Reducing Medication Administration Errors In The Emergency Department

Background

Discuss About The Health Global Qualitative Nursing Research.

The principal intention of this study is to minimize medication administration errors in the emergency department (ED) by promoting basic medication administration procedures. The aim is realistic and achievable because it focuses on a problem that widely occurs in ED (Blank, Tobin, Macomber, Jaouen, Dinoia, & Visintainer, 2011). Recent studies indicate that between 2% and 3% of admissions in Australia are medication-related. In any hospital, there are 2 medication errors for every 3 patients at the time of admission (Roughead, Semple, & Rosenfeld, 2016). Evidently, the aim informs the target audience why the study is being carried out and its importance for the medical professional in the ED.

The authors hypothesize that “Back to Basic” approach reduces medication errors in ED. Even though the authors have not specified a formal hypothesis, it is evident that they have predicted that “Back to Basic” is that best method of reducing medication errors in ED. Throughout the study, the authors pursue this hypothesis and test its ability to address the problem of medicine errors (Blank, Tobin, Macomber, Jaouen, Dinoia, & Visintainer, 2011). This hypothesis guides the authors to propose a future line of study in medication-related errors. Although the hypothesis of the study is not formal, it can be described as an experimental hypothesis, which is written before conducting the experiment and it specifies the dependent and independent variables.

The study explored a three-month educational intervention utilizing a quasi-experimental study. Notably, quasi-experimental studies yield better results than pre-experimental studies because they employ a method to compare groups. Quasi-experimental studies might be less reliable because they are non-randomized (Mangal & Mangal, 2013). Two educative interventions were used including “Preventing Medication” and “IV Administration Errors.” These educative procedures were the main resources for this study. 127 nurses were contacted to take part in this study. However, only 75% of the nurses participated in the study. The procedure of the study consisted of three measures, which included testing medication administration knowledge, assessing the recommended behaviors on medication administration practices and identifying medication administration errors using a chart (Blank, Tobin, Macomber, Jaouen, Dinoia, & Visintainer, 2011). The authors conducted both pre-test and post-test of the measures.

The post-survey revealed that the use of recommended practices increased in eight of the ten survey questions. However, this change failed to meet statistical significance. Based on the results, there was a little change in medication errors. Medication errors changed from 25% to 24%. Additionally, voluntarily recorded medication errors declined from about 1.28 to approximately 0.99 medical errors per 1000 patients (Blank, Tobin, Macomber, Jaouen, Dinoia, & Visintainer, 2011). The outcomes of this study support the use of the 4R’s in preventing medication errors. The 4R’s include the right patient, right route, right time, and right documentation (Smeulers, et al., 2015).

Study Objectives

The authors conclude that the use of “Back to Basic” method resulted in equivocal outcomes. However, the authors conclude that the results offer important insights into the existing medication process (Blank, Tobin, Macomber, Jaouen, Dinoia, & Visintainer, 2011). The educational intervention effectively buttressed knowledge of approved medication practices. Since the educational intervention was unsuccessful, the authors recommend more research in this area to establish interventions that can change practice in clinical settings.

The study has internal validity since the outcomes can be attributed to several elements. The instruments of this study were designed by nurses who might have insufficient experience in instrument design. Also, there was a selection bias because the participants consisted of volunteers. The study lacks external validity because the findings cannot be generalized. In terms of measurement validity, this study only claims face validity for the instruments. The instruments are deemed to measure the use of the recommended medication administration practices effectively. Face validity is perceived as a weak form of validity, but the measure helped to measure what it was expected to measure in this study (Johnson, 2014).

Manias, E., Gerdtz, M., Williams, A., & Dooley, M. (2015). Complexities of Medicines Safety: Communicating about Managing Medicines at Transition Points of Care across Emergency Departments and Medical Wards. Journal of Clinical Nursing, 24(1-2), 69-80.

In this study, the authors intended to determine how healthcare providers, family, and patients communicate about medication management across transition points of care in public hospitals in Australia (Manias, Gerdtz, Williams, & Dooley, 2015). Transition care points are locations where a patient moves across different clinical settings, which consist of hospital admission, transfer to another ward and hospital discharge. The management of medicines across care points or boundaries of specialist and care organizations has been identified as a key challenge by other researchers (Phipps, Morris, Blakeman, & Ashcroft, 2017). Acute kidney injury is an example of a technical condition that causes challenges in the management of medicines across care points. This example justifies the objective of this study.

There is no formal hypothesis in this study. However, the authors present the hypothesis by delineating the significance of the study. Based on the authors, family members, as well as patients, fail to ask for clarification about medication changes because of inadequate knowledge, the lack of chances to participate, and the lack of insights of feasible implications. Most patients and family members acknowledge the consequences of failing to get clarifications once a medication problem has occurred (Manias, Gerdtz, Williams, & Dooley, 2015). The study seems to hypothesize that there is a deliberate failure of medical professionals, patients and family members in terms of handling medicine.

Methodology

The design of the study was a qualitative description. A qualitative descriptive approach was suitable for this research because it is less sophisticated and offer researchers a systematic approach to accomplish research (Bradshaw, Atkinson, & Doody, 2017). Diverse participants were included from public hospitals in Australia. The participants were aged 18 years and above and understood English. Specifically, 10 patients and 10 family members were interviewed during this study. 83 healthcare providers participated in this study, through twelve focus groups. The medical professionals included nurses, pharmacists, and doctors. A majority of the healthcare professionals who participated in this study work in EDs while the rest practice in medical wards (Manias, Gerdtz, Williams, & Dooley, 2015). The procedure of the study involved comprehensive interviews focusing on questions that were developed by health professionals. Data was recorded using a digital audio-recorder. The use of an audio-recorder increases the security of the information from possible distortion or misinterpretation (Carlton, Jadhav, & Holsinger, 2015).

