Medication Errors In Australia: Causes, Effects, And Prevention Strategies

Causes of medication errors

One of greatest challenges in the health care industry in the present day scenario can be considered the medication errors. Medications errors are of various different types and each of them pose a significant threat to the health and safety of the patients. As per Cheragi, Manoocheri, Mohammadnejad and Ehsani (2013), the total number of medication related adverse events leads to almost AU$1.2 billion per annum. Hence, it is clear that the need for exploring the underlying reasons leading to the different medication errors and how to prevent them is extreme. This essay will attempt to discuss the main causes of medication errors, the effect of these events on patients and health care providers, strategies by the ACSQHC to reduce the frequency of medication errors, and the role of the nursing workforce to reduce the rate of medication errors in the context of Australia.

A medication error can be defined as a failure in the treatment process that potentially leads to severe and sometimes even fatal consequences for the patients. There can be various reasons that can lead to potential medication errors such as prescribing flaws, prescription errors, dosage errors, dispensing error, and most importantly administration flaws (Roughead, Semple & Rosenfeld, 2016). Years of research has been successful in categorizing the exact type of errors that happen in the health care facility on a frequent basis, such as knowledge-, rule-, action- and memory-based errors. On a more exploratory note, it can be mentioned that the prescribing faults that lead to different medication errors are associated with irrational, inappropriate or ineffective prescribing of the medication, under or over-prescribing and errors in writing of the prescription which can be attributed to the clinicians. The second genre of medication errors that occur is the errors in dispensing the formulation such as wrong drug, wrong formulation and wrong labelling. However, it has to be mentioned that the most of medication errors that is reported in the health care facility can be attributed to the administration errors (Parry, Barriball & While, 2015).

The administration errors can be attributed to the mistakes committed by the care provider administering the medication, which are mostly the nurses. These errors are the wrong dosage administration, wrong route administration, administering wrong frequency, and continuing infusion for wrong duration. Vaismoradi, Jordan, Turunen and Bondas (2014), have opined that the most common types of medication errors that are reported are the administration errors, especially the in appropriate dosage and infusion rate errors for intravenous injections, which is the most commonly reported medication rates. Researchers are of the opinion that the lack of pharmacological knowledge and literacy among the nurses is also a credible contributing factor behind the medication errors led by using abbreviation for the drug names instead of full names and the similarities in the drug names.

Effects of medication errors on patients and healthcare providers

The impact of the medication errors are extreme and drastic for both patients, their loved ones and the care providers associated with the medication error. First and foremost, it has to be mentioned that the impact of medication errors ranges from mild harm to even death, each of which has a significant impact on the patient and their family (Tga.gov.au, 2018). Loss of a loved one is a tragic event that has a severely deleterious impact on the patient family, however, apart from death, medication errors cause exacerbation or complications, prolonged stay in the hospital, financial burden due to added health care costs, and most importantly suffering of the patient. The cumulative impact of all the above mentioned results lead to anxiety and depression among the patients and their family members. The impact of medications errors is also considerably high on the care providers as well. Any harm or injury acquired by the patient via a medication error causes an extreme sense of guilt in the care provider. Along with that, administration related medication errors, which is the most common type of medication error, also is a direct mistake committed by the health care professional, and the impact of such a mistake leads to loss of confidence and professional competence along with legal consequences as well. Hence, it is crucial for both patients and the care provider to explore and adhere to a set of preventative and precautionary measures to reduce the rates of medications errors (Parry, Barriball & While, 2015).

There are various legislations and policies which have been designed in order to avoid the risk of medication errors, the policies designed by the Australian Commission on safety and quality in health care or ACSQHC provides the most credible set of directions. First and foremost, there are many strategies that have been developed to improve the safe medication administration practices (Safetyandquality.gov.au, 2018). These strategies include hospital medication charts such as the national inpatient medication charts and pharmaceutical benefits scheme hospital medication charts, medication reconciliation program which mandates the matching of the medicines administered to a patient t what has been prescribed to the patient. The other strategies include safer medicine administration with conjunction with the New Zealand college of Anaesthetists, a position statement on medicine safety in paediatrics promoting best practice in prescribing, dispensing, and administering the medication to paediatric patients, electronic medication management scheme involving national guidelines and on-screen display of medicines, and lastly medication safety in mental health (Safetyandquality.gov.au, 2018). Similarly the patient safety and quality systems section of the clinical governance guidelines also mandates safe administration of medication.

Strategies for prevention recommended by ACSQHC

Although the medication errors are a result of faulty health care delivery design and implementation, the role and responsibility of the nurses cannot be ignored. Lastly, the NMBA registered nurse standards for practice, the 6^th standard states the nursing care provided to be safe, appropriate and responsive (Nursingmidwiferyboard.gov.au, 2018). Hence, medication administration also needs to be safe and careful for the nurse to engage in a safe and effective practice. The nurses are required to be more careful and attentive while administering medication to the patient, so that avoidable errors can be prevented. Along with that, researchers are of the opinion that with the digitalized medication safety tools and resources, the nurses have been reported to be reluctant in embracing the new technologies due to time consuming and complicated procedures. There is need for change in the level of accountability in the nurses with respect to medication administration; although the need for training and skill improvement is vital in changing the issue, there is also need for change in behaviour and attitude towards this issue (Vaismoradi, Jordan, Turunen & Bondas, 2014).

On a concluding note, medication safety is an acute requirement of the present day health care scenario. Although the legislative policies and clinical guidelines provided by the local and national health care authorities is a progress towards reducing the impact of medication errors, yet the role of nurses that provide care cannot be overlooked. Hence, there is need for more extensive training along with behavioural or attitude change in the nurses with response to medication errors, so that the rate of these avoidable adverse events can be eradicated.

References:

Cheragi, M. A., Manoocheri, H., Mohammadnejad, E., & Ehsani, S. R. (2013). Types and causes of medication errors from nurse’s viewpoint. Iranian journal of nursing and midwifery research, 18(3), 228. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3748543/

Clinical Governance for Nurses And Midwives. (2018). Retrieved from https://www.safetyandquality.gov.au/wp-content/uploads/2017/12/Clinical-governance-for-nurses-and-midwives.pdf

Medication Safety | Safety and Quality. (2018). Retrieved from https://www.safetyandquality.gov.au/our-work/medication-safety/

Nursing and Midwifery Board of Australia – Professional standards. (2018). Retrieved from https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards.aspx

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. Doi: 10.1016/j.ijnurstu.2014.07.003

Roughead, E. E., Semple, S. J., & Rosenfeld, E. (2016). The extent of medication errors and adverse drug reactions throughout the patient journey in acute care in Australia. International journal of evidence-based healthcare, 14(3-4), 113-122. Doi: 10.1016/j.mayocp.2014.06.014

Therapeutic Goods Administration (TGA). (2018). Adverse events: Australian statistics on medicines. [online] Available at: https://www.tga.gov.au/publication/adverse-events-australian-statistics-medicines [Accessed 29 Aug. 2018].

Vaismoradi, M., Jordan, S., Turunen, H., & Bondas, T. (2014). Nursing students’ perspectives of the cause of medication errors. Nurse Education Today, 34(3), 434-440. Doi: 10.1016/j.nedt.2013.04.015