Medication Administration Error
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Abstract
Medication administration errors have been a severe medical administration problem for many years. It is defined as the mistake linked with medicine and intravenous solutions that are mainly created during transcription, dispensing a prescription, and administration preparation and distribution of drugs. Medication administration errors have severe effects on the patient, healthcare provider, and even healthcare institutions and organizations. To the patient, the effects vary from physical injury to death. To medical practitioners, medication administration errors may result in depression, guilt, and even shame. The institution may incur compensation costs. Medication administration errors are caused by various system and personal factors. This paper comprehensively discusses medication administration errors as one of the significant health care management problems. It discussed the actions that resulted in medication errors, the effects, and how they can be addressed. Medication administration error continues in hospitals even after medical practitioners have gone to great lengths to reduce cases of mortality and morbidity from such mistakes.
Keywords: Medication administration errors, personal factors, healthcare providers.
Introduction
For many decades, medication administration errors have persisted in several hospitals in the world. The medication administration issue has been the focus of research and scrutiny. Many individuals have chosen medication administration topics primarily because its error directly results in inpatient mortality and morbidity. The great need to offer patients safe and optimum drives researchers and healthcare practitioners to develop plans to curtail occurrence of administrative errors in health care facilities. Nonetheless, medical administrative errors still occur despite these great attempts by academics and practitioners.
Medical administrative mistakes are fundamentally considered as the failures occurring in healthcare facilities. The medication administration rights comprise of proper medication, dose, patient, route, and time. The five rights have been included in the nursing learning curriculum as the universal process to guarantee the safe administration of medicine. However, studies have highlighted that administration in a healthcare facility is part of the complicated process of medication use, where multidisciplinary teams collaborate and work together to deliver patient-centered care (Gonzales, 2010). As a result, the five rights cannot guarantee safe medication administration as a separate process. They work together with other additional four rights to ensure the safe delivery of medication to the patients. The additional four rights comprise right action, documentation, response, and form. As the current healthcare systems keep evolving, system design (clinical and technological workflow) emphasis has been essential to supplement medication. Medication administration error includes human-related and system-related errors. Medication errors caused by the hospital systems comprise distractors, inadequate training, system misconfiguration, and convoluted processes.
The development of quality and safe use of medicines has encouraged different medical practitioners globally to reconfigure how they theorize the safe use of drugs and examine the long-accepted medical administrative practices. In the last quarter of 2003, medical practitioners from New Zealand implemented a comparable plan of the same name to handle medication administration issues and uphold patient safety in the hospital (Gonzales, 2010). The plans offer unique opportunities to nurses to improve patient care quality by participating in practice initiatives at national policy levels. Medical practitioners must engage actively in this debate and participate in enhancing knowledge and understanding in this area.
Literature Review
Medication Administration Errors Definition
Different investigators define medication administration errors differently. The different definitions for this topic are present in published literature and research. One of the most critical definitions states that medication administration error is the aberration from the order of the doctor’s medication as mentioned on the patient’s chart (Rodriguez-Gonzalez et al., 2012). The deviation generally disagrees that errors due to doctor’s prescription are fundamental causes of medication administration errors. Nonetheless, the definition that has been composed and used by the nurses states that medication administration error is the mistake linked with medicine and intravenous solutions that are mainly created during transcription, dispensing a prescription, and administration preparation and distribution of drugs.
Medical administration errors are categorized as omission or commission acts and may comprise wrong patient, dose, route, timing, and drug. Other errors are the opposite indicated drug for that particular patient, the wrong form of drug, the wrong administration site, the expired date of medication, prescription error, and the wrong infusion rate. These errors can either be intentional or accidental.
Prevalence of Medication Administration Errors
Despite efforts made by different entities in various countries to reduce medication administration errors, it remains prevalent. Many entities have put great efforts into reducing errors during medication administration, including streamlining processes and the implementation of modern technologies. Studies have indicated great error rates during the administration of medicine. The studies have estimated intravenous administration to have higher medication administration rates varying between 48 and 53 percent (McLeod, Barber, & Franklin, 2013)… Thus, researches and investigations have proven medication administration errors to be prevalent in hospitals.
Additionally, other studies emphasized that a considerable percentage of errors in medication administration are more prevalent in hospitalized children. The high prevalence in children is primarily because of the complication of pediatric dosing, which is often weight-based. The pediatric dosing includes medicine doses given based on estimations of heights and weights. Weight variabilities employed during calculation raises the likelihood of the medication administration error (Gonzales, 2010). The existence of this variability complicates medication dose preparation in pediatric populations, increasing chances of medicine administration errors.
