Enhancing Quality and Safety in Medication Administration

Patient safety and care quality are healthcare’s most vital objectives, directly affecting treatment success and patient satisfaction. The constant quality improvement provides an increase in the overall efficiency of health care services. However, several issues interfere with quality enhancement and negatively affect patients’ health outcomes. The severe concern is medication error, “any preventable event that may cause or lead to inappropriate medication use or patient harm,” as described by the National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP, n.d). Medication errors (M.E.s) related to drug administration are frequently made by nurses. Such errors can occur throughout the health system; however, this paper aims to highlight the gravity of this issue within acute care settings.

Acute hospitals imply short-term yet vital treatment services such as emergency or intensive care. This setting implies many distractions and requires urgent medical attention quick decision-making, as well as may involve administering high-risk drugs in large doses. In such conditions, the probability of committing a medication administration error (MAE) is high. Thus, MAEs interfere with patient safety, and nurses should apply the best strategies and solutions to minimize administration-related errors for care quality improvement.

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Overview of Medication Errors

M.E.s are a critical health care issue leading to minor and severe harm to the patient. According to the U.S. Food and Drug Administration (FDA, 2019), there are more than 100 000 reported presumed cases of M.E.s annually. Much more patients experience M.E.s without reporting, and up to 9 thousand people die in the U.S. each year due to such errors (Tariq et al., 2021). Enormous expenses accompany those compromising patients’ health and life-threatening mistakes: the total care cost for patients suffering from M.E.s is over $40 billion per year (Tariq et al., 2021). Furthermore, M.E.s describe health care staff as negligent, carelessness, or inexperienced, which leads to emerging mistrust in health system services.

Factors Leading to Medication Administration Errors

Although M.E.s may happen at any stage of medication use, they frequently occur during administration. It is known that due to several factors, MAEs take place in up to 25% of drug administration (Koyama et al., 2020). The leading causes are inattention and distraction, resulting in such errors as the wrong drug, patient, or dose. Nursing inattentiveness can be associated with high workload, multitasking, and high patient flow (Bucknall et al., 2019). Different expected or unpredictable situations occur simultaneously in any healthcare facility, and it is difficult for nurses to focus. It is especially relevant in the acute care setting, where every health care professional must be ready to provide immediate assistance to patients and co-workers. A nurse may be distracted while preparing or administering a drug by conversations, urgent calls, or acute situations, resulting in the wrong drug or incorrect or extra dose (Tariq et al., 2021). Thus, various distractions lead to the most common administering-related M.E.s.

Another factor that contributes to MAEs is a flaw in competence or skill and insufficient drug knowledge. Other common causes are misunderstandings related to abbreviations or poor handwriting, similar drug names, alike packaging, or the wrong route of drug administration, as well as ignoring recommendations, rules, and protocols for medication usage (Tariq et al., 2021). Mentioned factors lead to MAEs, resulting in patient-safety risk. Nonetheless, most of these factors are preventable human errors and may be reduced by implementing proper strategies.

Strategies to Improve Patient Safety

Enhancement of patient safety and care quality requires reducing M.E.s rates. In turn, improvement in decreasing M.E.s will help to avoid enormous monetary losses. Considering reducing MAEs, the “five-rights” rule should be mentioned primarily. This rule is paramount and obligatory for nurses and involves assuring that “the right patient receives the right drug at the right time in the right dose and by the right route” (Martyn et al., 2019). Every health care professional should double-check the correctness of medication, dose, patient, time, and route before administering, which is described as an exceptional solution in preventing MAEs (Koyama et al., 2020). To avoid MAEs, nursing staff should follow five main rules as well as re-check every step.

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Nonetheless, several studies discuss the necessity of the emergence of new frameworks. A recent study testified that the five-rights rule “while helpful in principle does not reflective contemporary practice” (Martyn & Paliadelis, 2019, p. 116) and does not significantly reduce MAEs rates. According to Martyn et al. (2019), managing workflow, avoiding interruptions, and implementing patient-centered strategies contribute to safe and prompt medication administration. Martyn and Paliadelis (2019) highlighted four key points in providing safe and quality drug administration: appropriate access to tools, sufficient time, fruitful teamwork, and practical teaching. Thus, a new framework should be invented considering that five rights are the foundation that lacks realism and is non-oriented on actual nurses’ daily activities.

