Medication Errors

Administration of medications is an important nursing function and one that if not properly carried out, can lead to a host of problems for the patient and nurse. It is estimated that over 1.5 million preventable medication errors occur annually in the United States (Neal, 2006), leading to death, patient disability, increased length of hospital stays and costs.

Cause and Prevention: Medication Errors
Administration of medications is an important nursing function and one that if not properly carried out, can lead to a host of problems for the patient and nurse. It is estimated that over 1.5 million preventable medication errors occur annually in the United States (Neal, 2006), leading to death, patient disability, increased length of hospital stays and costs. According to Abudato (2004), medical errors (including medication administration errors and others) kill approximately 44,000 people yearly costing hospitals up to $30 billion annually. Medication errors can result in consequences for both the patient and the nurse; death for the patient and legal troubles for the nurse. By following some basic strategies, nurses play an important role in the reduction of such errors. These strategies include following established safety procedures, utilizing team communication to ensure safety, and using technology to reduce errors.
There are many factors that contribute to medication errors resulting in consequences to both patient and nurse. Factors that can contribute to errors include illegible handwritten drug orders, confusing drug names, and the use of nonstandard or unclear abbreviations (Neal, 2006). For the patient, the effect of drug errors can range from no side effects to death. For the nurse who commits a medication error the consequences can range from additional training and supervision to lawsuits and revocation of licensure. Medication errors can occur at any stage in the process of delivering medications to patients, from the originating prescriber to the pharmacy, but the majority of medication errors occur during administration.
Adherence to established safety procedures by all healthcare professionals can help to reduce medication errors. Errors occurring during the administration process are likely due to one of the steps of the five rights of medication administration being omitted: the right patient, medication, dose, route, and time, with the most frequent errors resulting from omission, wrong dose, and wrong medication (Davidhizar & Lonzer, 2003). Factors that can exacerbate errors include problems with the drug distribution system, inadequate staffing levels, environmental factors (e.g., distraction), nurses working in unfamiliar units, and not following standard policy and procedure. According to Davidhizar and Lonzer (2003), the following strategies are useful in addressing safety issues that revolve around medication errors: 1) reporting and analyzing errors using a multidisciplinary approach; 2) providing adequate staffing and training; 3) establishing and monitoring policies and procedures to ensure effectiveness and safety; and 4) all members of the healthcare team should have an awareness of how medication errors occur and be conscientious when administering medications. Attention to safe drug administration and safety guidelines is of particular importance in efforts to reduce medication errors and increase patient safety; it is an issue that is of concern across the various healthcare disciplines and nurses are essentially the final check and balance in the system.
Communication is a key function for nurses in providing safe and effective healthcare to their patients, and includes communicating effectively with patients and other healthcare team members. Abudato (2004) states that 90% of errors that occur within the healthcare industry are due to communication that breaks down at the nurse-physician level. Often, dysfunctional communication patterns between professionals in healthcare entities results from the organizational structure which determines how professionals interact with each other, who has the power (individual and group), and the cultural norms of the organization. RN’s are accountable to provide safe care to the point of questioning physician orders in order to fulfill the role of patient advocate. This can lead to dysfunctional communication because it represents a challenge to the authority and power of the physician, especially those who feel that they are where the “buck stops” when deciding what is and is not appropriate patient care (Arford, 2005).
Johns Hopkins has adopted a three-step model that focuses on assertiveness as a strategy for communication. This model advocates that when nurses communicate it is appropriate to use the first name of the person they are addressing in order to get their attention. The model further stresses that it is important to not only present the problem, but also present a solution and seek agreement to what has been proposed. Finally, the model suggests that if satisfactory resolution is not attained, move the problem up to the next level of authority (Abudato, 2004). Organizational structure often dictates the way communications occur and it is important to remember that no matter the situation, mutual respect must be maintained. Effective communication among all team members is an important aspect of delivering appropriate patient care and advocating for the patient, and is an area where things can often go wrong.
There is no substitute for common sense and diligence, but technological advances may be of use in helping to prevent medication errors. Technological measures include automated medication dispensing machines, computerized IV administration, and the bar coding of both patients and drugs. A research study conducted among a select group of nursing students at a suburban New York university was designed to answer the question: Does the use of PDAs (personal digital assistants) with drug and medication calculation software improve the accuracy and efficiency of medication administration (Greenfield, 2007)? Results of this study upheld the hypothesis that the use of PDAs and medical software did, overall, improve the accuracy and efficiency of medication administration. The author of the study recommends that all nursing students be required to have PDAs with drug and calculation software on them. There is evidence to suggest that use of technology is helpful in reducing medication errors, nonetheless, a strong human component remains and does not replace the need for carefulness and good judgment.
Medication errors represent a serious issue for the healthcare community as a whole. Errors can result for a variety of reasons; however, the majority of errors occur during administration of the medications. Because the nurse is the final link in the process of administering medications, it is the responsibility of the nurse to ensure accurate delivery of medications to patients. Strategies that the nurse can use to accomplish this include attention to policies and procedures, effective communication with other healthcare team members, and using available technological resources to complement other safeguards and individual competence.
a. Staffing and reporting
i. Staffing
1. Because of the high acuity of patients in the hospital setting today, adequate staffing levels are critical to providing safe patient care. With repeated interruptions nurses may find it difficult to establish and maintain a routine that may be critical to the delivery of appropriate and timely medications. In addition to disruptions in the work flow, the complexity of the work performed by nurses as they balance their workload, along with managing the goals of the organization and goals of patient care, contributes to the problem.
2. Aebersold, M., Kalish, B.J. (May/June 2006). Overcoming barriers to patient safety. Nursing Economics 24(3), pp. 143-155. Retrieved from ProQuest on February 2, 2008.
ii. Reporting of errors
1. Reporting of errors relies on voluntary reporting. Traditionally, the nursing profession has operated based on a culture of fear and blame that focuses on individual culpability rather than looking at problems from a system-wide perspective. There can also be some ambiguity with regards to what actually constitutes a medication error (e.g., is late delivery of a dose a medication error?) and there is often reluctance to report errors that do not result in patient harm. Often nurses feel that reporting medication errors will be personally and professional damaging and are also reluctant to report errors made by others such as physicians, pharmacists and other nurses.
2. Groves, M., Pafford, L., Stetina, P. (June 2005). Managing medication errors – a qualitative study. MEDSURG Nursing 14(3), pp 174-178. Retrieved from Expanded Academic ASAP on April 6, 2007.
j. Communication & organizational structure
i. Interpersonal communication
1. Historically, health care has been organized in a hierarchical fashion with physicians at the top of the hierarchy being seen as the ultimate authority when it comes to patient care. This type of culture has become so ingrained in our health care system that we don’t even question it. According to Abudato (2004), the acceptance of this culture can result in physicians subconsciously ignoring important information provided by nurses because they view them as subordinate. When this type of response is the norm, nurses may feel irrelevant and stop communicating, which only serves to further dysfunctional communication styles and may have an impact on the quality of patient care, including medication administration.
2. Abudato, S. (2004, September). Making the communication connection: To minimize miscommunication with colleagues and patients, get assertive. Nursing Management 35(9), pp. 33-35. Retrieved from ProQuest on October 24, 2007.
ii. Organizational structure
1. While each nurse should have accountability in delivering safe and competent care including medication administration, often the organization itself which creates problems. It is the organization that provides the context in which nurses and physicians communicate because it directs the behavioral norms and determines how nurses and physicians communicate with each other. Conflict can arise in the context of nurses performing their roles as independent practitioners resulting in dysfunctional nurse-physician communication when individual authorities are challenged. Organizations often do not provide environments that are conducive to fostering teamwork and collaborative communication between nurses and physicians.
2. Arford, P.H. (2005, March-April). Nurse-physician communication: An organizational accountability. Nursing Economics 23(2), pp. 72-77. Retrieved from Expanded Academic ASAP on April 6, 2007.