Rate of Medication Error
Ways of determining medication administration error rates vary significantly and depend on the selected measurement method to examine the error rates. Nonetheless, an accurate approach of gauging medication administration is practice observations. Some observational investigations determined that medication administration error rates in acute care hospitals range between 14.9 and 32.4 percent (Subramanyam et al., 2016). The drug administration error for intravenous treatment is considerably greater than other medication types. Studies observed the administration error rate to be 34 percent and the preparation error rate to be 26 percent (Subramanyam et al., 2016). The sum of all the observed drug administration errors portrayed that error existed in every two of ten doses.
When handling the medication administration rates issue, investigators always return to the universal categories to describe different ways where errors occur. These aspects cover errors in the wrong dose, wrong administration rates, and calculation errors. Studies have stated that the most occurring error in hospitals is the inaccurate four push rates, where 88% of doses are administered inappropriately. Another commonly observed error is the wrong administration rates between 5 and 21.6 in 100 doses administered. Dosage omission varied between 8.1 and 50 in 100 administered doses (Subramanyam et al., 2016). Errors related to allergy were the last commonly observed error. It ranged between 1.3 and 1.8 in every 100 administered doses.
Factors Influencing Medication Administration Errors
The factors promoting medicine administration errors in hospitals are categorized into three sub-groups. The subgroups comprise factors instigated by healthcare practitioners and those that are triggered by systems errors. The third issue is the reporting incident.
System Issues
Health facilities are complex systems that consist of both technological and human aspects. The systems are mostly considered to encompass equipment, design, operators, environment, and supplies. These are components in which medication errors may occur. One of the complex sub-systems of the hospital is medication. Therefore, preparing, prescribing, and administering drugs depends on several processes designed to provide appropriate treatment to the patients (Keers et al., 2013). Nonetheless, when a problem occurs in any stage of either the medication process or organizational system, it enhances the possibility of making an error during medication administration, compromising patient safety.
Additionally, researchers and experts have found several system factors that affect the patient’s safety concerning medication administration. The discovered system issues include level of patient acuity, nursing staff, and access to policy and medication documentation. Consequently, health facilities have developed system plans to minimize system errors. The system strategies comprise buying a single intravenous medication pump type that needs access to particular computer software and program to change the pump’s settings. However, few investigations have been carried out to examine the impacts of these system approaches employed to minimize medication administration errors in hospitals (Keers et al., 2013). Currently, the attention has shifted to organizational system errors. For instance, the British National Health Systems and the Veterans Health Administration in the US have significantly changed their strategies to adverse events. The two health administrations concentrate on the system factors that cause an error while filling the gap and failings in a system instead of concentrating on individual capabilities. The new healthcare administration’s new approach is to reduce the reoccurrence of an event instead of assigning blame to different individuals and parties. The focus on enhancing systems to evade errors has resulted in a significant decline in the error occurrence rate.
Professional Factors
Professional issues are the factors that directly influence the practice of an individual healthcare practitioner. Often, medication administration errors have been associated with specific professional characteristics, concentrating on the competencies, skills, and attributes of the individual practitioners. For instance, studies have discovered that an individual practitioner causes medication error due to a lack of understanding and knowledge about the treatment (Keers et al., 2013). The lack of information, knowledge, and understanding comprises the failure to calculate medication dosage, which considerably increases the nurse’s possibility of making an error. This is essential in neonatal intensive care and pediatric settings where drugs administration and usage are primarily determined by body weight.
Incident Reporting
The subject of reporting medicine administration errors has been primarily discussed in researches and literature. It has been recognized that many accidents during drug administration are not always reported, and the near-miss accidents are nearly never reported by nurses. The nurses are always afraid of reporting accidents during drug administration mainly because they need to introduce themselves when reporting and take responsibility when they are directly involved in the error (Keers et al., 2013). The nurse or other medical practitioner may lose their jobs if they are prone to making mistakes during drug administration. Drug administration is a critical practice in hospitals. It significantly determines the survival possibility of the patient. Thus, errors during medication administration should be avoided at any cost as they can lead to the patient’s death.
Besides, studies have shown how nurses and other medical professionals are afraid of the consequences of reporting errors while administering medication to patients. Adverse disciplinary actions make healthcare professionals not report medication errors to their seniors. As a result, nurses and physicians always hold on to their version of what exactly signifies a medication administration error. Most nurses always engage in processes that pursue mediation between practical constraints and institutional policy governing daily practices in the hospital. A research by Hung et al. (2016) showered that the attitude of the coworkers and managers significantly affects the possibility of the nurses to report error incidents. Thus, the healthcare facilities should enhance nurses’ recognition and awareness of medication error occurrence.
