Medication Errors In Nursing

Running head: MEDICATION ERRORS IN NURSING

MEDICATION ERRORS IN NURSING

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MEDICATION ERRORS IN NURSING 2

Abstract

A medication error involves divergence from the prescribed details in the patient’s chart. The

methods for identifying medication errors are such as questionnaires, incident reports, direct

observation, and the critical incident technique. Observation is the paramount error detection

method when finding accuracy. One of the significant concerns with medication errors report is

the order transcription. The aim and objective of understanding medication error in nursing are to

eliminate such errors to avoid patient complications. Main results indicate the effectiveness of

the method and conclusion indicating whether the method increases or decreases the medication

errors. Implications indicate the supposed repercussions of using the method and measures put in

place to mitigate the study. The errors are not all caused by nurses but due to the storage

conditions and the hygiene of the hospital environment. If a medical center has stagnant water

that creates a breeding point for mosquitoes that bite patients when they visit the center, the

errors done by the cleaning officers can cause such problems as being infected by diseases like

malaria. Accidents happen in any organization, but the areas that affect the health of the people

should be handled with great care to avoid errors. In the health sector, simple mistakes can lead

to the loss of lives due to the issue of wrong medications that can be poisonous to patients. The

research in this paper will cover the root causes of errors in nursing and suggest the possible

solutions that can help to reduce the errors. The factors causing the errors will be evaluated, and

the associated country for the research will be Ethiopia based on the previous findings (Feleke,

Mulatu, & Yesmaw, 2015).

MEDICATION ERRORS IN NURSING 3

Medication Errors in Nursing

Introduction

Administration of medication is a multi-step process that involves prescribing,

transcribing, dispensing, and administering drugs to patients. Errors in administration account for

a majority of all medication errors, and nurses are responsible for administering drugs to patients

(Wright, 2013). As such, nurses are required to pay close attention to physician instructions and

other hospital staff orders to help prevent the occurrence of medication errors. The principal

objective of this review is to evaluate the various interventions aimed at reducing medication

errors among children in pediatric units. Additionally, the paper proposes several interventions

targeted at reducing the occurrence of medical errors among the said population. Safety in

medication is vital to a patient and ensures security and quality in care. Despite medications

being believed to heal and cure diseases, they can also have adverse effects on patients. Errors

done in prescriptions (Edwards, & Axe, 2015) given to patients can cause serious dangers to

patients. “Reasons, why some medication errors are not reported, include reporter burden,

professional identity, information gap, organizational factors, and fear (Metsälä, & Vaherkoski,

2014).”

PICO (T) Question

A PICOT analysis identifies the population, intervention, comparison, outcome, and time.

In this case, the population under study is the pediatric patients with a particular medical facility.

The intervention is the use of health information technology in reducing medication errors

(Metsälä & Vaherkoski, 2014). The comparison is whether the technology would be useful in

achieving its result. The outcome is the reduction of medication errors in pediatric facilities.

MEDICATION ERRORS IN NURSING 4

Population/Patient/Problem

The human population is affected by cases of errors done during medicine prescriptions.

The errors occur because of accidental prescriptions or due to multi-tasking of nurses that occupy

the mind hence forgetting to issue the right dosage. Severe side effects are symbols of a wrong

prescription that is due to an error caused during the treatment process of issuing medicine. The

right dose has to be offered to patients to avoid causing more problems or patients suffering from

painful and severe side effects of wrong medications. Some of the factors that contribute to

errors in the nursing industry are the storage conditions of the drugs in hospitals. Changes in

temperatures can greatly affect the effectiveness of the medicine hence leading to severe side

effects that might lead to the development of other symptoms (Diakite, Payne, Todd, & Parker,

2013).

Indicator and Intervention

The idea of nurses engaging in many activities while attending to a patient causes the

mind to forget. The forgotten idea leads to a wrong prescription that makes patients suffer more

and in many cases worsen the situation of their sickness. It can be difficult to discover the effects

of the activities, but at the end, the patients will come back with more problems that are caused

by the errors done by the nurses. For example, the patient comes back to the hospital before

completing the dose and complains of more problems than before is a result of an error during

the issue of medicine.

Comparison

The comparisons of the drug prescribed by nurses from the hospital and drugs bought

from chemists have a great difference. When the symptoms are not severe can the pharmacists

MEDICATION ERRORS IN NURSING 5

issue medication that can help in relieving the pain? The pharmacists concentrate when issuing

the medicine, unlike nurses who have long queues in hospitals that lead to errors in prescriptions.

However, the drugs purchased from chemists are for relieving pain but not treating the cause of

the disease. After some time the symptoms arise, and the patient will require professional

attention from the nurses.

