Discuss about the issue or trend in nursing or health care.
Medication administration is an integral part of professional nursing practice, where execution of medical orders is done for the recovery and care of patient. The manner in which nurses administer medication to patient is reflective of nursing performance as well as patient safety. However, medication administration is a high risk activity because it involves complex medication calculations and strict adherence to administration methods. Medication errors have become a major issue in nursing practice as nurses fail to adhere to proper guidelines. Besides this, high workload and several distractions and interruptions become a major factor contributing to medication error (Cloete, 2015). Medication error results in serious consequences for patient such as increase in health complications, long duration of hospital stay, increase in mortality rate and high medical expense. Research evidence nursing as also showed that one-third of the medicinal complications occur due to medication Error (Cheragi et al., 2013). Hence, there is a need to explore the reasons and impact of medication error on nursing practice. The main thesis statement to proceed with the topic of medication error is ‘poor adherence to medication administration protocol among nurse is the reason for medication error’. The discussion paper analyzes the topic on the basis of this thesis statement.
In relation to the thesis statement, some of the arguments that support the thesis statement can be made after getting background information on the topic of medication error. Firstly, there is a need to understand what is medication error and what are the different types of medication errors that commonly occurs in health care setting. Aronson, (2009) defines medication error as any preventable event or failure in the medication use that results in harm to patient. It may occur due to several factors such wrong dosage calculation, inappropriate method of administering medication, prescription error and many other factors. Although medication error can be caused by any health care staffs, this paper mainly focuses on the medication error in nursing practice because nurses are the ones who are mostly involved in executing the medication order (Cheragi et al., 2013). Hence, exploring the reasons for medication error from the perspective of nurse is important.
It is necessary to explore in depth about the topic of medication error because this discussion will have great scope in improving nursing practice both in local province as well as in health care setting all over Canada. Reports related to adverse events in Canada has revealed that apart from surgical error, medication error is the second most common cause of adverse events in hospital setting (McIntyre & McDonald, 2013). In the year 2014-2015, about one in every eighteen patient were admitted to hospital because of medication error or getting the wrong drug. Very few events are officially recorded in patient’s chart due to fear of reprisal (Ubelacker, 2018). However, whenever such events occur in clinical setting, nurses become the main focus of investigation as they are typically involved in administering medication to patients. Their lack of compliance to physician order and following the right to medication administration becomes the main reason for medication error. Hence, identify the challenges for nurse in medication administration and recommending best practice to prevent error will have positive impact on performance of health care setting across Canada.
The adverse event related to medication error affects not only the performances of nurses, but it also has great impact on patient as well as the reputation of the health care organization. For instance, Agyemang & While, (2010) showed that medication error mostly affect nurses and both patients. The most potential victim is the patient as they suffer because of complications causes by drug related errors. It creates major safety issue for patient. In case of nurses, serious medication error has been found to affect nurses both personally and professionally. Agyemang & While, (2010) explained that nurses who are involved in medication errors suffer from feelings of guilt and loss of confidence. They always fear about disciplinary action and this eventually has an impact on their overall nursing performance. Apart from this, the effect of medication error on hospital is that high rate of errors results in loss of patient, trust, criminal charges and civil actions (Wittich, Burkle, & Lanier, 2014, August). Therefore, the reputation and image of hospital is damaged and it leads to extra cost on health services too. Hence, it can be said that medication errors has wide and adverse consequences for the whole health care system.
The above incidences clearly shows that nurses are the main staff involved in committing medication errors, however they are the ones who can reduce the rate of errors too. So, far incidence of medication error has occurred because nurses have not taken professional responsibility to fully adhere to medication administration protocol. For instance, many evidences has proved that errors occurs because nurse do not follow policies and procedures and violate the step involved in checking medication and their dose. Calculation difficulty among nurse and poor knowledge in preparing and administering medication has also become a cause of medication error (Fleming, Brady & Malone, 2014). These evidences support the thesis statement that nurses account for failure in drug administration process. However, there is a need analyze other counter-arguments too that may contradict the thesis statement and this is necessary to fully justify whether thesis statement can be accepted or not.
