In healthcare quality and patient safety complement each other and are essential aspects to patient-centered care. Quality care ensures patients’ needs are met and cared for in a timely, safe, and effective way. Patient safety involves ensuring no harm comes to patients in your care which includes preventing hospital acquired infections, adverse events, and medical errors. Quality care and patient safety can be improved within the healthcare setting by developing and implementing evidence-based clinical guidelines and protocols by use of best practices for patient care (MacGillivray, 2020). Medication administration errors are a common issue within the healthcare setting and can occur at any stage of the medication administration process, whether it is during the prescribing, dispensing, or administering stage. Medication errors can result in serious patient harm, and it is important that healthcare providers take steps to use evidence-based strategies to enhance quality of care and patient safety.
Patient-Safety Risk
During my experience working at Robert Wood Johnson Barnabas Health (RWJBH), the hospital has been faced with staff shortages. Due to these staff shortages, there has been concern about the possibility of increased likelihood of medication errors. As a nurse working at RWJBH, there have been times that poor communication and coordination between healthcare professionals have led to medication errors occurring to patients. Often these patients that have been subject to these medication errors tend to have comorbidities. Patients with comorbidities present unique problems to health professionals, especially regarding medication management, since often these patients require multiple medications to manage their conditions, placing the patient at an increased risk of medication errors or interactions (Rasool et al., 2020).
Comorbidities for patients within the hospital can be chronic like heart disease, hypertension, and diabetes or acute like traumatic injuries and infections. These patients often require multiple different medications to manage their conditions and can result in them having a complex medication administration record (MAR). Patients with these complex MAR’s can be challenging to manage and often can be difficult for health professionals to keep track of all the medications and their dosages, resulting in medication errors. Aside from complex MAR’s placing patients at risk for medication errors it also places patients at risk for drug interactions due to the multiple medications. Drug interaction can also put patients’ safety at risk due to adverse effects or by reduced effectiveness of the medications (Rasool et al., 2020). One scenario where poor communication among health professionals, patients, and caregivers can result in medication errors is during patient discharge. During patient discharge, patients may not be informed about their new medication regimen and can result in the patient accidentally taking the wrong dosage or wrong medication. Furthermore, patients that are older, have age-related issues like physical impairment, visual impairment, or cognitive impairment can find it challenging to manage their medications placing them at an increased risk of medication errors (Rasool et al., 2020). Due to these patients having complex MARs and comorbidities, there is an increased risk for these older adults to be exposed to a medication error, which can put their safety at risk.
Evidence-Based and Best-Practice Solutions
Improving patient safety while reducing costs has always been a goal for healthcare facilities including at RWJBH. In an attempt to meet this goal, healthcare facilities look to improve current best practices or adopt new ones. For this healthcare facilities look for evidence-based best practices to adopt into their policies to foster a culture of safety. Some key organizations that promote the use of evidence-based research to promote and encourage collaboration, open communication, and learning from errors include the Quality and Safety Education for Nurses, the Institute of Medicine, and The Joint Commission.
Looking at my current organization at RWJBH, the need is to improve patient safety by preventing medication errors and this can start at a patient’s admission with an accurate medication reconciliation to review all medications a patient has been prescribed to ensure an up-to-date and accurate medical administration record. This is particularly important for comorbidity patients as their medication list can be from multiple physicians treating multiple medical conditions. Performing an accurate medication reconciliation not only helps ensure patients safety it also helps reduce excess hospital costs by preventing ordering duplicate or discontinued medications (Manias et al., 2020). The use of technologies like computerized provider order entry (CPOE), electronic health records (EHRs), and barcode scanning helps minimize medication errors by enhancing accuracy and minimizing communication errors among health professionals. Such technologies can streamline the medication reconciliation process, ordering process, performing automatic drug interaction checks and medication administration, which is especially helpful among comorbidity patients, all while reducing costs related to manual processes (Manias et al., 2020). Another way to help prevent medication errors is through pharmacist-led medication reconciliation, helps to ensure patient safety but can also aid in finding potential cost savings by identifying duplicate medications, reducing unnecessary medications, and optimizing the patients overall MAR (Manias et al., 2020). Another way to determine areas for improvement regarding medication administration as well as reduce costs related to medication errors is thought quality improvement initiatives within the healthcare facility. These initiatives, like root cause analysis and medication safety teams, can help identify why a medication error might have occurred and develop strategies and policies to prevent future medication errors (Dreiher et al., 2020).
The Role of Nurses in Increasing Patient Safety
Nurses have a critical role to play in coordinating care among patients while ensuring patient safety. For example, a reliable medication reconciliation is a multidisciplinary collaboration between the physicians, nurses, and pharmacists to ensure patients receive the right medications and doses. It starts with nurses obtaining and reviewing the medications a patient has been prescribed at home, often from multiple physicians. Following the review, the nurse will enter the patient’s home medication list into the patient’s electronic health record. Once entered into the EHR, it can be used to perform a medication reconciliation to accurately create a patient medication administration record to ensures nurses can determine discrepancies and potential drug interactions that can lead to medication errors (Amiri et al., 2019). Nurses are also involved in patient education on medication administration and possible side effects to ensure patients understand how to take their medications effectively and safely (Dreiher et al., 2020). Nursing education provided included reviewing medication instructions, schedules, the importance of adherence, and potential side effects to improve patient outcomes and reduce costs associated with the likelihood of medication errors.
