Discuss about the Medication Error As The Quality Indicator.
Medication error can be defined as the failure that occurs in a treatment process while caring for the patient by the Healthcare professionals. This has the potential to harm patients resulting in severe threatening outcomes on their health as well as on their lives (Bogner 2018). Medication errors can occur anytime while deciding which medicine and dosage regimen should be provided to the patient, manufacturing the formulation of the medications, dispensing the formulation, administering the medicine, during the monitoring therapy, and many others. Medication error can be classified into a number of psychological classifications of errors that can be knowledgeable action as well as memory based errors. Medication errors can range from less serious to highly threatening for the patient even resulting in preventable hospital death (Vancott et al. 2018). Therefore researchers have stated that it is important for the detection of medication errors since System errors which might lead to minor errors in the initial stages can later turn to serious errors in the latter stages. Therefore, reporting of such areas should be encouraged by creating blame free as well as a non punitive environment (Makary and Daniel 2016). Therefore, medication errors can be considered as one of the quality indicators which ensure that the care provided to the patient is whether safe or not and whether the patient life is at threat or not. This assignment will help to establish medication error identification and reporting as one of the quality indicators for help. It will also provide different evaluation Pathways by which medication errors can be reported and the initiatives that can be taken for every Healthcare centers so that they can reduce the chances of medication errors and help in development of a safe environment for the patient to be treated.
Medication error can be defined as any kind of failure in the treatment procedure which has the potential to affect the lives of patients. On the analysis of different types of literature that had been research by the eminent authors over the age, different types of medication errors can be noted. The first type of medication error that might occur is in the choosing of the correct medicine which might be irrational, inappropriate as well as resulting from ineffective prescribing, under prescribing or over prescribing. It may also occur during the time of writing the prescription that may result in prescription errors as which might include ineligibility (Keers et al. 2015). It also may occur during the time of manufacturing of the formulation that is to be used by the Healthcare professional. It might have wrong strength as well as contaminants or adulterants as well as may also have wrong or misleading packaging. Errors might also occur during dispensing of the formulation that is having the wrong drug, wrong formulation, wrong label (National Academies of Sciences, Engineering, and Medicine 2016). It might also occur while administering or taking the drug that may result from wrong doses, wrong route, wrong frequency as well as wrong duration. Healthcare professionals can also make errors during monitoring therapy that may result in failing to alter therapy when required or resulting in erroneous alteration.
In a hospital based study of about 36200 medication errors, prescribing errors were identified in 1.5% of the cases and most of the errors (for about 54%) were associated with the choice of drugs that was administered that became potentially severe and harmful for the patients. This was accounting for about 0.4%. In a survey of about 40000 medication errors in 173 Hospital trusts, it was seen that approximately 15% of this caused slight harm and 5% caused moderate-to-severe harm. In another study it was found that 1.7% of the prescriptions dispensed from the community for pharmacies contain errors. Since approximately 3 million prescriptions are dispensed each year and about 50 million prescriptions contains errors. Among those, only 0.1% was thought to be clinically important giving an annual incidence of such errors of about 50000 (Samp et al. 2014). Wrong label information and instructions were also found to be among the common types of errors. There are harmful impacts on the life of the patients where the patients have either to live for longer days in the hospital that results in increased financial burden on them and their families. They also sometimes have to undertake readmission for the effects of the medication occur much later. This results in anxiety and fear among these patients along with financial burden. In many of the cases, patients were seen to suffer immensely before facing death in the hospital which otherwise could have been prevented if the Healthcare professionals had been careful about their approach. Medication error has been determined to be one of the most common causes of death in most of the hospitals and therefore this has become one of the most significant indications for safe practice in every hospital (Carayon et al. 2014). Researchers are therefore of the opinion that important evaluative studies should be conducted in every hospitals to understand the conditions of medication errors occurrences and thereby to stop these occurrences in the hospitals.
Literature review has been conducted on different types of medication errors. The first type of medication errors that has been noted in the different evidence-based studies are the knowledge based error which occurs through the lack of knowledge of the Healthcare professionals. In an Australian study, communication problem with the senior staff and facing different kinds of difficulty in accessing appropriate drug dosing information has resulted in knowledge based prescription errors (Westbrrok et al. 2015). Researchers are of the opinion that Healthcare professionals should always try to avoid these kind of errors by being well informed about the drug that is been prescribed and the patient to whom the drug would be administered (Wachter 2015). For this, computerized prescribing systems as well as barcode medication systems and even cross checking by others can help to mitigate such kind of errors. Education is also found to be extremely important to prevent this kind of medication errors. An example can be provided in order to give idea about knowledge based errors. Knowledge-based errors might happen when the Healthcare professionals provides penicillin to a patient even without knowing that the patient is allergic to it or not (Lewis et al. 2016). Important initiative should be taken so that such kind of errors does not occur in the organisations.