Health care professionals have to be experienced and possess knowledge and competence to operate with medications. The study of Martyn et al. (2019) discusses clinical reasoning as a successful strategy. Moreover, the implementation of new teaching strategies may result in nurses’ awareness of proper drug administration. McCabe and Ea (2016) suggested reflection and remediation educational models as appropriate strategies for reducing MAEs. Reflection promotes critical thinking, while remediation allows nurses to ponder and correct mistakes (McCabe & Ea, 2016). Another strategy to decrease MAEs is computerizing and automatizing the process of medication preparation and administration. Risør et al. (2018, p. 464) implemented two automated medication systems and, after researching, concluded that “technological interventions in the M.A. process can reduce the occurrence of medication errors.” Hence, maintaining high-level clinical judgment, critical thinking, and awareness of MAEs are vital strategies in improving patient safety as well as inventing technological solutions.

Nurse Roles

Health care professionals, mainly nurses, carry out most manipulations, especially in acute care departments. Nursing staff represent safety and quality of care by providing patients with appropriate treatment. Regarding the topic, nurses can be responsible for medications’ prescribing, preparing, dispensing, and administering. Therefore, educated, experienced and attentive nurses can avoid M.E.s due to their high competencies. Nurses are key persons in the medication use process since they are the last ones who can prevent MAEs by double-checking if the correct drug is prescribed for the right patient. Moreover, nurses connect all levels of medical staff and coordinate the medication use process since they are right in the middle of the whole range of health care professionals.

Nurse Coordination with Stakeholders

Neglect of interdisciplinary consulting while being unsure about medication leads to the emergence of MAEs. A nurse may need additional information from clinicians, physicians, pharmacists, or other nurses to provide safe drug administration (Bucknall et al., 2019). Poor communication with a patient can also result in MAE due to missing patient information, failure to attain medical and allergy histories, or not knowing that patient tends to suffer from side effects. Nursing staff connects health care professionals with patients and coordinates communication for better mutual understanding. Thus, nurses transfer information between such stakeholders as patients, doctors, and pharmacists to ensure safe medication use. Their primary duties are maintaining appropriate health care and interprofessional communication, coordinating care, and promoting a high level of patient safety.

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Medication errors related to drug administration can result in patient harm up to death. Many factors contribute to the emergence of such errors. Nonetheless, MAEs are preventable incidents, and much effort needs to be invested in investigating the efficiency of better strategies. Reducing the MAEs rate is essential to provide patients with safe and quality care. The nursing staff’s skills, knowledge, and attitudes are crucial and should be maintained at a high level.

References

Bucknall, T., Fossum, M., Hutchinson, A. M., Botti, M., Considine, J., Dunning, T., Hughes, L., Weir-Phyland, J., Digby, R. & Manias, E. (2019). Nurses’ decision‐making, practices and perceptions of patient involvement in medication administration in an acute hospital setting. Journal of Advanced Nursing, 75(6), 1316-1327. Web.

Food and Drug Administration (2019). Working to reduce medication errors. Web.

Koyama, A. K., Maddox, C. S., Li, L., Bucknall, T., & Westbrook, J. I. (2020). Effectiveness of double checking to reduce medication administration errors: a systematic review. BMJ Quality & Safety, 29(7), 595–603. Web.

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Martyn, J. A., & Paliadelis, P. (2019). Safe medication administration: Perspectives from an appreciative inquiry of the practice of registered nurses in regional Australia. Nurse Education in Practice, 34, 111-116. Web.

Martyn, J. A., Paliadelis, P., & Perry, C. (2019). The safe administration of medication: Nursing behaviours beyond the five-rights. Nurse Education in Practice, 37, 109-114. Web.

McCabe, D. E., & Ea, E. E. (2016). Enhancing medication safety teaching through remediation and reflection. QSEN Institute Teaching Strategy. Web.

National Coordinating Council for Medication Error Reporting and Prevention (n.d.). About medication errors. Web.

Risør, B. W., Lisby, M., & Sørensen, J. (2018). Complex automated medication systems reduce medication administration errors in a Danish acute medical unit. International Journal for Quality in Health Care, 30(6), 457-465. Web.

Tariq, R. A., Vashisht, R., Sinha, A., & Scherbak, Y. (2021). Medication dispensing errors and prevention. StatPearls Publishing. Web.

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