Nurses also aid in ensuring that medications are prepared and stored appropriately and that patients receive their medication while ensuring the 5 rights of medication administration, the right patient, the right drug, the right time, the right dose, and the right route. Nurses can also collaborate with health professionals to ensure patients receive proper medications based on their comorbidities which could involve clarifying prescriptions, reviewing medication orders, and reporting potential adverse events (Amiri et al., 2019). Nurses also participate in continuous quality improvement initiatives geared towards improving patient safety and reducing costs related to medication errors reviewing the medication administration processes regularly and making iterative adjustments to improve outcomes if needed. With the use of technologies like barcode medication administration, nurses can verify medication ordered to medication to be given and ensure the 5 rights of medication administration. Barcode medication administration reduces the likelihood of medication errors that arise due to human error of improper medication dispensing, wrong patient identification, and wrong medication administration (Thompson et al., 2018). In addition, this technology aids in reducing costs related to medication errors like extended hospital stays and the need for additional treatment.
Driving Safety Enhancements
As nurses, we need to collaborate with various stakeholders such as pharmacists, quality improvement teams, physicians, patients and their families, and regulatory agencies to ensure patient safety. Working with regulatory agencies ensures healthcare compliance with laws and regulations associated with medication administration and safety. Nurses should work with patients and their families to ensure education is provided to them about medication administration and possible side effects to minimize the risk of medication errors and improve patient outcomes. Collaborating with pharmacists helps ensure that medication is prepared and dispensed correctly (Cho et al., 2020). Pharmacists can also provide medication education to patients, and their families, as well as to healthcare professionals. Nurses can coordinate with hospital administration to advocate for technology use in improving medication safety, implementing medication safety protocols, and ensuring that tools to maximize medication administration success is available (Cho et al., 2020). Coordinating and collaboration with other healthcare providers ensures that patients receive appropriate medications depending on their medical conditions, review of medication orders, clarify prescriptions, and address potential adverse impacts of medications.
Conclusion
Medication administration is a key element of patient care that requires attention to detail, communication, and coordination with other healthcare professionals to ensure patient safety and reduce costs from medication errors. Nurses play an essential role in coordinating care and collaborating with patients and patients’ families, physicians, pharmacists, quality improvement teams, and hospital administration to promote patient safety. Being aware that comorbidity patients are at a higher risk for medication errors it’s important to utilize evidence-based practice solutions like interdisciplinary collaboration, medication reconciliation, and technological tools to assist in improving medication safety and reducing costs from medication errors. As healthcare continues to grow, it is important for nurses to stay updated on best practices, collaborate with stakeholders, and utilize technology as it becomes available to ensure that medication administration is effective and safe.
References
Amiri, A., Solankallio-Vahteri, T., & Tuomi, S. (2019). Role of nurses in improving patient safety: Evidence from surgical complications in 21 countries. International Journal of Nursing Sciences, 6(3), 239–246. https://doi.org/10.1016/j.ijnss.2019.05.003
Cho, I., Lee, M., & Kim, Y. (2020). What are the main patient safety concerns of healthcare stakeholders: A mixed-method study of Web-based text. International Journal of Medical Informatics, 140, 104162. https://doi.org/10.1016/j.ijmedinf.2020.104162
Dreiher, D., Blagorazumnaya, O., Balicer, R., & Dreiher, J. (2020). National initiatives to promote quality of care and patient safety: Achievements to date and challenges ahead. Israel Journal of Health Policy Research, 9(1), 62. https://doi.org/10.1186/s13584-020-00417-x
MacGillivray T. E. (2020). Advancing the culture of patient safety and quality improvement. Methodist DeBakey Cardiovascular Journal, 16(3), 192–198. https://doi.org/10.14797/mdcj-16-3-192
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://doi.org/10.1177/2042098620968309
Rasool, M. F., Rehman, A. U., Imran, I., Abbas, S., Shah, S., Abbas, G., Khan, I., Shakeel, S., Ahmad Hassali, M. A., & Hayat, K. (2020). Risk factors associated with medication errors among patients suffering from chronic disorders. Frontiers in Public Health, 8, 531038. https://doi.org/10.3389/fpubh.2020.531038
Thompson, K. M., Swanson, K. M., Cox, D. L., Kirchner, R. B., Russell, J. J., Wermers, R. A., Storlie, C. B., Johnson, M. G., & Naessens, J. M. (2018). Implementation of bar-code medication administration to reduce patient harm. Mayo Clinic Proceedings. Innovations, Quality & Outcomes, 2(4), 342–351. https://doi.org/10.1016/j.mayocpiqo.2018.09.001
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