Quality improvement project

Medical Administration Errors
Student’s Name
Professor’s Name
Medical Administration Errors
Project Title
Reducing medication errors by checking on the rights of medication and how they are being
administered in Holmesglen Private Hospital.
Statement of the problem
In healthcare, the most common intervention in reduction of injuries is medication; which
may come along with errors. Medication errors have a negative impact on the patient and society
both clinically and economically (Ng et al., 2016). The Australian Commission on Safety and
Quality in Healthcare’s report on admissions in Australia indicates that there is a 3% average
medication errors in all hospital admissions. Of the total medication errors, 9% occur during
administration of medication. Medication errors are multidisciplinary and nurses have the biggest
role in combating the errors due to the level of interaction they have with the patients. Promotion
of safety and reduction of adverse incident occurrences is a responsibility accorded to stakeholders
in healthcare, professionals, patients and families to the patients (Australian Commission on Safety
and Quality in Health Care, 2012). Evidence from studies have revealed that due to limitations on
time and the perceived notion by nurses that they know their patients well, nurses tend to deviate
from procedural check, therefore, increasing the risk of errors in medication administration
(Young, Cochran, Mei, & Adkins-Bley, 2015). To reduce medication errors in administration of
medication there is need for training and education that is focused on how nurses handle
interruptions and disruptions when medication is administered in healthcare systems (Hewitt,
Tower, & Latimer, 2015; Xu, Li, Ye, & Lu, 2014).
Barrier to Quality
Before the proposal of this quality improvement project, nurses were observed by a select
number of students while in their workstations. The observations were directly supervised by the
Nurse Manager who withheld the purpose of the observations from the nurses. This was effective
in reducing the Hawthorne effect (Kermode, Richardson-Tench, & Taylor, 2014) that would have
tampered with the results of the observation. The observation revealed that there was a high
percentage in medication administration errors. Most of the medication errors were a result of
interruptions and disruption of nurses during the process of medication administration. The main
cause of these interruptions and administrations was the busy nature of the hospital. The handling
of the medication errors also noted to be a main contributor of the errors hence the need for an
understanding and improvement in handling of interruptions and disruptions during medication
Project Aim
The aim of this quality improvement project is to reduce Medication Administration Errors
(MAE) in the cancer ward of Holmesglen Private Hospital in one year through understanding and
improving medication administration for nurses. This will later be facilitated through educating
and training nurses in the cancer ward and undergraduate nurses.
Background of the Problem
Medication administration errors have been an issue in various medical facilities. These
errors arise due to various reasons, some of which can be averted or reduced. Safety in healthcare
is a multidisciplinary issue that needs to be addressed from the source. An increase in adverse drug
reactions from previous studies indicate the need for action in containing this problem hence the
proposal of combating interruptions and disruptions through education and improvement of skills
for both registered nurses and student nurses. The revision and improvement of curriculum for
student nurses has also been an issue being featured in various studies.
Literature Review
Medication errors in hospitals
In one of the studies, Hayes et al. (2015) aimed to explore available information on
interruptions and distractions on the administration of medication based on undergraduate
education for nurses (Hayes et al., 2015). Their review is based on incidents and errors that occur
during the administration of medication. They noted that the incidents continue to be a significant
issue in the safety of patients in healthcare institutions globally (Hayes et al., 2015). Interrupting
administration of medicine was noted as the leading reason for errors in medication administration.
Their review on literature revealed that some of the interruptions could not be avoided. Therefore,
in order to reduce the errors that happen when medication is administered, there is a need to
understand the process of learning medication administration for undergraduate nurses and how
they learn to deal with interruptions in the process of administering medication. The results of the
study revealed that researchers who have been in the field have responded to the effect of
interruptions and distractions in administration of medication by trying to eliminate them (Hayes
at al., 2015). Quality improvements which have been introduced in administration of medication.
However, there is little knowledge on how nurses manage the interruptions and distractions when
they are administering medication or how they acquire knowledge on how to deal with them
(Feleke et al., 2015). The researchers identified the literature gap that is lack of information on
innovative and sustainable strategies which help nurses who are undergraduate to learn on safe
and confident management of interruptions in medication administration. The study concludes that
there is a need for further studies to discover on how nurses gain knowledge on management of
interruptions and distractions during the administration of medication (Hayes at al., 2015). This is
a significant issue due to the relationship between error rates in medication administration and
Reducing nurse medicine administration errors
Drug administration errors by nurses has been an issue and is a great contributor to
morbidity and mortality (Wright, 2013). Some of the factors leading to these errors include
working in complex healthcare environments which are characterized by noise. They are busy and
susceptible to interruptions and distractions which usually requires nurses to multitask. According
to Biron et al (2009) research, there is a lack of a clear definition of “interruptions” in medication
administration. Cleary-Holdforth and Leufer (2013) states that interruptions and disruptions are a
major reason for reduced concentration in nurses during medication administration. There are
various suggestions to reduce drug administration errors (Choo et al, 2014). However, there is a
significant lack of pharmacology knowledge among nurses. One method that can reduce the gap
in knowledge is the establishment of structured precetorship programme in medicine
administration which will support newly qualified nurses or those with less experience the
administration of medicine.
