Strategies To Reduce Harming Patient From Medication Error
Question:
What strategies can be implemented to reduce harming patient from medication error?
Answer:
A medication error is an umbrella term that encompasses all kinds preventable events that might cause or contribute to administration of wrong or inappropriate medication, thereby directly resulting in patient harm. This also includes the process of prescription, ordering communication, packaging, labeling products, nomenclature, dispensing, distribution, compounding, education, administration, monitoring, and use (Alsulami, Conroy and Choonara 2013, p.995). The academic reflection helped in gaining a sound understanding of the fact that there is a need of reviewing all medications from senior nurses or the MIMS, before administering it to any patient, with the aim of preventing any medication error.
The ‘Five Rights of Medication Administration’ were identified as a major strategy by one article, for eliminating chances of medication errors across healthcare settings. The article suggested that most healthcare professionals, especially the nursing practitioners, should demonstrate a sound understanding of the ‘Five Rights’ of medication administration, namely, right patient, right drug, right dose, right time, and right route (Kim and Bates 2013, p.591). Strength of the article is related to its selection of the topic related to medication errors. However, the study was conducted at a single hospital and the researchers did not address the ethical issues. Trustworthiness and validity are established by the precision of results regarding low adherence to the guidelines. Major strength of this strategy lies in the fact that it places a focus on individual performance, rather than human factors and defects in the system (Dolansky et al. 2013, p.103). Unless the health organisations are capable of formulating a set of procedural rules, the strategy cannot be appropriately implemented due to issues that exist in the system.
Another article identified the role of medical reconciliation procedures in preventing high rates of medication errors, in hospitals. This strategy encompasses the procedure of comparing the medication orders of a patient, to all medications that he/she has been taking. Such reconciliation has been found effective in avoiding or reducing chances of several medication errors that occur due to medicine duplications, omissions, drug interactions, or dosing errors (Kwan et al. 2013, p.398). The article’s strength lies in its recognition of the potential benefits of medical reconciliation related to clinically significant medication discrepancies and visits to the emergency department. The fact that it also evaluated the cost effectiveness of the strategy was another strength of the article. Limitations are related to uncertainity that surrounded assumptions about the reductions in ADEs. Validity and trustworthiness are established by similarities with other findings that found medical reconciliation as a potential intervention. The phase of transition in care often encompasses several changes that occur in the service, practitioner, setting, or levels of care. Therefore, the five stages that are involved in the process of medical reconciliation namely, (1) developing a list of current medications, (2) developing a list of medications that will be prescribed; (3) comparing the medications from the two lists; (4) making clinical decisions, based on comparison, and (5) communicating the new list to the primary caregivers and patients have been found effective in reducing the rates of medication errors across healthcare settings (Lehnbom et al. 2014, p.1301).
The authors identified the process as a state where a nursing professional, working on same or incoming shift has the role of reviewing new orders for ensuring that each order for a patient is duly noted, followed by its correct transcription on the orders given by the physician and the MAR (medication administration record) or treatment administration records (Alsulami et al. 2014, p.1405). The article’s strength can be attributed to the fact that it focused on identifying the major contributing factors involved in medication errors. However, the search strategy used for the systematic review did not prove effective as the databases were biased to English published articles. Validity and trustworthiness are established by the precision of the results of the articles included in the review. Strength of this strategy lies in the fact that it is an independent cognitive task, and not any superficial routine task. However, it can be deduced from the evidences that there needs to exist explicit definitions in the medical organisations, for double or triple checking, which if not applied consistently, might result in dilution of the potential safety benefits of the patients.
Evidences are also available that consider it utmost importance of having a physician or nursing professional read back the prescribed medications, before they are administered to the patient (Kellett and Gottwald 2015, p.16). Strength of the study is related to the fact that it considered all previous research studies that were successful in illustrating the benefits of this strategy in ensuring appropriate transcription of the ordered medication, and also elaborated on the steps that comprise this strategy. However, one limitation was related to the failure to illustrate more on the effects of human factors. Similarity with other findings that elaborated on the role of re-reading medications that can be conducted from one nursing practitioner to the next, established the validity and trustworthiness of the article. The benefit of this strategy is based on the fact that stating back the order helps in obtaining a confirmation from the individual, initially involved in prescribing the set of medications. However, huge workload and staff shortage can possibly create barriers in implementing this strategy, thereby violating the safety of the patients.
Evidences have also identified the role of computerized prescribed systems in reducing such errors due to the fact that such electronic prescribing outline the ability of sending error-free, understandable and accurate prescriptions, in an electronic form, from the concerned healthcare professional. This has been identified as an appropriate strategy because it eliminates chances of errors that can occur due to illegible handwritten prescriptions, thereby decreasing risks that pertain to liability (Radley et al. 2013, p.472). Its strength lies in the fact that it was the first attempt to produce a nationally representative account of the effects of CPOE on frequency of medication error. Weaknesses can be attributed to variations in detection mode of medication error across the included articles. Its trustworthiness and validity is established by similarities with previous evidences. However, lack of computer literacy among the healthcare professionals might prevent its appropriate implementation.
Thus, it can be concluded that the situation related to medication error that was witnessed can be addressed in a safe manner, upon utilization or implementation of the strategies mentioned above. When faced with such events in future, the primary objective would be to take all possible efforts to ensure that the patients are being administered the correct drug, in addition to abiding by the five rights, since it is the primary duty of a nurse to emphasise on patient safety in health care.
References
Alsulami, Z., Choonara, I. and Conroy, S., 2014. Paediatric nurses’ adherence to the double?checking process during medication administration in a children’s hospital: an observational study. Journal of advanced Nursing, vol.70, no.6, pp.1404-1413.
Alsulami, Z., Conroy, S. and Choonara, I., 2013. Medication errors in the Middle East countries: a systematic review of the literature. European journal of clinical pharmacology, vol.69, no.4, pp.995-1008.
Dolansky, M.A., Druschel, K., Helba, M. and Courtney, K., 2013. Nursing student medication errors: a case study using root cause analysis. Journal of professional nursing, vol.29, no.2, pp.102-108.
Kellett, P. and Gottwald, M., 2015. Double-checking high-risk medications in acute settings: a safer process. Nursing Management (2014+), vol.21, no.9, p.16.
Kim, J. and Bates, D.W., 2013. Medication administration errors by nurses: adherence to guidelines. Journal of Clinical Nursing, vol.22, no.3-4, pp.590-598.
Kwan, J.L., Lo, L., Sampson, M. and Shojania, K.G., 2013. Medication reconciliation during transitions of care as a patient safety strategy: a systematic review. Annals of internal medicine, vol.158, no.5_Part_2, pp.397-403.
Lehnbom, E.C., Stewart, M.J., Manias, E. and Westbrook, J.I., 2014. Impact of medication reconciliation and review on clinical outcomes. Annals of Pharmacotherapy, vol.48, no.10, pp.1298-1312.
Radley, D.C., Wasserman, M.R., Olsho, L.E., Shoemaker, S.J., Spranca, M.D. and Bradshaw, B., 2013. Reduction in medication errors in hospitals due to adoption of computerized provider order entry systems. Journal of the American Medical Informatics Association, vol.20, no.3, pp.470-476.
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