Similarly, the format of the reporting forms significantly affects medication error reporting in hospitals. Many of the incident forms are designed in a way that system errors are not acknowledged. Due to this reason, many healthcare practitioners and researchers have proposed changing incident forms to include the identification of system factors. Also, the researchers have suggested anonymous reporting where nurses do not have to identify themselves while reporting and errors (Keers et al., 2013). The two strategies have been proposed to encourage nurses and medical practitioners to develop the urge of reporting any medication error and even near-misses. Also, the strategies to incident reporting factor enhance the chances to identify the issues promoting system-related errors. That means, the approach will concentrate majorly on the individual nurses and ignore most of the system related factors. There is a great need to change incident reporting methods to encourage medical practitioners to report medication errors. Therefore, to encourage incident reporting in hospitals, the management should reduce the severity of the consequences and develop strategies that do not focus on a single individual.
Solutions Analysis
There are a number of approaches that can be employed to mitigate the instances of medication errors in hospitals. Many healthcare institutions have employed both low- and high-tech strategies to help reduce medication errors by improving safe drug administration, which aligns with the nine rights of drug administration. Most of the low-tech strategies corresponds to the nine rights and the use of standardized communication approaches.
Low-Tech Solutions
Caregiver and Patient Education
Patient and caregiver training is one of the low-tech approaches that has been employed by hospital management and medical practitioners to reduce the risks of medication administration errors. To alleviate the risks of medication errors when the patient has been discharged from the hospital, it is essential for health care professionals like nurses to train the patients on how to train patients and their caregivers how to administer medication (Parry et al., 2015). Health care practitioners should use formal language with common terminologies to train their patients to enhance understanding. Routine patient education is essential, mainly when the medication schedules are changed or modified. Most of the errors occur mainly because the patient or the caregiver does not understand how and when to administer medication. The primary challenge patients and caregivers face is understanding the medication administration regime and even the interventions to enhance understanding and communication. Therefore, it is crucial for health practitioners to educate patients and their caregivers to understand their medication schedules.
Patient education is an essential medication management component, especially with high-risk medications, including anticoagulation therapy. Routine patient education is essential to understand the therapy indication, symptoms of acute events, and the intended results. For instance, anticoagulation medicines, such as warfarin tablets, are categorized by their strengths by all their producers to help reduce the chances of wrong dose errors. Thus, medical practitioners should always advise their patients to check the tablet color properly after getting a new prescription. The color of the tablet should not change if the prescription is not altered. It requires thorough and continuous training of the patients and their caregivers for them to understand the issues related to color differences during anticoagulation therapy.
Standardized Communication
Standardized communication is another strategy employed by medical institutions to mitigate errors due to medication administration. They are set of rules that govern medication are properly communicated to the patients. As a result they mitigate errors that may arise due to medication administration. The rules have been used in various drug information resources, and product labeling to signal medical professionals to sound alike and look like medicine. Similarly, standard numerical conventions and abbreviations are highly suggested by Joint Commission. There are some standards for numerical doses expression which are discouraged by the commission. Some discouraged communication includes trailing and leading decimals (such as 2.0mg and 0.2mg). They are highly discouraged because of the possibility of misreading. For instance, 2.0mg can be read by the patient as 20mg, significantly increasing the risk for medication administration error.
Improving Workflow of Nurses to Reduce Potential Error
In healthcare systems, there are many distractors during the process of medication administration. The distractors are highly linked with increased severity and risk of errors. Reduced interruptions when administering medication and establishment of safety checks by ensuring constant workflow are vital strategies to enhance safe medication administration. However, there are significant challenges linked with a completely distraction-free area. A study discovered that a completely free zone is highly effective but has limited sustainability and feasibility.
Besides, increased high-risk administration areas, including emergency departments or intensive care units, permanently reduce the non-interruption zone observance because the medication passes frequencies and nursing workflow and titration events. To reduce nursing interruptions, health systems should recognize areas where preparation of medication administration by nurses frequently occurs. Also, independent double check strategy can be employed to enhance safe medication administration. Independent double checks involve two or three different medical practitioners to intercept errors before administration with high-alert medications. The two or three different practitioners will do a completely different assessment before medication administration. Through this kind of workflow, a high percentage of errors can be detected.
High-Tech Solutions
High-tech prevention measures and solutions adopted by healthcare systems comprise patients’ armbands, smart infusion pumps, and barcode scanning. All these solutions guarantee the proper medication to the right patient, the correct route, and the appropriate administration rate.
