Nurses’ Perspectives On Medication Administration Errors

Causes of Medication Administration Errors

Write about the Critical Appraisal for Research Design and Methodology.

Nurses are charged with the responsibility of administering medication and prescribed drugs to patients.  Medication error is defined as any event that can be prevented and is likely to cause harm to patients or consumers (Keers, Williams, Cooke & Ashcroft, 2015).  In the process of drug administration, many errors are likely to occur depending on many factors, some of which will be discussed in this study.  Medication errors result into health care expenses and cost the lives of patients.  Approximately 20 percent of medication errors arise from medication administration and during medication prescription by nurses (Schnock et al., 2016). 

This paper is a critical appraisal of the article – Smeulers, M., Onderwater, A. T., Zwieten, M. C., & Vermeulen, H. (2014). Nurses’ experiences and perspectives on medication safety practices: an explorative qualitative study. Journal of nursing management, 22(3), 276-285. In order to solve these errors, there was need to carry out a study on the possible causes of medication administration errors and the best solutions to the problem.  To implement safety practices by nurses, it is important to study how they perceive medication administration errors (Berdot et al., 2016).  This study was carried out in a health care of a college institution that had twenty nurses who had different views on health safety and possible solutions to medication administration errors.  Medication errors can be prevented when preventive measures are taken (van der Veen et al., 2017).

Medication errors occur to any person and at any given place; it could be at home, health facility, doctor’s office, or even the senior hospitals.  Children are at a higher risk of medication errors since they require a variety of drug doses than adults.  The most common cause of medication administration errors is poor communication.  It could be poor communication between doctors and patient or nurses and doctors. Drug names that sound alike may also result into MAEs (Ohashi, Dalleur, Dykes & Bates, 2014). Many attempts have been used to prevent medication administration errors but most of them have failed.  Knowledge is the best defense to solve medication errors. This will help improve accuracy. 

Bar-coded administration for many years was believed to be the most effective way of preventing medication administration errors, but it was later realized that it had some faults.  It could not be used in cases where one lacked limbs to be used for entry of information.  Furthermore, in cases of power blackout or low battery, the bar code machine would be inefficient (van der Veen et al., 2017).  Some of the risk factors that are because of medication administration errors include unexpected harm especially when the correct process of administering a drug was used but the drug is a wrong one.  Allergic reactions may occur to a patient who is using medication for the first time (Parand, Garfield, Vincent & Franklin, 2016).

Solutions to Medication Administration Errors

It was therefore necessary to carry out a study that would device the best way to curb medication administration errors since the devised methods yielded minimal results.  The main aim of this study is to investigate on nurses’ perspectives and experiences in eliminating medication administration errors (Raban & Westbrook, 2014).

A qualitative interview was conducted among twenty nurses between the months of March and December 2011 (Smeulers, Onderwater, Zwieten  & Vermeulen, 2014). The research was conducted at a tertiary care university hospital situated in Netherlands (Smeulers, Onderwater,  Zwieten & Vermeulen, 2014).  Each ward contains 30 beds and each nurse is designated patients whom they prescribe and administer medication.  Nurses record and document the prescriptions and administrations of each patient on paper.  Clinicians prescribed medication through an electronic prescribing system (Bogner, 2018).

Those who participated in the study involved qualified nurses.  To obtain varied ideas, nurses from different levels of seniority and different departments were selected.  Nursing ward managers and nursing managers were reached through email requesting them to take part in a study that aims to improve medication safety (Kelly, Harrington, Matos, Turner & Johnson, 2016).  Stratified sampling was then used o obtain names of other nurses who would take part in the study.  These nurses represented different departments and training seniority.  They also had to have varying attitude on medication safety.  All participants were requested via email and text messages to take part in the research (Nanji, Patel, Shaikh, Seger & Bates, 2016).

Individual interviews were done to all the twenty nurses.  Each interview lasted between 30 to 60 minutes.  The interview was semi structured and this gave the interviewees a chance to speak openly with the guidance of two of the researchers (Smuelers et al., 2014).  The topic was divided into different sections after collection and analysis of data from around 10 interviewers.  The participants were advised to reflect upon the topic towards the end of the study.  Participants were informed that the aim of the study was to obtain their perspectives and experiences on eradication of medication errors.  With the consent of interviewees, the interview sessions were recorded for analysis (Smuelers et al., 2014).

Data analysis and interview process were done in parallel.  Guidelines of qualitative research were used for data analysis with the help of software.  Each interview was coded and the codes compared until uniform results were reached.  Consensus meetings were also held to reach uniform results from the interview.  Themes related to preventive measures of MAEs were identified during data analysis (Van Cott, 2018).

Results of the Explorative Qualitative Study

 From the analysis, three major themes were evident: Ability of nurses to work safely, nurses roles, and responsibilities and acceptance of nurses to comply with safety practices.  Some of the possible ways to curb medication administration errors were derived from the study (Smuelers, 2014).