This discussion paper is focusing on the issue of medication error in nursing practice and finding strategies to medication error is considered necessary to provide benefit to nurses as well as the health care system. Due to medication error, the reputation of hospital is damaged and nurses suffer from shame and embarrassment. Hence, if nurse take part in correcting factors contributing to errors, this will greatly increase their confidence as well as nursing performance. With the rise in medication error, reporting about medication error is regarded as an effective strategy for health care organization. Nurses must also take full responsibility to immediately report about medication error because this will have significant implications on safety of patient. Another advantage of reporting about medication error is that it helps in identifying limitation in current practice and implementing additional patient safety standards to prevent future errors. Error reporting is considered a useful exercise to understand why error occurs, prioritize ways to prevent such errors and develop long term plans for patient safety (Elden & Ismail, 2016). Beside this, it is necessary for nurse to hone their medication administration skill to effectively manage illness, improve patient outcome and save them from demoralizing disciplinary actions (Smeuler et al., 2015).
When nurses administer medication to patient, the common responsibility for them is to follow the five rights of medication administration which are right medication, right dose, right time, right route and right patient (Parry, Barriball & While, 2015). However, in accordance with the thesis statement that nurses fail to adhere to policies and guidelines thus resulting in medication error, it can be said that there are several reasons to believe this statement. For instance, Shawahna et al., (2016) also supported the fact that nurses fail to follow the 5 rights of medication administration and the checking-rechecking process thus increasing the risk of medication errors. Nurses have reported that they face challenges in following these medication procedures because they get confused in calculating medication dose and understanding the function of infusion device. Other individual nurse factor that has been found to have links with medication errors includes miscommunication factors, misreading of medication lable, non-adherence to proper steps and administration without checking (Karavasiliadou & Athanasakis, 2014). All these points show that nurses neglect vital guidelines and procedures that is necessary for safe medication administration. Hence, these examples best support the thesis statement and makes it more plausible. However, evidences of certain organizational cause of medication errors clearly shows that the thesis statement of nurse neglect alone cannot be believed to be the sole cause of medication error. These factors are discussed in detail in the next section.
Nurses have been found to be highly involved in medication error because of organizational challenges too. Review of research literature on causes of medication errors has revealed that unsafe practices of health care staff alone is not cause of medication error, instead such events also occurs because of faulty health care structure or health care environment. For examples, several nurses have reported that they have not got appropriate work environment and support to effectively adhere to medication administration guideline. Some of the top organizational factors that prevents nurses from safely administering medication to patients includes regular interruptions during the process, heavy workload, poor staffing level or nurse-patient ratio or poor labeling of drugs (Karavasiliadou & Athanasakis, 2014). Heavy workload creates challenges for nurses because they are often interrupted while performing an activity and another task arises for them before finishing one intervention. Interruptions in clinical setting have also been regarded as the most common cause of error in drug calculation because attention of nurses breaks down during the medication preparation and administration process (Thomas, Donohue-Porter & Fishbein, 2017). Interruptions from patient also increased dilemma for nurses (Cheragi et al., 2013). These evidences offers counter-examples and opposing views related to the thesis and indicates about the challenges for nurse too.
The explanation regarding the organizational and work environment related challenges offers good counter arguments to criticize the thesis statement. It clears argues that nurses cannot engage in safe medication administration unless they get the right environment and devices to do so. If medication error has occurred due to labeling or packaging issue, the organization or the manager is at fault and not the nurses. Secondly, if error occurs due to heavy workload and understaffing issue then the hospital is to be blamed for keeping faulty structure and work process and not the nurse. Two strength of the counterargument is that health care setting is a complex environment where multi-professional team works together for the care of patient. So, counter argument has strength because health care providers have the responsibility to provide right resource and environment to nurses to work efficiently (Sahay, Hutchinson & East, 2015). Another strength of the counter argument is that organizational factors play a key role in reducing medication errors because if strict protocols and penalty exist for negligence, then such event will not arise at such alarming rate. However, the weak point of the counterargument is it cannot totally defend the action of nurses because if nurses are accountable enough to understand their responsibility in medication administration, then they can overcome all disruptions too. Hence, the thesis statement of non-adherence to protocol as the cause of medication error should be give more importance because nurses are more involved in medication administration than any other staffs (Shahrokhi, Ebrahimpour & Ghodousi, 2013). Therefore, nurses are better placed to reduce rate of error if all barriers in the way of medication administration is eliminated.
