Certain health problems being experienced in the world currently are cancer, addiction, cardiovascular, obesity, and diabetes, which are linked to lifestyle changes and, in turn, result in taking medication. Medication errors are common medical errors that may happen as wrong use of medication in every one of the drug prescription phases for patients. Medical errors involve prescribing the wrong medication at any phase of the treatment procedure that is avoidable. Giving medication is among the most significant yet complex processes of nursing care, and it requires the right function and knowledge of nurses. Besides, medication errors might have adverse effects on patients, like increased hospitalization duration, healthcare costs, severe harm, distrust in providers and organizations, disability, and even death. Medication order implementation is a crucial step of the treatment process and patient care, and it is perceived as a significant element of the nurse’s role. Medication errors are caused by poor communication between providers, lack of pharmacological knowledge, ineligible handwriting, and action-based errors. Identifying and dealing with the causes of medication administration errors is among the best techniques for increasing patient safety by lowering the severity of MAEs.
Medication Errors and Their Causes
Medication administration errors (MAEs) are generally presumed to fail one of the rights of medication administration, which includes the right time, route, dose, patient, and medication. These rights have been integrated with the nursing curriculum as the standard procedure to facilitate the safe administration of medication. However, medication administration is a component of a complex medication use procedure whereby a multidisciplinary team works collaboratively in order to allow the delivery of patient-centered care (Gorgich et al., 2019). One of the significant causes of medication errors is wrongly prescribed medication. There has been an increase in the number of deaths caused by medication errors in recent years. Preventable MAEs happen since systems for safe medication prescriptions and orders are not used appropriately. Illegible handwriting of prescriptions is one of the causes of the MAEs.
A dispensing error can be defined as medication errors related to the pharmacy or whatever healthcare providers dispense the drugs. These involve commission errors such as dispensation of the wrong medication, wrong dose, or wrong entry in the computer system. The common dispensing errors are dispensing the wrong dosage form or strength, incorrect medication, and miscalculation of the dose. Besides, errors caused by medicine administration may be made by practitioners or patients. Communication is the major problem in medicine administration. Patients tend to be unaware of errors and do not actively participate in understanding what providers are communicating to them (Gorgich et al., 2019). Medication errors mostly happen when there is unclear communication pertaining to drug name, why the patient is taking the medication, drug appearance, and how often and how much to take it. Also, over-the-counter medications might result in medical errors since labels cannot be adequately understood or read at times.
The lack of adequate pharmacological knowledge among providers can lead to medication errors. Also, in terms of shift work impacts, it has been shown that the rates of medication errors tend to be higher during the day shifts as compared to night and evening shifts. This is because fewer prescriptions are written and dispensed during the day shift. This indicates that situational factors such as the number of patients and prescriptions can cause medication errors (AHRQ, n.d.). Other than that, the level of skills and experience such as calculation skills affect the incidents of medication errors. Certain research studies have found out that providers will little experience have a higher likelihood of making medication errors when calculating medication volumes to be administered to patients.
Analysis of Medication Administration Errors
Medication errors are characterized by commission or omission in the execution or planning that lead to adverse effects. Most of medication errors lead to patient harm and even death. Negative effects of medication errors refer to undesirable reactions to medicine that are unintended or harmful like death, disability and injury. Because of these effects caused by medication errors, nursing professionals actively participate to reduce medication errors and enhance patient safety. In addition, medication administration are the primary responsibilities of nurses whereby they spend about 40% of their time (Alrabadi et al., 2021). Nurses represent the final safety check in the different events in the process of medication administration as well as are the final safeguard of patient safety and well-being.
Medication errors lead to increased healthcare costs due to prolonged hospitalization duration of the affected patients. Incidents of medication errors tend to lower the satisfaction levels of patients and practitioners, resulting in poor outcomes. Nurses experience increased workload because of the increased hospitalization duration, decreased motivation as well as burnout (Alrabadi et al., 2021). Medical errors can contribute to legal implication as patients can sue the organization or providers for the caused harm or injury. Thus, medication errors are a major problem in healthcare facilities that should be addressed effectively.
The Affected Populations
The problem of medication administration error is real causing severe threats to patient safety. Some systematic reviews and studies have illustrated the severity of MAEs being high even today. Medication errors, especially the ones that happen during medication administration are very prevalent with every patient and medication having at least one form of medication error. MAEs are costly to families, patients, employers, healthcare providers, insurance companies, and hospitals. Patients are the main survivors of medication errors as they profoundly impact patients in terms of hospital stay, morbidity, adverse drug event, mortality and additional costs (Wondmieneh et al., 2020). Other patients tend to suffer from disability as a result of medication errors. A systematic review of adverse medication errors and drug events in hospitals showed that 8.4% of hospitalized patients reported experiencing adverse drug events while at the same time led to 2.8% admissions. On the other hand, the mortality rate caused by adverse medication errors stood at 0.1%.
Healthcare providers are also affected by medication errors. For example, nurses involved in medication errors have been found to experience emotional distress, punitive actions, and reduced confidence, especially when the MAE lead to significant patient harm. Nurses also suffer from loss of trust by families and patients who suffered from MAEs (Wondmieneh et al., 2020). Healthcare organizations suffer from MAEs via increased costs of unintended prolonged hospital stay as well as treatment in order to correct such errors. The costs linked to medication errors is about 42 billion dollars yearly.
