely to be compromised if health care professionals do not comprehend their responsibilities and the extent to which their actions can enhance health management systems (Saunders et al., 2018).
Improving drug administration tools
Pre and post-intervention research evaluated the effect of installing a smart infusion pump for giving intravenous drugs (Roughead, Semple $ Rosenfield, 2014). The study applied direct observation to analyze the results. Doctors and pharmacists evaluated the medical significance of errors. The study found that:
- In the pre-intervention session, 18% of IV infusions produced one or several errors, while only 9.4% of smart infusion pumps produced similar results (p=0.003).
- Out of the study’s 165 infusions that utilized the Guardrails software, 4% of the infusions produced errors (p<0.001).
- There was an empirical reduction in MAE when drugs were administered in the infusion with Guardrails systems.
This suggests that actualization of efficient technologies with drug libraries and alert operations help mitigate the probability of errors.
Providing Standardized Medication Patient Charts
In a recent evaluation, standardized medication charts were used to indicate their importance in promoting insulin prescription and administration (Roughead, Semple & Rosenfield, 2016; Jackson & Welsh, 2017). Insulin’s management was accessed via pre and post documentation audit and glucose control. The documentation revealed significant improvements when the strategy was executed:
- The number of administration forms that had precise insulin infusion had increased with a 13% rate (p<.0002).
- The number of incorrectly recorded infusion rates reduced with 5% (p=.0004).
- The number of unclear administration forms reduced with 30.4% (p=.0002).
According to the medication safety standard, all clinicians should ensure safe prescription, preparation, and appropriate administration of drugs, as well as perpetual evaluation of drug usage. Also, the standard ensures that all drug consumers are literate on the drug they use, the needs and risks arising from drug .
The standard further entails actions that direct clinicians towards efficient drug administration to curb the instance of errors (Woods &Murfet, 2015). In the clinical governance sub-standard, health care professionals are required to actualize policies and procedures that promote better medication management, install risk-based strategies that reduce the risk of MAEs, and provide clinical training needed to ensure that the staff comply with the stated medication guidelines.
The second sub-standard entails documenting the patient’s data. Based on this paper’s reflection section, the MAE was caused by inadequate administration data depending on the patient’s status. If the hospital had implemented modern technologies – standardized medication charts or administration software – then the probability of giving unordered Azithromycin could have been reduced.
5.1 Consumer-Centered
Enhance Continuity of Care
Nurses are required to maintain medication safety by avoiding potential errors. MAEs arise when there is unclear communication (in both written and electronic information) that results in insufficient drug data that increases the likelihood of making a mistake. According to this Framework, clinicians need to enhance their care by been informed of and apply, updated and improved communication strategies, as well as document credible patient information.
Reduce Risks at Handover
One of the reasons I failed to administer the right dose of antibiotic, is because there was inadequate handover information regarding the next shift’s order. This Framework engages the National Clinical Handover Program that enhances the flow of data within the clinical setup. It not only enhances team interaction but also reduces the risks emanating from obscure handovers.
- 2 Driven by Information
Standardized Guidelines to Prevent Variations in Healthcare Delivery
In the clinical setup, there are varied policies and procedures, outlined in the NSQHS that could confuse a clinician. Therefore, a hospital needs to come up with a unified system that makes it easy to uphold. For instance, in promoting medication safety, clinicians could be assigned with standardized medication forms that make it easy to transit information, while ensuring that all policies are put in place.
- 3 Organized for Safety
To enhance medication safety, clinicians should be well-informed and adhere to all processes for communicating patient and drug-related instances. If one identifies imminent risk, research and response resources should be used to reduce and control the error to enhance patient safety.
This paper identified that medication safety is paramount in reducing medication administration errors. Based on the reflection, the junior nurse could have harmed the patient by administering a surplus of 5mg/kg of Azithromycin. Although the patient did not acquire adverse events, previous studies indicate that MAE-related incidences result in substantial clinical challenges: morbidity, use of resources, and increased mortality.
To effect interventions that can curb MAEs, a clearer understanding of causative factors is needed. Among the causalities are insufficient information, pharmacology and stock-related dispensing errors, understaffing, practitioner’s health status, and avoidable interruptions.
Prevention of MAEs incorporates evidence-based resources that need to comply with the Australian set of clinical frameworks. The use of new medical technologies like smart infusion pumps with modified software is significant in reducing IV-related MAEs. However, a clinician should apply customer-centered, and operate within the patient’s medical information, to ensure that he is organized towards safety.
- Conclusion
Although medicines are vital in ensuring health quality and safety, they can be detrimental in harming the patient’s life is proper procedures are disregarded in all medication pathways. Based on the conditions and strategies established by a hospital, health care professionals are potential agents that create MAEs. Nevertheless, the same professionals can actualize evidence-based approaches to ensure that the errors are avoided. If the errors are evident, professionals can apply risk-based interventions to create solutions.
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