Quality Improvement Project

Running head: MEDICAL ADMINISTRATION ERRORS 1

Medical Administration Errors

Student’s Name

Institutional

Professor’s Name

Date

MEDICAL ADMINISTRATION ERRORS 2

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).

MEDICAL ADMINISTRATION ERRORS 3

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

administrations.

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

MEDICAL ADMINISTRATION ERRORS 4

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

MEDICAL ADMINISTRATION ERRORS 5

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

interruptions.

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

MEDICAL ADMINISTRATION ERRORS 6

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

MEDICAL ADMINISTRATION ERRORS 7

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

MEDICAL ADMINISTRATION ERRORS 8

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

MEDICAL ADMINISTRATION ERRORS 9

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

care.

MEDICAL ADMINISTRATION ERRORS 10

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44, 35.

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