Medication Management And Safety Issues In Nursing: Challenges And Solutions

Medication administration process: complex and critical

Question:

Discuss about the Reflection On Medication Management Error.

There are many challenges that a graduating nurse faces while making the transition from to the stage of professional practice, and one of the myriad of different issues medication management issues are the most frequent. The rate of medication errors and resultant hospital admissions have been identified as the most prevalent reason behind the rate of hospital admissions and hospice referrals. Australian data declares that the rate of medication related hospital admissions have increased by 3% in the last couple for years in Australia itself, and elaborating more on the global context the rates are alarming (Westbrook et al. 2015). It has been observed that the prevalence of medication related hospice admissions have been 12% in all age groups of patient population and close to 30% in the elderly patient population (Nuckols et al. 2014). However, the medication safety and administration are often handled by the nursing professionals and the professional misconduct of the nurses is directly associated with any mishap occurring within the concept of medication safety and administration. However, the novice nurses neither have adequate experience nor adequate training that can help them effectively maintain adequate medication management. And, as a graduating nurse myself one of the major professional issues that I have faced while applying my theoretical knowledge to practical application is the misconduct associated with medication management.

I have chosen medication management and safety issues as the focal point of this reflective assignment as I have faced the majority of challenges in this sector in my placement practice. And the medication management and safety issue that I have gone through the most in my professional tenure is the issues with IV administration and utilizing all the different tools and techniques required for correct IV administration. It has to be understood that there are plenty of medication management issues that can present itself in the health care scenario, although in my opinion, the most of the issues that are prevalent in this sector are due to the extreme gap that has been left behind in between theory and practice (Nuckols et al. 2014). As a nursing student myself I have experienced the fact that it is very difficult for me to have had made a serious connection between the theoretical knowledge that I have gained and the practice scenarios where I have to apply the theoretical knowledge.

Prevalence of medication errors and external/internal factors

It has to be mentioned that the medication administration procedure or MAP is a highly complex and critical procedure which is based on numerous theories and protocols. Although, the process of prescribing the medication is completely based on the critical judgment of the respective physician, the rest of the different phases of the MAP are dependent heavily upon the different nursing professionals who are responsible for the caring of the patients. According to the Ostini et al. (2012), it has to be mentioned that the complex nature and the abundance of overlapping protocols and practice guidelines, the complex nature of the MAP exposes a high amount of risks that can lead to a variety of different medication errors. The different variety of medication management errors can occur in different phases of the MAP, and each of the errors have a significant detrimental impact on the health and safety of the patients, that is the reason why any medication management errors is considered as a severe professional misconduct on the part of the nursing professional under consideration. Although, from my own experience, I would like to emphasize on the fact that there are various external and internal factors that influence the everyday professional practice of the nursing professionals, and hence all of those interrelated factors contribute heavily on the occurrence or frequency of the medication errors as well. These factors include extreme world load, chaotic environment and lack of privacy in the clinical environment, inadequate competency in the nursing professionals, miscommunication and technical errors, and knowledge gap in the new nursing professionals (Westbrook et al. 2015).

According to the article by Leufer and Cleary-Holdforth (2013), the miscommunication and technical errors are one predominant factor that leads to many instances of further complications for the patients and extended hospice stay for the patients in case of experienced nursing processions, for both registered and enrolled nurses. It has to be mentioned that the technological information or patient record maintenance systems are still very new to the health care scenario, and a vast majority of experienced nursing professionals without adequate training on operating the technological devices or idea on the internet linked databases end up making medication administration errors like prescribing the wrong dosage or even wrong medication due to not being able to correctly use the devices, although with the extensive progressive training and skill Improvement programs in the health care system reform under the national government authorities, the older and more experienced nurses are increasingly becoming more and more trained to operate and decipher the electronic information system  devices within the patient information circulation framework and in turn the rate of the medication management errors are decreasing as well (Roughead, Semple and Rosenfeld 2013). The extreme workload and chaotic environment in the clinical setting is one factor that is still a viable reason behind a large number of medication errors in the current health care scenario. According to the article by the Manias, Williams and Liew (2012), concentration is extremely important pursuit in case of maintaining all the critical requirements or protocols associated with medication administration procedure, any distraction during this procedure can lead to errors which will eventually lead to complications and even fatal consequences for the patient under consideration. Elliott et al. (2012), in agreement have opined that extreme work pressure due to the alarming staff patient ratio in the Australia, and the chaos in the professional clinical setting can be a rich source of burnout related exhaustion and distractions, and both of these elements are equally responsible for the misconduct in the MAP procedure.

