I have returned with comments all the papers that have been sent to me as drafts for part 1. Now our job is to get them finished as part 1 and put the completed perfect paper aside and prepare part 2

Running head: MEDICATION ERRORS

The Importance of Medication Administration to Prevent Errors

Danielle Terry

Lincoln University

The purpose of this paper is to address the nursing practice of gathering all their patients’ medications at one time. During a clinical rotation many different techniques were used by nurses to gather patient’s medications. At Brandywine Hospital a Registered Nurse gathered all her patients’ medication from the Pyxis system at once. She separated the patient’s medications using different cups as a way of organizing the medications. This practice of medication administration is strongly discouraged and has been found to lead to errors that are avoidable.

Medication administration is an important topic that is often addressed by the Joint Commission. The Joint Commission is a nonprofit organization that certifies health care institutions. They help develop performance standards that address medication administration and other health issues such as patient care, and infection control.

This topic was chosen because of the patient related problems that medication administration errors can cause and because of the high frequency of medication administration incident reports that are reported annually.

Statement of purpose:

This research is intended to change this nursing practice and reduce the medication administration errors that occur in a hospital setting. With the education and anticipated compliance of the nursing staff, the medication administration policy as outlined by the Joint Commission will be enforced. Compliance with this practice will help reduce the amount of incidence reports for medication administration errors.

Research question:

Will medication administration errors be reduced or eliminated by a change in practice that supports single patient medication administration?

Qualitative perspective:

From a qualitative perspective, interviews would be scheduled with nursing staff to determine their understanding of the best medication administration policy to enforce for reducing medication errors. The focus of education would be reinforcement of existing protocols in place that mandate administration of single patient medications at a time.

Quantitative perspective:

From a quantitative perspective, a retrospective review of medication errors over the past years would be undertaken to determine the real cause to attempt to relate the need for practice change to effectively reduce medication errors. A review of medication administration errors post education will be undertaken to determine if the number of errors has been reduced.

For the purpose of this research project the approach selected will be a mixed perspective of both qualitative and quantitative.

Review of the Literature

A literature review was carried out using a variety of different credible sources. These sources included the US National Library of Medicine, National Institutes of Health, PubMed, Wiley Online Library, NCBI, and NIH. Over a 100 of articles were retrieved but only 8 were reviewed. The articles were chosen based on the supportive information it contained, the year it was published, and if it was valuable to the research topic. Keywords that helped retrieve the articles were medication administration, medication errors, five rights to medication, medication incident reports, and medication safety. The literature review is separated into three different topic areas: Medication Errors, Medication Administration Errors, Safe Medication Administration Practices.

Medication Errors

Cheragi, Manoocheri, Mohammadnejad, and Ehsani (2013) conducted a questionnaire study about medication errors. Medication errors are one of the most common problems that affect patient care. These mistakes can extend a patient’s hospital stay, increase mortality rate, and related cost issues. A total of 237 nurses were randomly selected to participate in the study to help researchers get an idea of medication errors from a nurse perspective. Medication errors were made by 64.55% of the nursing staff. Another 31.37% reported almost carrying out a medication error. The common cause of medication errors reported included dosage and infusion rates mistakes. Most errors occurred due to the usage of medication abbreviations. Oral medication administration errors were notably related to the number of patients. There was no significant relationship between medication errors and the amount of work experience.

Esqué, Moretones, and Rodríguez (2016) performed an analysis to declare the number of medication errors that occur on a neonatal unit. The neonatal units in hospital settings are most exposed to treatment errors. There was a total of 511 medication errors reported in the past seven years. There was a 39.5% error in prescribing medications, 68.1% in administering medications, and 0.6% in adverse reactions. Majority of the medication errors had no impact on the patients, however a small percentage of 0.6% caused permanent damage or death. The most common cause of the medication error was due to distractions. The goal is to have more nurses report medication errors to help establish preventable measures. With the help of others, teamwork and good practices nurses can help promote an environment of safety for the clients.

Oshikoya et al., (2013) administered a questionnaire to seven female nurses working in public hospitals to obtain information about their experience with medication errors and their opinion on medication administration errors and contributing factors. There was a total of 64% that committed a medication error at least once throughout their career. The percentage for wrong doses error was 48% and wrong time administered was 40%. The most common factors contributing to medication error was an increased workload and not double checking the medication dosages. A conclusion was made that frequent medication administration errors were carried out and appropriate measures needed to be implemented to reduce the errors rate.

Medication Administration Errors

Kim and Bates (2013) organized a medication guidelines checklist for nurses. The checklist included the 5 rights of medication, infection recommendation, and medication rules. A total of 293 cases were evaluated and observed. “Only 45.6% of nurses verified the amount of medication indicated on the vial at least once for at least one-second. In addition, only 6.5% read the name of the patient from the wristband. Administering the medication at the correct time guideline was observed 41.0% of the time. The guideline regarding hand washing before external and oral medications was followed only 4·5% of the time” (p.1 paragraph 4). This information is evidence that nurses are not using proper precautions during medication administration which can affect the patients. Verifying the medication with the vial ensures that the right amount of medicine is being administered. Reading the patient's wristband verifies the medication is being given to the right patient. Administering medications on a scheduled basis helps the effectiveness of the medication. Lastly, hand washing prevents the spreads of harmful microorganisms.

