Assessment 4: Analyzing a Current Health Care Problem or Issue
Capella University
NHS FPX 4000
9th April 2022.
Medication Error as Current Healthcare Problem / Issue
As discussed in assessment two, a medication error is one of the most important elements that can compromise the delivery of quality healthcare. In this assessment, the issue of medication errors is discussed further concerning the hospital setting. A medication error is a failure in drug therapy that eventually results in harmful effects on the patient. Medication error is a very serious concern in the United States as it leads to an increased risk of drug-to-drug interaction, and the frequency of hospital admissions is also elevated (Marufu et al., 2022). For those already admitted to the hospital medication errors could lead to prolonged stay in the hospital, increase the cost of managing patients, and elevate the mortality risk for patients. The following paper looks at the impact of medication errors as a healthcare-related issue for nurses and proposes solutions that can be integrated within the hospital setting.
Elements of the problem/ issue
The problem of medication errors affects seven million patients each year and 3.5 million patients will visit the hospital and emergency department. In the United States, medication errors are also responsible for outpatient visits after cancer and cardiovascular disease. In the United States, studies show that more people die due to medication errors than they do from auto-immune deficiency syndrome, traffic accidents, or breast cancer. Also, medication errors are said to be responsible for up to 41.3% of all hospital admissions and 22% of all readmissions on a global scale (Salar et al., 2020).
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Based on the studies conducted in the previous assessment, the most common type of medication error often includes unintentional prescription when the patient is being discharged and they are mistakenly given medication that they are required to discontinue. There are also errors regarding dosage and unintentional omission of active medication which the patient is supposed to continue taking (Salar et al., 2020). The most likely cause related to a medication error is poor communication which can be preventable. Communication occurs from different areas in the hospital environment (Marufu et al., 2022). For example, medication reconciliation at all transition points from admission to discharge where can be one of the best areas to prevent medication errors. Reconciliation of medication is supposed to be completed from the time the patient is admitted and the current medication list by the nurse and the physician. This list is supposed to be compared to the current discharge plan by the physician and the pharmacists to ensure that all related discrepancies have been dealt with (Dehvan et al., 2019). For nurses, medication errors will also occur during the administration of medication when the patient is still in the hospital setting, often this could be due to a lack of the nurse to have read the name of the medication well, lack of knowledge regarding the medication the patient is taking, or poor coding, which could make the nurse administer the wrong medication. Also, studies have shown that nurses cause medication errors due to personal aspects such as fatigue, and shift hours. In one study it was discovered, that medication errors often occur more during night shift nurses than day shift nurses(Izadpanah et al., 2018). Other elements of medication errors include verbal instructions given to the nurse by the physician, where the nurse could interpret the instructions wrongly and end up giving the client an overdose or the wrong medication. The nurse’s inability to place the catheter as required could also see the medication being administered wrongly. Challenges to ensuring the right administration of medication include lack of resources, time constraints, incomplete medication, communication gaps between the healthcare providers, and lack of electronic health records that help with the transfer of required medical information.
Analysis
Working as a nurse in critical care, it is very important to be aware of poor communication leads to medication errors and errors in the discharge summaries which may have an adverse impact on patient outcomes.
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In critical care, medication errors also have the potential to result in adverse impacts on patients, especially those that are still very sick during discharge(Schneidereith, 2017). Also when the nurse is not well educated to identify different medications, it could lead to adverse effects; for example, a patient may be prescribed a painkiller, however, one time of painkiller may work for them and the other may not. The nurse needs to ensure that the right type of painkiller is administered to the patient.
The Context for Medication Errors
During the administration of medication, nurses may often forget to insert the catheter, or when it is detached they may fail to reattach meaning the patient will not receive the required dosage (Schroers et al., 2021). There are also cases where the catheter medication is not well monitored by the nurse and this could lead to a patient receiving an overdose that might impact the medication process. Other issues related to critical care nursing include administering the wrong coding for medication and compromising the patient’s health leading to a long stay in the hospital or readmission (Schneidereith, 2017). Apart from long stay and readmission, the patient is likely to suffer harm that includes unintended stroke, increased medical costs due to long stay, and sadly death. The likeliness for nurses to commit medication errors will also follow with the age of the patient leading to high-risk medications.
