In today’s current fast-paced and demanding field of heath care, medication administration has become complex and time-consuming task. Approximately one-third of the nurses’ time is used in medication administration. There is much potential for error because of the complexity of the medication administration process. Since nurses are the last ones to actually administer the medication to the patient therefore they become responsible for medication administration errors (MAE). Reasons for MAE may include individual factors, organizational factors or system factors. This paper will discuss the root causes analysis of MAE and strategies to prevent them.
Root Causes – Fishbone Diagram
Communication
Wieman TJ and Wieman EA (2004) demonstrates communication factors that result in MAE. They say that nurses’ failure to question unclear orders or pursue concerns because of intimidation by prescriber (physician or pharmacist) contributes to these errors. Illegible handwritten orders and ambiguous orders written in MARs or patient profiles further contribute to these medical errors. Moreover, other factors that also contribute are an incomplete medication orders such as missing dose or route, abbreviations misunderstood (Appendix B) (Davis N.M., 2005), and spoken orders misheard. According to Cohen M.R. (2007), nurses’ who contributes to MAE fail to identify the patient (checked ID band, allergy band, MAR sheet), unable to share correct information during the shift report and ineffective communication.
In the above methadone case scenario, the nurse was unable to communicate adequately with the physician and her co-workers. She failed to question the physician about the transcription error (dosage error). She did not apply the “Five me...
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Parker, M. E. (2006). Nursing theories and nursing practice (2nd ed.). Philadelphia: F.A. Davis Company.
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Wakefield, B. J., Holman, T. U., & Wakefield, D. S. (2005). Development and Validation of the Medication Administration Error Reporting Survey. Agency for Healthcare Research and Quality . Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK20599/#N0x1a52fc0N0x5b8ac78
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4). Examples of how nurses can integrate this competency include; using current practice guidelines and researching into hospital’s policies (Jurado, 2015). According to Sherwood & Zomorodi (2014) nurses should use current evidence based standards when providing care to patients. Nurse B violated one of the rights of medication administration. South Florida State Hospital does not use ID wristbands; instead they use a picture of the patient in the medication cup. Nurse B did not ask the patient to confirm his name in order to verify this information with the picture in the computer. By omitting this step in the process of medication administration, nurse B put the patient at risk of a medication error, which could have caused a negative patient
Nurses were the professional group who most often reported medication errors and older patients were those most often affected in the medication errors reports analyzed for this study (Friend, 2011). Medication error type’s revealed omitted medicine or dose, wrong dose, strength or frequency and wrong documentation were the most common problems at Site A where the traditional pen and paper methods of prescription were used; and wrong documentation and omission were the most common problems associated with medication errors at Site B where the electronic MMS was introduced (Friend, 2011). Reports of problems such as wrong drug, wrong dose, strength or frequency, quantity, wrong route, wrong drug and omitted dose were less frequent at Site B (Friend, 2011). The reduced incidence of omission errors at Site B supports suggestions that an advantage of the MMS is easy identification of patient requirements at each drug round time slot. Despite the finding of less omission errors at site B where the MMS had been introduced, there was a relatively high frequency in the incident reports of medication errors related to both omission and wrong dose, strength and frequency at both sites (Friend, 2011).
Unver, V., Tastan, S., & Akbayrak, N. (2012). Medication errors: Perspectives of newly graduated and experienced nurses. International Journal Of Nursing Practice, 18(4), 317-324. doi:10.1111/j.1440-172X.2012.02052.x
Some method such as audits, chart reviews, computer monitoring, incident report, bar codes and direct patient observation can improve and decrease medication errors. Regular audits can help patient’s care and reeducate nurses in the work field to new practices. Also reporting of medication errors can help with data comparison and is a learning experience for everyone. Other avenues that has been implemented are computerized physician order entry systems or electronic prescribing (a process of electronic entry of a doctor’s instructions for the treatment of patients under his/her care which communicates these orders over a computer network to other staff or departments) responsible for fulfilling the order, and ward pharmacists can be more diligence on the prescription stage of the medication pathway. A random survey was done in hospital pharmacies on medication error documentation and actions taken against pharmacists involved. A total of 500 hospital were selected in the United States. Data collected on the number of medication error reported, what types of errors were documented and the hospital demographics. The response rate was a total of 28%. Practically, all of the hospitals had policies and procedures in place for reporting medication errors.
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The topic of this article is medication error related to chemotherapy drugs. Forty percent of medication errors have been related to chemotherapy drugs. It is imperative that the nurses are properly trained on these medications and fully understand what is being administered before giving it to the patient as well as know what the proper dose is before administering anything to the patient. More importantly the nurse must pay close attention to their patient’s response to the chemotherapy given to the patient or it could lead to a serious injury or death.
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Tzeng, H., Yin, C., & Schneider, T. E. (2013). Medication Error-Related Issues In Nursing Practice. MEDSURG Nursing, 22(1), 13-50.
Medication errors made by medical staff bring about consequences of epidemic proportions. Medical staff includes everyone from providers (medical doctors, nurse practitioners and physician assistants) to pharmacists to nurses (registered and practical). Medication errors account for almost 98,000 deaths in the United States yearly (Tzeng, Yin, & Schneider, 2013). This number only reflects the United States, a small percentage in actuality when looking at the whole world. Medical personnel must take responsibility for their actions and with this responsibility comes accountability in their duties of medication administration. Nurses play a major role in medication error prevention and education and this role distinguishes them as reporters of errors.
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Despite the frequency of verbal interactions, miscommunication of patient information occurs that can lead to patient safety issues. . . . ‘Effective communication occurs when the expertise, skills, and unique perspectives of both nurses and physicians are integrated, resulting in an improvement in the quality of patient care’ (Lindeke & Sieckert, 200...
Research has demonstrated that nursing practice guided by theory from a perspective of nursing and caring has shown “improved patient and nurse satisfaction, and improvement in institutional reputation.” (Dyess et al., 2013, p. 167) Nursing theories specifically are created and shaped to describe this phenomenon called nursing. Afaf Meleis defines nursing theory as “a conceptualization of some aspect of nursing reality communicated for the purpose of describing phenomena, explaining relationships between phenomena, predicting consequences, or prescribing nursing care.” (Meleis, 2012, chap.
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