Westbrook, Rob, Woods, and Parry (2011) conducted an observational study of 107 nurses preparing and administering 568 medications to patients. Procedural failures such as checking a patient’s identification and administering the wrong medication dosage was identified. The results concluded that 91.7% of medication errors were due to wrong rate, medication mixture, volume for IV medications or drug incompatibility. The conclusion was made that a portion of medication errors were associated with routine violations which are learned workplace behaviors. A need for an intervention was concluded as well to reduce the amount of medication errors.

Safe Medication Administration Practices

Fore, Scuill, Albee, and Neily (2013) implemented a technique to help minimize distractions during medication administration to help reduce the number of medication errors. The intervention implemented was a sterile cockpit, which refers to an environment that is free of unnecessary distractions. Data was collected during the first 11 weeks of the intervention for evidence. Medication errors were tracked one year prior to the intervention and one year after implementation to determine if the intervention was effective or not. The analysis revealed a 3decrease in the mean number of distractions and the medication error rate. The medication error rate was decreased to almost 50%. After one year of the new implementation medication error rates decreased to 42.78%. The study concluded that the use of a sterile cockpit can have a significant impact on patient safety.

Bonkowski, Carnes, and Melucci (2013) organized an observation study of nurses using the BCMA (barcode assisted medication administration) in the emergency department. BCMA can help benefit in reducing medication errors in health care settings. Medication errors were recorded before and after using the electronic medical record with the use of BCMA. A total of 1,978 medication administrations were observed; 996 were observed before the use of BCMA and 982 after BCMA was implemented. The medication errors were divided into different groups such as wrong dose, drug, route and administered without a physician's orders. “The baseline medication administration error rate was 6.3%, with wrong dose errors representing 66.7% of observed errors. BCMA was associated with a reduction in the medication administration error rate to 1.2%, a relative rate reduction of 80.7% (p < 0.0001). Wrong dose errors decreased by 90.4% (p < 0.0001), and medication administrations with no physician order decreased by 72.4% (p = 0.057)” (p.1 paragraph 3). This information is evidence that implementing the BCMA into the emergency department helped reduce medication administration errors and more importantly wrong doses administered.

Smeulers, Onderwater, Zwieten, and Vermeulen (2011) conducted a qualitative interview study to explore nurses’ perspective on preventing medication errors. The study was conducted between March and December of 2011. “Three themes emerged from this study: (1)nurses' roles and responsibilities in medication safety: aside from safe preparation and administration, the clinical reasoning of nurses is essential for medication safety; (2) nurses' ability to work safely: knowledge of risks and nurses' work circumstances influence their ability to work safely; and (3) nurses' acceptance of safety practices: advantages, feasibility and appropriateness are important incentives for acceptance of a safety practice.” (page 1 paragraph 4). The study concluded that safe medication management requires a learning and profession practice environment for nurses.

In conclusion, this research highlights the importance of proper medication administration practices and its effects. Nurses gathering client’s medications at once for all their patients is not a safe and proper way to administer medications. It can cause additional medication errors that can affect the patients. Safe medication administration practices can help decrease the amount of medication errors generated by nurses. Some safety practices include decreasing the amount of distractions while administering medications, the 5 rights, to medication double checking dosages, and gathering medications for one patient at a time. Complying with these practices benefits the nurse, patient, and the facility.

Methods

Approval from the Institutional Review Board (IRB) of Lincoln University of Pennsylvania is required before data can be collected. A mixed method would be applied for this research which includes qualitative and quantitative. The purpose of this research is to provide evidence for the need to change medication administration methods or increase compliance with already existing policies in order to decrease medication errors in the health care settings.

References

Bonkowski J, Carnes C, Melucci J, et al. Effect of barcode-assisted medication administration on emergency department medication errors. Acad Emerg Med. 2013;20(8):801-806.

Cheragi MA, Manoocheri H, Mohammadnejad E, Ehsani SR. Types and causes of medication errors from nurse’s viewpoint. Iran J Nurs Midwifery Res. 2013;18(3):228-231.

Esqué Ruiz MT, Moretones Suñol MG, Rodríguez Miguélez JM, et al. [Medication errors in a neonatal unit: one of the main adverse events.] [Article in Spanish] An Pediatr (Barc). 2016; 84(4):211-217.

Fore AM, Sculli GL, Albee D, Neily J. Improving patient safety using the sterile cockpit principle during medication administration: a collaborative, unit-based project. J Nurs Manag. 2013;21(1):106-111.

Kim J, Bates DW. Medication administration errors by nurses: adherence to guidelines. J Clin Nurs. 2013;22(3-4):590-598.

Oshikoya KA, Oreagba IA, Ogunleye OO, Senbanjo IO, MacEbong GL, Olayemi SO. Medication administration errors among paediatric nurses in Lagos public hospitals: an opinion survey. Int J Risk Saf Med. 2013;25(2):67-78.

Smeulers M, Onderwater AT, van Zwieten MC, Vermeulen H. Nurses’ experiences and perspectives on medication safety practices: an explorative qualitative study. J Nurs Manag. 2014; 22(3):276-285.

Westbrook, J. I., Rob, M. I., Woods, A., & Parry, D. (2011). Errors in the administration of intravenous medications in hospital and the role of correct procedures and nurse experience. BMJ quality & safety, 20(12), 1027–1034. https://doi.org/10.1136/bmjqs-2011-000089

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