Ability of nurse to work with minimal medication errors depends on risk awareness, circumstance, and environment in which the nurses work.  Knowledge of consequences of medication errors equips nurses with awareness of possible risks of MAEs (Nuckols et al., 2014).  Delayed administration of medication or even failure to administer medication is seen as a problem that is dangerous to specific medications.  When nurses perform a medication error, awareness should be made and this would lead to special attention to the particular error and nurses become more cautious.  This should be practiced in cases were a particular error is reported often (Keers, Williams, Cooke  & Ashcroft, 2015).

Environment in which nurses work also affects medication safety.  Nurse’s workload in the hospitals makes them have pressure and is likely to get loose focus and administer wrong medication.  Because of this, more nurses should be trained and employed.  Short vacations and retreats would help nurses regain their concentration (Durham, Suhayda, Normand, Jankiewicz, & Fogg, 2016).

Nurses ought to admit when they perform a medication error and report the matter immediately; this would help rectify the error before it gets worse.  They should also accept to perform practices that promote medication safety.  Nurses should use all their senses and be alert when handling patients (Raban & Westbrook, 2014).

Conclusion

Medication administration errors are harmful to patients and consumers; there was therefore a need for this study to be conducted.  Nurses play a major role in radiating eradication administration errors.  When the nurses are aware of the effects of these errors, they will be keener.  When nurses are burdened with work, they are prone to performing errors due to fatigue, this problem can be solved by ensuring work is evenly distributed among workers, more nurses employed and retreats set aside for the sake of refreshing nurses minds.  Nurses should also agree to take precautions as they perform their duties and report any error caused immediately for quick actions.  To ensure medication administration errors are reduced, nurses should adhere to the above safety practices.

References

Berdot, S., Roudot, M., Schramm, C., Katsahian, S., Durieux, P., & Sabatier, B. (2016). Interventions to reduce nurses’ medication administration errors in inpatient settings: A systematic review and meta-analysis. International journal of nursing studies, 53, 342-350.

Bogner, M. S. (2018). Human error in medicine. CRC Press.

Durham, M. L., Suhayda, R., Normand, P., Jankiewicz, A., & Fogg, L. (2016). Reducing medication administration errors in acute and critical care: multifaceted pilot program targeting RN awareness and behaviors. Journal of Nursing Administration, 46(2), 75-81.

Keers, R. N., Williams, S. D., Cooke, J., & Ashcroft, D. M. (2015). Understanding the causes of intravenous medication administration errors in hospitals: a qualitative critical incident study. BMJ open, 5(3), e005948.

Kelly, K., Harrington, L., Matos, P., Turner, B., & Johnson, C. (2016). Creating a culture of safety around bar-code medication administration: an evidence-based evaluation framework. Journal of Nursing Administration, 46(1), 30-37.

Nanji, K. C., Patel, A., Shaikh, S., Seger, D. L., & Bates, D. W. (2016). Evaluation of perioperative medication errors and adverse drug events. Anesthesiology: The Journal of the American Society of Anesthesiologists, 124(1), 25-34.

Nuckols, T. K., Smith-Spangler, C., Morton, S. C., Asch, S. M., Patel, V. M., Anderson, L. J., … & 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), 56.

Ohashi, K., Dalleur, O., Dykes, P. C., & Bates, D. W. (2014). Benefits and risks of using smart pumps to reduce medication error rates: a systematic review. Drug safety, 37(12), 1011-1020.

Parand, A., Garfield, S., Vincent, C., & Franklin, B. D. (2016). Carers’ medication administration errors in the domiciliary setting: a systematic review. PloS one, 11(12), e0167204.

Raban, M. Z., & Westbrook, J. I. (2014). Are interventions to reduce interruptions and errors during medication administration effective?: a systematic review. BMJ Qual Saf, 23(5), 414-421.

 Smeulers, M., Onderwater, A. T., Zwieten, M. C., &Vermeulen, H. (2014). Nurses’ experiences and perspectives on medication safety practices: an explorative qualitative study.  Journal of nursing management, 22(3), 276-285.

Schnock, K. O., Dykes, P. C., Albert, J., Ariosto, D., Call, R., Cameron, C., … & Husch, M. M. (2016). The frequency of intravenous medication administration errors related to smart infusion pumps: a multihospital observational study. BMJ Qual Saf, bmjqs-2015.

Van Cott, H. (2018). Human errors: Their causes and reduction. In Human error in medicine (pp. 53-65). CRC Press.

van der Veen, W., van den Bemt, P. M., Wouters, H., Bates, D. W., Twisk, J. W., de Gier, J. J., … & Ros, J. J. (2017). Association between workarounds and medication administration errors in bar-code-assisted medication administration in hospitals. Journal of the American Medical Informatics Association, 25(4), 385-392.