Outcome

As the world is growing digital and much of the activities are done online, the patient

records and prescriptions should be recorded in the hospital databases to ensure the right

information and dose is offered. However, the person issuing the medicine can confuse the

information and interchange within patents. Instead, the computerized system should be used to

seal and print the patient names on the medicine envelopes. With such a policy and system, the

patients can read the information printed on the envelopes to ensure that the names are right and

that no confusion can be done. “As the primary outcome, we defined the number of patients with

at least one identified medication error in the drug handling process before (baseline) and after

the three-step intervention. As secondary outcomes, we defined the overall frequency of errors,

errors per observed process and errors per patient (Niemann, Bertsche, Meyrath, Koepf, Traiser,

Seebald, & Bertsche, 2015).”

Aim(s) and Objective(s) of the review

The reason for this research is to evaluate the effectiveness of health information

technology in reducing the frequency of medication errors among the pediatric patients under a

well-established human resource management system. Also, the review will analyze the existing

MEDICATION ERRORS IN NURSING 6

evidence on the selected topic to identify current interventions and their effectiveness in

preventing medication errors in the pediatric unit.

Inclusion and Exclusion Criteria

The review utilizes several inclusion and exclusion criteria to generate a comprehensive

list of literary sources on the topic. Studies to be used for the analysis include cohort studies,

clinical trials, meta-analyses, and systematic reviews of clinical trials. These research studies are

better preferred as they contribute quality evidence that is likely to be applied in a clinical

setting. Specifically, the review includes research studies that target pediatric patient in the

hospital and assess the effectiveness of health information technology in reducing medication

errors. Research studies that describe the situation without evaluating the impact of the use of a

health information technology initiative (HIT) on reducing medication errors among the target

population will not be part of the review as their contribution to evidence on the topic is minimal.

However, they will be used for reference purposes to enable the researcher to obtain an overview

of the issue, as well as to provide background information.

Methods: Systematic Review

Some important databases, which would be used for search strategy, include Pub Med,

MEDLINE, and CINAHL. These databases are preferred in this context as they contain a wide

array of medical, scientific literature, thus likely to produce high-quality evidence on the issue of

medication errors. Other sources of information that were part of the review include Google

Scholar, which is a highly reliable source of gray literature. To prevent publication bias, the

researcher will ensure that the selected studies accurately coincide with scientific evidence. Also,

meta-analyses are better preferred since they aren’t biased and incorporate numerous

MEDICATION ERRORS IN NURSING 7

participants. Search strategies employed to refine the search results include the use of Medical

Subject Headings (MeSH) terms and Boolean operators. MeSH terms utilized for this review

include clinical informatics, health information technology, medical computer science, critical

medical incidents, medical mistakes, medical errors or commission/omission, and hospitalized

child, among others. Additionally, the Boolean operators applied to the literature search include

terms such as OR, AND, NOT and further refine the search results.

However, some of the medication errors are created within the work environment or by

the nurses. Some of the activities engaged while attending to a patient can lead to mind

destruction that can cause errors to occur (Karavasiliadou & Athanasakis, 2014). “Of the person-

related factors, nurses’ work experience in the nursing profession and the unit; nurses’ fatigue,

sickness, and nervousness. Also, asking for help from other health professionals during

medication administration; and double-checking were used, as well as the number of patients and

number of bed-ridden patients under the nurse’s control. Work environmental factors were

interruptions and distractions, such as noise, rush, answering a phone or patient call, distractions

created by a patient or other personnel, and additional people in the medication room causing

distractions (Härkänen, Ahonen, Kervinen, Turunen, & Vehviläinen‐Julkunen, 2015).”

Critical Application and Data Extraction

Once identified, the research studies to for use in the review need to be critically

appraised to ascertain their relevance to the study. This list is comprehensive in that it analyzes

various aspects of the research study including the conceptual framework, intervention,

comparison, participants, results of the survey, and the impact of the evidence provided in

nursing practice as described in the PICOT question.

MEDICATION ERRORS IN NURSING 8

Synthesizing the evidence

Eight studies were identified in the search. All eight studies got implemented in a hospital

context, and their aim was reducing the incidence and frequency of medication errors in the

various pediatric sections according to the PICOT question under study. Four of the studies were

carried out in neonatal and pediatric intensive care units, while two of the studies got

consideration in one pediatric medical ward and one surgical ward. The last two reviews were in

place in a pediatric emergency department.