It is also necessary to give full attention to the issue of medication error in nursing practice because it has great impact on nurses and their daily practice. Nurses suffer from feelings of low self-esteem and poor confidence in their skills when they commit medication error. One study investigating about impact of medication error on nurses revealed that such experience was devastating for them both personally and professionally. The event of disciplinary action and exposure to criticism from managers created feelings of same in patient. Some nurses even faced difficulty in finding another job because of shame and embarrassment. Even if nurses continued practice in the same setting, feelings of incompetence remained with them and they always had the fear of making new mistakes (Agyemang & While, 2010).
Medication errors indirectly affects human resource management too because incidence of error creates stress for nurse. They develop feelings of guilt which affect their performance. High level of stress due to committing mistakes again often forces nurses to think about quitting the job (Vogus et al., 2014). Hence, a health care setting which experience challenges already due to poor staffing level and workload, will have to spend additional time in hiring and looking for new and skilful nurses. Other negative implications of medication error include negative emotions among patients, family members and lack of trust with the health care system (Bari, Khan, & Rathore, 2016). Evidence also points out to rise in bioethical issues for hospitals because of medication errors. dos Santos Dalmolin & Goldim, (2013) argued that ethical dilemma and bioethical issues for health care provider and staff increases due to medication error.
This discussion paper analyzed the issue of medication error in nursing practice with the thesis that non-adherence to medication protocols among nurses lead to medication error. If this statement is true, then the consequence of the issue is huge. This is because if nothing is done to develop the skills of nurses or eliminate barrier in following the protocol, then such incidences will continue to happen and patient safety will be seriously hampered. So, to avoid adverse event in health care setting and protect nurses from embarrassing disciplinary actions, there is a need to identify strategies to improve medication safety practices. The health care provided, nurse manager and multi-professional team needs to get involved to work together to curb the rate of medication errors in clinical setting.
As this discussion paper has showed that certain organizational factors create disruption for nurses during medication preparation and administration, hence it is necessary to modify the workplace structure and environment. Supportive workplace climate should be provided to nurse to reduce adverse event. As lack of skills and confusion in medication administration is also an issue for nurses, there is a need to provide education and learning support to nurses. Education training programs related to independent drug dose calculation has been found to decrease medication error (Alsulami, Choonara, & Conroy, 2014). Provision of budding and dividing workload may also sustain supportive work climate and foster skill acquisition and professional development in nurses (Sahay, Hutchinson & East, 2015). Nurses must also understand the importance of medication protocols and they must always observe the contraindications of medications before administration. Lastly, a system should be in place by which nurses can easily report about errors without any fear. Error reporting system should be improved to improve current practice and prevent future incidences of medication error.
Conclusion:
The essay gave insight into the incidence of medication errors and the potential impact of such event on nursing practice and health care system. The main thesis statement for discussion and argument was ‘poor adherence to medication administration protocol among nurse is the reason for medication error’. To support the thesis statement, evidence of non-adherence to five rights and checking-rechecking process was provided. However, counterarguments to the thesis also pointed to the fact that organizational factors like understaffing, high workload and interruptions in the procedures also affects attention of nurse during medication administration. Considering the negative implication of medication error on patient, nursing practice and health care organization, it is recommended that key members of the health care organization work together to provide education and learning support to nurses. The improvement in error reporting system has also been proposed to reduce rate of medication errors and burden associated with it for nurses
References
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