Four important concepts were established in relation to medicine management. Firstly, the contextual setting of care was influenced by efficiency and time limits. Secondly, competing responsibilities were found to be a key factor influencing medicine management. Competing responsibilities often occur due to differing interests for the ED and medical wards. Thirdly, the pertinent stakeholders are aware of safety issues and acknowledge the chain of events involved. Fourthly, interpersonal communication impacted patients and family members (Manias, Gerdtz, Williams, & Dooley, 2015). Careers have been found to cause multiple medical errors due to the lack appropriate knowledge (Parand, Garfield, Vincent, & Franklin, 2016). The authors discovered that interdisciplinary communications were linked to communication modalities utilized in encounters.

This study concludes that the management of medicines at care transition points consists of an intricate interplay of dynamic features. Due to this interplay, the management of medicines tends to affect patients both within and outside the public hospitals (Manias, Gerdtz, Williams, & Dooley, 2015). The challenge of medicine management can be attributed to several issues in the public hospitals. There is an attempt to reconcile the demands of various stakeholders, with the objective to improve medicines management. These challenges also tend to occur in electronic medicines profiles (eDPs), where medicines are managed through modern technologies (Ng, Welch, Luddington, Bui, Glasson, & Richardson, 2013).

This study is internally valid because the limitations can explain discrepancies. Only ten patients and ten careers were interviewed. Besides, only the participants who understood English were included in the study. The study is externally invalid since the transferability of the findings is limited. Further, a study conducted in a different setting with different participants is likely to yield different results. The study claims face validity for the instruments since there is no comparison with the theory of the construct.

Results

The first study by Blank and colleagues challenges nurses to adhere to the recommended medicine administration practices. The background of this study is that the failure to adhere to standard medicine administration practices increases the rate of medicine administration errors. Even though the study was unsuccessful in designing a protocol that can be used to minimize medicine administration errors in ED, it has presented a clear pathway for future research (Blank, Tobin, Macomber, Jaouen, Dinoia, & Visintainer, 2011). A small reduction in the number of medicine errors that were reported in this study gives the medical fraternity a hope that medicine errors can be eliminated in EDs. Hence, the study successfully achieved its aim and emphasized its unstated hypothesis. The second study by Manias and colleagues seeks to identify how different stakeholders handle medicines across care transition points. Based on the authors, there are significant failures in handling medicine across care points. This study contributes immensely to the field of medicine because it emphasizes the importance of partnership in medicine management across care points. The study proposes that nurses, pharmacists, and doctors should utilize synchronous and asynchronous methods of communication to assist in enhancing medicines safety (Manias, Gerdtz, Williams, & Dooley, 2015). Through this study, healthcare professionals across different care centers learn the importance of partnership and collaboration in enhancing medical safety. Evidently, medicine safety is important in preventing adverse outcomes (Mansur, 2016). Both studies focus on the aspect of medication administration safety in public hospitals and emphasize the importance of adhering to a certain procedure in medicine prescription and administration.

References

Blank, F. S., Tobin, J., Macomber, S., Jaouen, M., Dinoia, M., & Visintainer, P. (2011). A “Back to Basics” Approach to Reduce ED Medication Errors. Journal of Emergency Nursing , 37 (2), 141-147.

Bradshaw, C., Atkinson, S., & Doody, O. (2017). Employing a Qualitative Description Approach in Health Care Research. Global qualitative nursing research , 4 (1).

Carlton, E. L., Jadhav, E. D., & Holsinger, J. W. (2015). Leading people – managing organizations: Contemporary public health leadership. Frontiers Media SA.

Johnson, T. P. (2014). Handbook of health survey methods . John Wiley & Sons.

Mangal, S. K., & Mangal, S. (2013). Research methodology in behavioural sciences. PHI Learning Pvt. Ltd.

Manias, E., Gerdtz, M., Williams, A., & Dooley, M. (2015). Complexities of Medicines Safety: Communicating about Managing Medicines at Transition Points of Care across Emergency Departments and Medical Wards. Journal of Clinical Nursing , 24 ((1-2)), 69-80.

Mansur, J. M. (2016). Medication safety systems and the important role of pharmacists. Drugs & aging , 43 (1), 213-221.

Ng, C., Welch, S. A., Luddington, J., Bui, D., Glasson, E., & Richardson, K. L. (2013). Medication reconciliation challenges at discharge from hospital using an electronic medication management system and electronic discharge summaries. Journal of Pharmacy Practice and Research , 43 (1), 25-28.

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.

Phipps, D. L., Morris, R. L., Blakeman, T., & Ashcroft, D. M. (2017). What is involved in medicines management across care boundaries? A qualitative study of healthcare practitioners’ experiences in the case of acute kidney injury. BMJ open , 7 (1), e011765.

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, 113-122.

Smeulers, M., Verweij, L., Maaskant, J. M., de Boer, M., Krediet, C. P., van Dijkum, E. J., et al. (2015). Quality indicators for safe medication preparation and administration: a systematic review. PloS one , e0122695.