All the studies aimed at implementing various forms of health technology to help

minimize the number and frequency of medical errors arising in these departments. The system

supported the process of drug administration by confirming crucial information such as the drug

type, dose, route, time and frequency, and the identity of the participant by scanning the barcodes

on the unit-dose medication and patient wristband (Kim, & Bates, 2013). The study equipped

half of the beds with the BCMA system while the other half were not, and acted as the control

groups. Data was obtained from medical records and incident reports on prepared by two

pediatric nurse practitioners in the wards under investigation. Data got collected in four weeks

after which a conclusion on the severity and preventability of the different errors were in place

by a team consisting of a neonatologist, a pediatric clinical pharmacist, and two pharmacists.

The research intended at evaluating the effectiveness of the system in reducing pediatric

medication errors compared to the use of the same system in an adult population. The

intervention was carried out in the pediatric and neonatal intensive care units, and surgical and

pediatric medical wards. Medication dosage checks were provided along with a pediatric weight-

based dosage calculator after which wrong dosage alerts, allergy alerts, and drug interactions got

MEDICATION ERRORS IN NURSING 9

noted. The primary outcome was the rate of non-intercepted medication errors that were serious.

The pediatricians made judgments regarding the severity and preventability of the reported

medication errors. Data was collected from hospitalized patient records over some months before

and after installing the system. Observation is another way of ensuring that patients are treated

well and the way they are handled with great care (Young, Cochran, Mei, Adkins-Bley,

Ciarkowski, & Wagner, 2015).

The control group was made up of patients who had been in the hospital for one medical

and two pediatric surgical wards that used handwritten orders as usual. There was the collection

of data for over a nine-month period after implementation of the system after which two

physicians assessed the medication errors database and classified the incidents as either adverse

drug events, potential adverse drug events, and others. Two medical students reviewed all the

charts for all the patients and extracted demographic, therapeutic, and clinical data into a

database.

Critique of the Articles

The critique of articles was of paramount importance in the determination of the most

suitable way of medication errors reduction in the nursing practice. A gap existed in the area that

necessitated the need for research to establish an outcome that could be used to mitigate the issue

of medication errors. Information health technology was considered one of the most preferred in

realizing the much-needed solution. It was with consideration on technological flexibility as it

could be implemented in any circumstance or scenario. On top of that, it could accurately track

all the processes and procedures and alert on major areas of concern. However, there were

challenges such as homogeneity of the study hence a need to determine the accuracy of the

MEDICATION ERRORS IN NURSING 10

technology. Therefore, the articles adequately comment on the PICOT question and uphold all its

considerations. “Exploration of medication administration error as an outcome of human

behavior rather than as an individual event may offer new insights regarding the contributors to

medication administration error (Parry, Barriball, & While, 2015).”

Study Results

Due to the heterogeneity of the research design, outcome measures and methods of data

collection and analysis, it was difficult for a homogeneous data synthesis of the selected studies.

Overall, all the studies reported significant improvements as a result of the interventions. Based

on the results, both potential and preventable adverse drug events were made minimal, although

medication errors increased after the implementation of the BCMA. The study also recorded a

seven percent decrease in non-intercepted serious medication errors, which the authors note is

significantly lower than that recorded for adults.

Medication errors and adverse drug events got selected as the primary outcomes for the

study. Before the intervention, 173 medication errors (4.48 per 100 admission days) in the

intervention wards, while the control wards recorded a total of 243 (4.80 per 100 admission

days) medication errors. Following the implementation of the system, medical mistakes in the

intervention wards decreased to 120 (3.13 per 1000 admission days), while the control wards

recorded 268 (5.19 per 1000 admission days).

Finally, the last group reported the results of using structured preprinted order sheets in

the pediatric emergency department. The primary outcomes of the study included the total

number of medication errors recorded and the medication errors that were put as significantly or

severely harmful to the patients. The results identified 68 medication errors in the regular forms

MEDICATION ERRORS IN NURSING 11

and 37 in the new order sheets, a significant decrease. Potentially harmful medication errors were

also reduced from 36 when the regular prescription forms were used to 14 in the new ways, again

a substantial drop took place.

Summary of Results

The review included eight studies describing three organizational interventions that were

a target of reducing medication errors and undesirable drug events in a pediatric hospital setting.

It includes adopting a computerized system, a barcode medication administration system

(BCMA), and a pre-printed, structured prescription form (Cabilan, Hughes & Shannon, 2017).

The studies indicated a reduction of the medication errors, but there was no proof on the decrease

of patients’ effects. Therefore, the studies had several shortcomings translating to affecting the

final evidence. The review identifies two systems: a computerized physician order entry system

and a barcode medication administration system. Implementation of the computerized physician

order entry (CPOE) system required flexibility to adapt the constant children weight changes.