Another type of error that has been notified in many of the Literature articles is the rule based error where the Healthcare professionals usually use a bad rule on misapplying a good rule (Fox et al. 2014). They have stated that proper rules and education help in the avoiding of these types of error and computerized prescribing systems can also be used as a support to reduce rule-based errors. This can be exemplified. When health care professional inject a diclofenac into the lateral thigh of a patient instead of giving it into the hip region, it causes rule-based errors and might result in the suffering of the patient in various kinds of ways.
Another type of error is called the action based errors. This might occur due to slip in attention that take place during routine prescribing, dispensing and administration of drugs. This can be minimised by the creation of conditions in which these errors are unlikely. This can be done by avoiding distractions, by cross checking, by labelling of different medications clearly and also by the use of proper identifiers like that of barcodes. Many of the researchers have also proposed that a way to avoid misreading of labels can be done by the tall man lettering procedure with well mixing of upper and lowercase letters in the same word has been proposed (Yoder et al. 2015). However this method has not yet been tested in the real life conditions and therefore their affectivity is not yet ensured. Different types of action based errors can also occur like the technical error for putting the wrong amount of potassium chloride into an infusion bottle can also take place. This type of error can be prevented with the help of proper utilisation of checklist, fail-safe systems as well as computerized reminders (Karavasiliadou and Athanasakis 2014). One example of action based error can be picking up of a bottle of containing diazepam from the pharmacy shelf when the professional actually intended to take one containing diltiazem. Therefore his type of error should be avoided in order to ensure safety of patients.
Memory based errors can also take place which are otherwise called lapses for example the professional already knows that the patient is allergic to penicillin but due to lapsing or due to forgetting, he might give penicillin to the patient (Coffman et al. 2017). These are usually hard to avoid and they can be intercepted by computerised prescribing systems and also by cross checking
Indicators of medication safety are usually considered as an important subset of Healthcare indicators. Medication safety can be referred to two aspects. The first aspect is ensuring that the patients are ordered the most appropriate pharmacological intervention plan that remains based on the best available evidence. The second aspect is ensuring that the treatment plan is carried out as the professionals have ordered them (Kasper et al. 2015). However researchers have stated that this aspect should be consistent with the position that achieving safer care are following three important agendas for successful safety care of patients. This three agendas are identifying what works best for the patients that is otherwise called efficacy, ensuring what the patient receives is appropriate, as well as delivering the medications flawlessly that is without any errors.
One of the most important types of indicators is the structure indicators. researchers have said that structure indicators usually help in measuring the environment such as the hospital infrastructure as well as the systems. Determining whether a Healthcare institution has the correct policy and procedure for reporting as well as analyzing medication incidence would be an example of a structure indicator (Berner and Lande 2016). Also stated that such outcomes are not directly linked with the outcomes but they can be helpful in guiding improvements of systems. Indicators are mainly requiring yes/no answers as well as providing a snapshot for the organizational culture. Another important type of indicator is the process indicators. Process indicators usually help in measuring the compliance with different processes of care that usually shows improvement of health outcomes. One of the very good example of a process indicator stated by the researcher would be measuring the percentage of appropriate as well as eligible patients who are receiving effective and specific treatment. This can be antithrombotic medication for patients with the risk of venous thromboembolism and many others (Xie and Carayon 2015). Process indicators are usually linked with the outcomes and are usually saying to be helpful in guiding system based improvements. Another type of indicator is the outcome indicator. This type of indicators mainly helps In providing data related to the outcomes of care as well as health system performance. One of the example that can be stated in order to provide light on the type of indicator is the number of medication incidents that occurred resulting in the harm of death, per patient day of care. Outcome indicators may be easy for the general public to understand and at the same time they may not provide specific information which would help in guiding the improvement of the systems.