Smart infusion Pumps
The infusion pumps have been highly employed in current years to minimize medication administration errors. The devices have dose error reduction software to ensure the proper dose administration to the patient. A study confirmed that a high percentage of hospitals in the US are currently using smart infusion pumps. Even though the pumps provide significant patient safety benefits, they are prone to human or implementation factors, including complex programming needs and difficult user boundaries that creases higher chances for medication errors (Giuliano, 2018). A vital step to reduce these errors is using a drug library to guarantee accurate programming of the pump.
Barcode Medication Administration
Barcode medication significantly reduces drug administration errors in healthcare settings when appropriately used. According to Bonkowski (2013), the barcode scanning technology mitigates errors by using medical and medication records to electronically connect the appropriate dose of a suitable drug at the right time to the right patient. The barcode scanning technique significantly reduces potential adverse drug events and errors due to medication technology. Also, timing errors are significantly reduced when using barcode scanners. Nonetheless, barcode medication administration is subject to many workarounds and usability issues that may reduce its practice effectiveness. Therefore, all the mentioned factors should be appropriately considered for the equipment to function correctly and reduce errors to a greater extent.
Discussion
Medication administration error continues in hospitals even after medical practitioners have gone to great lengths to reduce it. It has adverse effects to adverse effects on the patient ranging from physical injury to death. Also, it causes severe psychological, emotional, and financial stress to the healthcare provider facility and organizations. Medication error is a mistake that can be prevented. Medical professionals who unintentionally administer the wrong medication to the patient or encounter a near-miss may suffer from self-doubt, guilt, depression, and even shame. The adverse effects of these syndromes are life-threatening. For instance, there are many instances where medical professionals commit suicide because they administered the wrong dose to the patient. Additionally, patients or their family members may sue healthcare providers and the institution where the nurse is employed (Alomari et al., 2013). As a result, healthcare institutions and organizations may incur substantial legal settlement costs. Also, the healthcare organization may stand a loss of the nurse staff who are involved directly in the error. This occurs when the medical professionals are exposed to harsh punishments such as expulsion. The hospital will lose their staffs as a result of medication administration error.
Conclusion
In a nutshell, medical administration is an essential part of offering safe patient care. Despite a considerable desire to provide safe and high-quality care by medical practitioners, errors in medication errors still are experienced at both personal and system levels. Medical professionals such as nurses have relaxed when it comes to developing initiatives that focus on addressing medication administration errors and related issues. Nonetheless, health care providers have developed considerable skills in medication administration and have significant understandings concerning the systems. The knowledge is utilized ad assessed within quality programs addressing medication administration issues. The safe and quality use of medicine groups offers worldwide nurses a greater chance to participate in policy development in safe medication use.
References
Alomari, A., Wilson, V. J., Davidson, P. M., & Lewis, J. (2015). Families, nurses and organizations contributing factors to medication administration error in pediatrics: a literature review.
Bonkowski, J., Carnes, C., Melucci, J., Mirtallo, J., Prier, B., Reichert, E. Moffat-Bruce, S., & Weber, R. (2013). Effect of barcode‐Helped medication administration on emergency department medication errors. Academic Emergency Medicine, 20(8), 801-806.
Giuliano, K. K. (2018). Intravenous smart pumps: usability issues, intravenous medication administration error, and patient safety. Critical Care Nursing Clinics, 30(2), 215-224.
Gonzales, K. (2010). Medication Administration Errors and the Pediatric Population: A Systemic Search of the Literature. Journal of Pediatric Nursing. 25(6): 555-565.
Hung, C. C., Chu, T. P., Lee, B. O., & Hsiao, C. C. (2016). Nurses’ attitude and intention of medication administration error reporting. Journal of clinical nursing, 25(3-4), 445-453.
Keers, R. N., Williams, S. D., Cooke, J., & Ashcroft, D. M. (2013). Causes of medication administration errors in hospitals: a systematic review of quantitative and qualitative evidence. Drug safety, 36(11), 1045-1067.
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Parry, A. M., Barriball, K. L., & While, A. E. (2015). Factors contributing to Registered Nurse medication administration error: A narrative review. International journal of nursing studies, 52(1), 403-420.
Rodriguez-Gonzalez, C. G., Herranz-Alonso, A., Martin-Barbero, M. L., Duran-Garcia, E., Durango-Limarquez, M. I., Hernández-Sampelayo, P., & Sanjurjo-Saez, M. (2012). Prevalence of medication administration errors in two medical units with automated prescription and dispensing. Journal of the American Medical Informatics Association, 19(1), 72-78.
Subramanyam, R., Mahmoud, M., Buck, D., & Varughese, A. (2016). Infusion medication error reduction by two-person verification: a quality improvement initiative. Pediatrics, 138(6).