Population affected
Patients with chronic health conditions are often affected by medication errors as they are often meant to take medications for almost the rest of their lives, making them susceptible to errors such as an overdose or mixing different medications. Research has also shown that children are more likely to be affected by medication errors than adults (Schroers et al., 2021). While in terms of practice, male nurses are more likely to medication administration errors than female nurses. Patients who are apt to be poly-medicated, like those with geriatric conditions are also likely to fall victim to medication errors, especially during a hospital stay.
Potential Solutions in reducing medication errors
One of the ways that medication errors can be reduced in a hospital environment is by developing an effective and efficient process of medication reconciliation. This is important as it keeps patients safe and reduced cases of readmission. It is also important to have a standard channel of communication when it comes to medication administration, nurses and physicians should make it a tradition to use electronic health records and channels during medication administration, documentation of what has been administered to the patient, and acknowledgment of instructions given to the nurse by the physician when it comes to issues around medication. It is also important to ensure that there is an organized way of exchange of information during discharge, especially between the nurses, what is posted on the electronic records, and the pharmacist (Schroers et al., 2021). However, when it comes to the inpatient setting, it will be important for the pharmacy department to also ensure that there right coding for all medication, the medication should also be properly labeled to ensure that the nurse can visually acknowledge the medication which is being administered to a patient. Coding should also consider dosage, the name of the manufacturer, expiry dates of the medication, and recommended dosage as communicated in the electronic health records among other factors.
Ethical Principles
Concerning the use of ethical principles to reduce medication error, nurses should consider the non-maleficence principle which means that nurses must not harm intentionally (Gorgich et al., 2015). The principle of non-maleficence thus requires the nurse to provide a standard level of care by avoiding risk or minimizing the risk related to medication administration. One of the ways that nurses can do this is by ensuring that there is accurate medication reconciliation during discharge (Gorgich et al., 2015). Also if the nurse realizes he or she has committed a medication error, it is important that they or disclose the incident to the administration in the best interest of the patient, which also goes in hand with the principle of beneficence. If nurses learn to practice transparency in communication and full disclosure immediately after an error occurs, then they can help reverse any detrimental outcome.
Conclusion
This paper discussed medication administration errors by nurses in a hospital environment as a current healthcare issue. In conclusion, medication error is one of the leading causes of patient readmission, long stay, increased medical costs, and death. Various interventions such as training for nurses on medication, application of electronic health records, and exercising ethical principles must be applied by nurses to ensure that medical administration errors are reduced and incidences reported in due time.
References
Alandajani, A., Khalid, B., Ng, Y. G., & Banakhar, M. (2022). Knowledge and attitudes regarding medication errors among nurses: A cross-sectional study in major Jeddah hospitals. Nursing Reports, 12(4), 1023-1039. https://doi.org/10.3390/nursrep12040098
Dehvan, F., Saeed, D. M., Hasanpour Dehkordi, A., & Ghanei Gheshlagh, R. (2019). Quality of life of Iranian patients with type 2 diabetes: A systematic review and meta-analysis. Nursing Practice Today. https://doi.org/10.18502/npt.v6i4.1939
Gorgich, E. A., Barfroshan, S., Ghoreishi, G., & Yaghoobi, M. (2015). 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://doi.org/10.5539/gjhs.v8n8p220
Izadpanah, F., Nikfar, S., Bakhshi Imcheh, F., & Amini, M. (2018). Assessment of frequency and causes of medication errors in pediatrics and emergency wards of teaching hospitals affiliated with Tehran University of medical sciences (24 hospitals). Journal of Medicine and Life, 11(4), 299-305. https://doi.org/10.25122/jml-2018-0046
Marufu, T. C., Bower, R., Hendron, E., & Manning, J. C. (2022). Nursing interventions to reduce medication errors in pediatrics and neonates: Systematic review and meta-analysis. Journal of Pediatric Nursing, 62, e139-e147. https://doi.org/10.1016/j.pedn.2021.08.024
Salar, A., Kiani, F., & Rezaee, N. (2020). Preventing the medication errors in hospitals: A qualitative study. International Journal of Africa Nursing Sciences, 13, 100235. https://doi.org/10.1016/j.ijans.2020.100235
Schneidereith, T. (2017). Nursing students and medication errors: Why don’t they question? Creative Nursing, 23(4), 271-276. https://doi.org/10.1891/1078-4535.23.4.271
Schroers, G., Ross, J. G., & Moriarty, H. (2021). Nurses’ perceived causes of medication administration errors: A qualitative systematic review. The Joint Commission Journal on Quality and Patient Safety, 47(1), 38-53. https://doi.org/10.1016/j.jcjq.2020.09.010