The system used was suitable in this regard, as it contained specific features used in a pediatric

unit such as a weight-based dosage calculator and electronic dosage checks.

Comparing the reviewed studies to the existing literature highlights several strengths and

weaknesses of the studies. Additionally, the use of a CPOE system also introduces other errors

such as typographical errors and poor designs of screens, therefore, highlighting inconsistencies

in the system. The same results are reported by similar groups although in this case an increase in

potentially harmful adverse drug events was noticed. Some of the interventions addressed

include; installing CPOE systems, using preprinted order sheets, pharmacist participation,

protocol implementation, and education although a majority of the studies reported statistically

MEDICATION ERRORS IN NURSING 12

significant results, they presented high risks of bias (Teunissen, Bos, Pot, Pluim, & Kramers,

2013).

Conclusion

The evidence presented on this topic is not conclusive and should receive consideration

when implementing. Concerning the implications on practice, organizations that consider

endorsing these interventions should be aware that the evidence is limited both, regarding

volume and regarding regarding quality. The review also develops several implications for

research. First, methodological studies are primary before any evidence-based review. Future

research efforts should focus on selecting study designs that eliminate bias as much as possible

while maximizing generalization.

Similarly, interventions should include components that focus on the specific issues that

affect medication safety in pediatric settings. For instance, technological interventions should

address matters such as calculation aids, alerts in case of the wrong dosage, and close monitoring

among others. Non-technical interventions need to be explored in detail, as these could be

important in regions where technology is not feasible. Attention should also focus on recruiting

comparable participant groups or study settings to make it possible for comparisons. “At present,

minimizing medication errors and ensuring the adequate and efficient delivery of medicine to

patients should largely depend on good training and communication between healthcare

professionals with the assistance of the electronic medical system. An effective, efficient, and

comprehensive education program of medication administration should be routinely provided to

caregivers (Chen, 2013).”

MEDICATION ERRORS IN NURSING 13

To sum it up, future research activities should target at evaluating the impact of

medication errors rather than merely the incidence and frequency. Also, researchers should

ensure that they provide consistent definitions of medication errors and patient harm as current

studies indicate a wide variation. Consequently, future studies should aim at addressing the

impact on this population group, as well as conducting the research activities in standard hospital

settings as opposed to highly specialized pediatric units in tertiary hospitals.

MEDICATION ERRORS IN NURSING 14

References

Cabilan, C., A Hughes, J., & Shannon, C. (2017). The use of a contextual, modal, and

psychological classification of medication errors in the emergency department: A

retrospective descriptive study. Journal of Clinical Nursing, 26(3), 5-6

Chen, C. J. (2013). Medication errors in pediatrics. Pediatrics & Neonatology, 54(1), 3-4.

Diakite, M., Payne, A., Todd, N., & Parker, D. L. (2013). Irreversible change in the T1

temperature dependence with thermal dose using the proton resonance frequency‐T1

technique. Magnetic resonance in medicine, 69(4), 1122-1130.

Edwards, S., & Axe, S. (2015). The 10 ‘R’s of safe multidisciplinary drug administration. Nurse

Prescribing, 13(8), 398-406.

Feleke, S. A., Mulatu, M. A., & Yesmaw, Y. S. (2015). Medication administration error:

magnitude and associated factors among nurses in Ethiopia. BMC Nursing, 14(1), 53.

Härkänen, M., Ahonen, J., Kervinen, M., Turunen, H., & Vehviläinen‐Julkunen, K. (2015). The

factors associated with medication errors in adult medical and surgical inpatients: a direct

observation approach with medication record reviews. Scandinavian journal of caring

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Karavasiliadou, S., & Athanasakis, E. (2014). An inside look into the factors contributing to

medication errors in the clinical nursing practice. Health Science Journal, 8(1), 32-44.

Kim, J., & Bates, D. W. (2013). Medication administration errors by nurses: adherence to

guidelines. Journal of Clinical Nursing, 22(3-4), 590-598.

MEDICATION ERRORS IN NURSING 15

Metsälä, E., & Vaherkoski, U. (2014). Medication errors in elderly acute care–a systematic

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Metsälä, E., & Vaherkoski, U. (2014). Medication errors in elderly acute care–a systematic

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Niemann, D., Bertsche, A., Meyrath, D., Koepf, E. D., Traiser, C., Seebald, K., ... & Bertsche, T.

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handling in pediatric care. Journal of clinical nursing, 24(1-2), 101-114.

Parry, A. M., Barriball, K. L., & While, A. E. (2015). Factors contributing to Registered Nurse

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Ensuring Safe Medication Administration through Direct Observation. Quality in

Primary Care.

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