There are 6 different types of structure indicators that have been found from the different literature of evidence-based articles. Three of the structure indicators belonging to the category of safety management are incident reporting and analysis, prospective medication safety analysis, as well as top 10 medications analysis. The Other 3 structure indicators belonging to the category of availability of high alert medications are the concentrated potassium, concentrated electrolyte as well as narcotic safety (Hicks et al. 2015). There are also 11 types of process indicators that have been identified from the literature. In the category of verification there are three important process indicators which are monitoring and reducing the adverse drug events by the pharmacist on the ground, effective verification of the different types of high alert prescriptions, and machine readable coding systems for effective administration. In the category of visual reminders, the process indicators are the differentiation for various types of high alert prescription medications. In the category of protocols there are five important types of process indicator which are chemotherapy protocols, antibiotic therapy for different types of surgical patients, venous thromboembolism prevention, antibiotic prophylaxis, as well as administration protocols for effective high alert prescription medication. In the category of documentation of clinical info, two important indicators are postoperative pain management as well as adverse drug reactions (Kruer et al. 2014). There are five outcome indicators which fall in the category of adverse events. These indicators are the medication error rate, medication incident types, death incidents, medication error, medication incident rates with death incidence, and death associated with medication incidence.
The first step of the PDSA cycle is called the planning stage. This stage usually helps in planning the taste of observation including a plan for collection of the data. In this step, the healthcare organization who is facing the issue of medication error should first develop a committee that would be consisting of experienced healthcare professionals, representatives of the higher authorities, nursing professionals and managers along with leaders. They can introduce questionnaire-based survey that would be provided to both the patients as well as to the Healthcare professionals like the nurses, pharmacists and others associated with medication administration (Phatak et al. 2016). Information would be collected from the patients about their feelings about how the professionals are maintaining their medication administration. Then information would also be collected from the nursing professionals regarding the number of mistakes they had made, the number of reports that they have made about their own mistakes as well as that of the Other professionals, the environment of the organizational culture which is supportive of the concerns on medication error reporting and many others. this would help the committee to understand what different types of errors are most prone in the Health Care centers and thereby develop ideas about how they could be developed in the organization to reduce such occurrences.
The next step is called the “do” step where individual should try out the step on a small scale. Here the committee that was formed in the previous step should be analyzing the types of errors that are made by the professionals and try out ways by which the areas would be reduced. This could be done in the form of educating the professionals about the different strategies they can take to reduce the errors. They should influence and encourage the professionals to develop blame free environment where they can report incidences, develop skills by which they can use the modern day information Technologies as well as the computerized system by which medication error could be reduced and many others. The professional should learn to use patient specific identifiers, learn to verify allergies and reactions, highlight physical diagnosis and conditions, update current medications, standardize height and weight measurements, follow proper guidelines, identify high alert medications, and many others. The organization should itself develop an organizational culture that would promote communication among the Healthcare professionals like sharing of information, improvement of handwriting, avoiding problematic abbreviations, be aware of the similar drug names, reconsidering using electronic systems and many others. The higher authority should also introduce proper labeling and storage so that separating problematic drugs, in keeping the storage well organized so that they become their main priority. They are also advised to use proper drug devices like using the right syringes and thereby training staff to use the devices properly.
The next step would be the step call “study” where the committee would be setting aside time for analyzing the data they have collected and studying the results of the initiatives that have been proposed by them (Belda et al. 2015). Here the monitoring Authority would take an observation of each of the professionals while they are working so that they can understand the behavior and attitude of the Healthcare professionals during administration of medicines. They will be also conduct interviews to understand how the different initiatives that have been taken in the previous state are helping the professionals to overcome the various issues during administering medications and how it has helped them to reduce the errors.
The next step would be called the Act step where new initiatives would be undertaken depending from the information derived from the last stage. From the evaluation made in the previous step before, the higher authority would then introduce initiatives so that medication error can be reduced and safe and quality care is provided to the service users.
From the above discussion, it becomes quite clear that medication error is one of the biggest problems that the healthcare centers in the nation of Australia are facing in the present generation. It is considered to be one of the most important indicators for quality and safety in the Healthcare industry. Three important types of indicators have been proposed in order to check the condition of medication error in the nation. These are the structure indicators, the process indicators as well as the outcome indicator. Depending upon these indicators and after planning a proper pdsa cycle, the Healthcare organizations can develop a secure plan with initiatives that would help the Healthcare professionals to develop proper knowledge and skills with which they can reduce the occurrence of medication error. Development of an organizational culture supportive of the reporting of medication error and encouraging in the development of technological system for reduction of the medication error can help in providing quality and safety to patients.
References:
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