Challenges with IV medication administration and gaps in knowledge

Reflecting on my own professional experience, the distraction and exhaustion are one of the contributing factors behind the medication management issues I have faced as well. The impact of distraction has also been a significant contributing factor behind the issues u faced with the IV medication administration. Elaborating more on this context, I would like to mention that IV medication administration is extremely complicated and there are a vast variety of protocols and precautionary procedures that are followed to ensure the IV medication is administered with the right dosage and via the right route as per the NSW guidelines. And all these protocols and procedures make the MAP of IV medication even more complicated (Westbrook et al. 2012). Along with that it has to be mentioned that, performing a complicated procedure like the IV medication, distraction has been one of the major contributing factors behind the errors and complications that I have faced. Although, another contributing factor that has contributed majorly to the errors and issues with IV medication administration is the conspicuous gap left behind in the knowledge and understanding of the theoretical concepts and its practical application in the clinical scenarios. And as per my own understanding on this issue, most of the IV medication related issues or errors are associated with the gaps left behind between the theoretical concepts and real world clinical scenarios. According to the article by the Ostini et al. (2012), almost 68% of the total IV medication management and administration issues had been reported to be due to the very limited scope of practice in the coursework classroom scenario and very limited associated or familiarity with the IV infusion devices and such IV medication management related resources. In most cases the graduating nurse is given the task to handle devices for the first time in the clinical setting that the nursing professional must have only theoretical understanding about. The IV medication devices are complex and only theoretical understanding is not enough for a nursing professional to handle it, hence there is need for demonstrative and practice workshops in the coursework itself so that the graduating nurses have the opportunity to have ample practice with devices as complicated as the IV MAP to avoid the risk of medical errors (Redley and Botti 2013). For instance, it has already been emphasized that there are extremely low scope for practice in the graduation coursework for registered nurses, which creates extremely dependent on theoretical knowledge, which inevitably creates chances of errors in MAP process, especially in case of IV medication management. And hence, there is need for more scope for practical application in the coursework design for the graduating nurses. Along with that there is extreme need for periodical specific training that will help the nurses to improve their skills, and along with that implementation of evidence based practice can also help the situation effectively.

Possible solutions to prevent medication errors

As per the guidelines of NMBA, the professional practice standards or a registered nurse includes providing safe and effective patient centered care to the patient with maintaining the optimal quality of practice while handling each and every patient (Nursingmidwiferyboard.gov.au. 2017). Medication management errors on the other hand can be considered extreme violation of the MNBA codes of conduct, and hence, each and every graduate nursing practitioner must employ equal efforts to skill themselves for providing safe and effective care to the patients. As a graduating registered nurse myself I will attempt to take my moral and ethical responsibility towards my patients with grave seriousness and will attempt to bridge the gaps left behind my professional knowledge and skills taking the help of continuous professional development standard of NMBA so that I can avoid making medication management errors and provide efficient holistic care to the patients without any mishaps.

References:

Elliott, R.A., Tran, T., Taylor, S.E., Harvey, P.A., Belfrage, M.K., Jennings, R.J. and Marriott, J.L., 2012. Gaps in continuity of medication management during the transition from hospital to residential care: an observational study (MedGap Study). Australasian journal on ageing, 31(4), pp.247-254.

Keers, R.N., Williams, S.D., Cooke, J. and Ashcroft, D.M., 2013. Causes of medication administration errors in hospitals: a systematic review of quantitative and qualitative evidence. Drug safety, 36(11), pp.1045-1067.

Leufer, T. and Cleary-Holdforth, J., 2013. Let’s do no harm: Medication errors in nursing: Part 1. Nurse education in practice, 13(3), pp.213-216.

Manias, E., Williams, A. and Liew, D., 2012. Interventions to reduce medication errors in adult intensive care: a systematic review. British journal of clinical pharmacology, 74(3), pp.411-423.

Nuckols, T.K., Smith-Spangler, C., Morton, S.C., Asch, S.M., Patel, V.M., Anderson, L.J., Deichsel, E.L. and Shekelle, P.G., 2014. The effectiveness of computerized order entry at reducing preventable adverse drug events and medication errors in hospital settings: a systematic review and meta-analysis. Systematic reviews, 3(1), p.56.

Nursingmidwiferyboard.gov.au. (2017). Nursing and Midwifery Board of Australia – Home. [online] Available at: https://www.nursingmidwiferyboard.gov.au [Accessed 25 Nov. 2017].

Ong, W.M. and Subasyini, S., 2013. Medication errors in intravenous drug preparation and administration. Med J Malaysia, 68(1), pp.52-57.

Ostini, R., Roughead, E.E., Kirkpatrick, C.M., Monteith, G.R. and Tett, S.E., 2012. Quality Use of Medicines–medication safety issues in naming; look?alike, sound?alike medicine names. International Journal of Pharmacy Practice, 20(6), pp.349-357.

Redley, B. and Botti, M., 2013. Reported medication errors after introducing an electronic medication management system. Journal of clinical nursing, 22(3-4), pp.579-589.

Roughead, L., Semple, S. and Rosenfeld, E., 2013. Literature review: medication safety in Australia. Australian Commission on Safety and Quality in Health Care.

Westbrook, J. I., Reckmann, M., Li, L., Runciman, W. B., Burke, R., Lo, C., … & Day, R. O. (2012). Effects of two commercial electronic prescribing systems on prescribing error rates in hospital in-patients: a before and after study. PLoS medicine, 9(1), e1001164.

Westbrook, J.I., Li, L., Lehnbom, E.C., Baysari, M.T., Braithwaite, J., Burke, R., Conn, C. and Day, R.O., 2015. What are incident reports telling us? A comparative study at two Australian hospitals of medication errors identified at audit, detected by staff and reported to an incident system. International Journal for Quality in Health Care, 27(1), pp.1-9.]