Potential Solutions for Medication Errors
Both high and low-tech strategies have been tailored to facilitate the safe administration of medicine as well as align with the medication administration rights. For example, standardized communication can be employed to ensure the right medication administration. Tall man lettering is utilized in different electronic health records, drug information and product labeling resources to alert people of sound alike and look alike drug names (Manias et al., 2020). Also, encouraging effective communication between patients and practitioners will substantially reduce MAEs and attain the desired outcomes. Motivating, purposeful, and effective communication is important for pharmaceutical counseling as it reduced errors in dispensing, prescriptions, delays, and dosage computing.
Another solution is to optimize nursing workflow in order to lower error possibility. In healthcare facilities, interruptions during medication administration are very common and linked to increased severity and risk of errors. Lowering distractions during the administration of medicine and establishing safety checks via standardized workflows are core techniques in facilitating safe medication administration (Manias et al., 2020). Other strategies like independent double checks are a component of medication safety optimization via nursing workflows. The independent double check procedures entail an entirely independent examination by another nurse before administration. Finally, implementing barcoding administration will significantly lower medication errors by utilizing barcode labeling of medications, medical records, and patients in order to electronically connect the right medication to the right dose to the right patient and at the right time (AHRQ, n.d.). Also, the use of computerized provider order entry (CPOE) will allow practitioners to send and enter instructions like medication, laboratory order, and radiology via a computer app rather than fax or telephone.
Solution
In order to implement CPOE, there is need for incorporation with existing information systems at the hospitals like pharmacy, registration, as well as electronic medical record systems. There is a need to provide technical support to providers that is vital for CPOE to be successful. Healthcare facilities should expect users to have various questions and concerns regarding CPOE after and during implementation. Due to the inpatient care nature, questions about CPOE might happen any time (AHRQ, n.d.). Thus, hospitals should have readily accessible technical support resources at all times. This support ought to be considered during the training process as well as the planning and development for internal technical support. Practitioners will also be educated about pharmacology in order to update them with the current changes which otherwise might lead to medication errors.
Ethical Principles
The veracity principle mandates healthcare providers to provide objective, accurate, and extensive information. Being honest and truthful about any medication errors allows the formation of a trusting patient-practitioner relationship and a comfortable environment. The nonmaleficence and beneficence principles mandate healthcare providers to give the best practices as well as prevent causing patient harm. Practitioners can attain by using CPOE, barcode system, and electronic health records, preventing medical errors and safeguarding patients’ information (Sorrell, 2017). On the other hand, the autonomy principle as well as self-determination rights tend to acknowledge patients’ rights in making their decisions as well as participating based on their personal perspectives. Medical providers are mandated to inform patient about their care process and medical errors.
This paper recommended the use and implementation of various strategies to deal with medication errors. Every strategy has its pros and cons; hence, implementing different strategies will effectively solve medication errors. For example, CPOE offers safety features like allergy alerts, drug-disease interaction checks, and may suggest safe medication doses intervals and ranges. It also guides uses in adopting clinical practice standards and also care pathways (Srinivasamurthy et al., 2021). However, CPOE is linked to increased time for finishing certain physician workflow.
To conclude, it is important to address medication errors as they lead to patient harm and even death. They are caused by different factors such as insufficient pharmacological knowledge and thus strategies such as CPOE, provision of training and education, and effective communication will address this issue.
References
Agency for Healthcare Research and Quality. (n.d.). Medication Administration Errors. PSNet. https://psnet.ahrq.gov/primer/medication-administration-errors
Gorgich, E. A. C., Barfroshan, S., Ghoreishi, G., & Yaghoobi, M. (2019). Investigating the causes of medication errors and strategies to prevention of them from nurses and nursing student viewpoint. Global Journal of Health Science, 8(8), 220. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5016359/
Manias, E., Kusljic, S., & Wu, A. (2020). Interventions to reduce medication errors in adult medical and surgical settings: a systematic review. Therapeutic Advances in Drug Safety, 11, 2042098620968309. https://journals.sagepub.com/doi/pdf/10.1177/2042098620968309
Sorrell, J. M. (2017). Ethics: ethical issues with medical errors: shaping a culture of safety in healthcare. OJIN: The Online Journal of Issues in Nursing, 22(2). https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/O JIN/TableofContents/Vol-22-2017/No2-May-2017/Ethical-Issues-with-Medical- Errors.html
Srinivasamurthy, S. K., Ashokkumar, R., Kodidela, S., Howard, S. C., Samer, C. F., & Chakradhara Rao, U. S. (2021). Impact of computerized physician order entry (CPOE) on the incidence of chemotherapy-related medication errors: a systematic review. European Journal of Clinical Pharmacology, 77(8), 1123-1131. https://link.springer.com/article/10.1007/s00228-021-03099-9
Wondmieneh, A., Alemu, W., Tadele, N., & Demis, A. (2020). Medication administration errors and contributing factors among nurses: a cross sectional study in tertiary hospitals, Addis Ababa, Ethiopia. BMC Nursing, 19(1), 1-9. https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-020-0397-0
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