Undergraduate students have been noted to lack adequate preparation in safe administration
and management of medication when learning (Vaismoradi et al, 2014). Experienced nurses or
practitioners can intervene in the transition process from newly qualified nurse to expert nurse
(Fowler, 2011). Every clinical practice area should allocate new and experienced nurses adequate
to make improvements in pharmacology knowledge and in developing their profession in
medication administration. This will drive the push the drive for the increase in knowledgeable
and confident practitioner as well as creation of a safer environment for patients. It will also
increase satisfaction for both the staff and patients (Morgan et al, 2012). Knowledge and
competence among student nurses in medical administration and management may also improve
by engaging them in theoretical and practical clinical examinations that have objective structuring
(Hemingway et al, 2011). The literature indicates a lack in education and professional development
for both registered nurses and students. Education programs are significant in improvement of
nurses’ competence and their legal obligation (Miller and Emanuel, 2010).
Wang et al (2015) conducted an intervention study that was aimed at reducing medication
administration errors in in-patients. The study includes comprehensive interventions like process
optimization, educational, information technology, and organizational measures. Medical
administration errors derived was subjected to data mining through a compulsory electronic
reporting system. The study revealed a constant decrease in MAEs in six months with a decreased
occurrence rate. The study noted that there were lesser medication errors among experienced
nurses. Medication errors made by nursing staff cannot be eliminated. However, they can be
reduced through in-depth and efficient multi-disciplinary collaboration between hospital
administrators, information engineers, nurses, pharmacists, physicians, and hospital
administrators. These are vital to ensuring safety in medication administration.
Analysis of literature review
Generally, the literature review reveals that there is a need to swiftly make enhancements
in training and ensure regular updates in the nurses’ training curriculum (Jeffreys, 2015). The
nurses’ curriculum is bound to create competent and well trained nurses with a curriculum that is
firm and strong. The nurses will be willing to ensure that the safety of medication is upheld through
adhering to safe practices when they are on their routine work. Moreover, thorough training of the
nurses will eventually yield competency of practice (Boltz et al., 2013). This area needs a lot of
dedication and effort in the elimination of factors that present a threat medication safety and
ensures there is no compromise in anyone’s safety through avoidable mistakes and errors.
Current/Ideal State
Current State
Currently, the number of interruptions and disruptions during medication administration
are high as shown by the results of the statistics. The busy nature of the hospital had a great
contribution in the number of medical administration errors. A majority of the nurses showed
discrepancies in medication administration especially after interruptions and disruptions. Over 100
medication errors were recorded during the observation period.
Ideal State
While there haven’t been high numbers of fatal incidents due to medical errors, there is
still a need for an ideal situation where patients can be hospitalized without worrying on medical
errors that may occur. Therefore, the ideal state is a reduction of the number of medical
administration errors by half through the promotion of proper knowledge acquisition for student
nurses. The quality improvement’s project aim is to maintain this improved state to ensure that
patients receive care that is focused on their wellbeing.
Project Details
The project will take a PDSA (plan, do, study and act) strategy to implement and assess small
changes. The PDSA model will help reduce medication errors in the private hospital through
making enhancements in the curriculum of undergraduate nurses and ensure that the curriculum
receives constant updates.
1. Plan
This quality improvement project aims at enhancing reducing MAEs at the cancer ward of the
Holmesglen Private Hospital through improvement of the curriculum for training both registered
nurses and student nurses in order to help make competent decisions during medication
administration to reduce errors made in this section. Second year students will be assigned nurses
whom they will monitor as they do medication administration to make observations under the
supervision of the nurse manager. The observations will be made with the aim of identifying
discrepancies that need improvement in the curriculum. Random patients will also be interviewed
to see whether they have an understanding of the medication being administered. Data from the
direct observation will be collected by the nurse manager who will later submit to a committee
allocated with the responsibility to review the curriculum.
2. Do
The nurses will be invited to a workshop where they will be allowed access to the data collected
from the observation. They will be given a chance to give their input on areas that they need
improved in the curriculum. In the meantime, the nurses will be given short courses on how to
reduce medication administration errors and asked to use the skills they learn when on duty. The
refresher courses will be aimed at improving the skills of nurses in the ward as well as ensuring
that there is a reduction in the number of medical administration errors. Information acquired from
the literature review will also be shared with the nurses to allow their input in the matter as well
as ensure that they understand the importance of the project.
3. Study
The project aims to reduce medication administration errors by 50% through increasing
knowledge on handling of interruptions and disruption during the process of medical
administration in the ward. The main obstacle to be overcome in this project is to ensure that all
nurses will be available for the workshop. All the nurses will have to be present for the successful
implementation of the project. This is a major obstacle to the project due to the busy nature of the
hospital which at times requires the nurses to contribute in emergencies that may need all hands
on deck.
4. Act
There is a need for the creation of a new PDSA cycle that will have all the nurses in the ward
being participants. This move aims to ensure that the project is successful and there is a maintained
improvement in medical administration. The success of the project at the cancer wing will entail
successful reduction of MAEs by half of the number recorded during the observation. Students
will be sent to the cancer wing for a second observation to prove the project’s success. Upon
clarification of the project’s success, the strategy will be shared with nurse managers in other wards
as well as other healthcare institutions. Training institutions will be given information on the
project to test its functionality and possibly make it part of the curriculum as a push for better
training of student nurses.
Concluding Remarks
Due to the multidisciplinary nature of medication safety, the involvement of the PDSA cycle
is a small step towards establishment of a better foundation and reduction in medication
administration errors (Paparella, 2008). World Health Organization (2016) proposed safe primary
care that is person centered. The project will, therefore, the effective completion of this project
will consequently lead to a contemplation of effective and efficient administration of medication
in healthcare systems which is a move towards WHO’s proposal of safe person-centered primary
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