 
References
Abudato, S. (2004, September). Making the communication connection: To minimize miscommunication with colleagues and patients, get assertive. Nursing Management 35(9), pp. 33-35. Retrieved from ProQuest on October 24, 2007.
Aebersold, M., Kalish, B.J. (May/June 2006). Overcoming barriers to patient safety. Nursing Economics 24(3), pp. 143-155. Retrieved from ProQuest on February 2, 2008.
Arford, P.H. (2005, March-April). Nurse-physician communication: An organizational accountability. Nursing Economics 23(2), pp. 72-77. Retrieved from Expanded Academic ASAP on April 6, 2007.
Davidhizar, R., Lonser, G. (2003, July-September). Strategies to decrease medication errors. Health Care Manager 22(3), pp. 211-218. Retrieved from Expanded Academic ASAP on April 6, 2007.
Greenfield, S. (2007, March). Medication error reduction and the use of PDA technology. Journal of Nursing Education 46(3), pp.127-131. Retrieved from ProQuest on April 6, 2007.
Groves, M., Pafford, L., Stetina, P. (June 2005). Managing medication errors – a qualitative study. MEDSURG Nursing 14(3), pp 174-178. Retrieved from Expanded Academic ASAP on April 6, 2007.
Harrington, S., Lilley, L., and Snyder, J. (2007). Pharmacology and the nursing process (5th ed.). St. Louis: Elsevier Saunders.
Neal, T. (2006, September 19). Preventing medication errors. The Seattle Times. Downloaded from seattletimes.nwsource.com on April 6, 2007.

Leave the following text intact.

Cause and Prevention: Medication Errors
Administration of medications is an important nursing function and one that if not properly carried out, can lead to a host of problems for the patient and nurse. It is estimated that over 1.5 million preventable medication errors occur annually in the United States (Neal, 2006), leading to death, patient disability, increased length of hospital stays and costs. According to Abudato (2004), medical errors (including medication administration errors and others) kill approximately 44,000 people yearly costing hospitals up to $30 billion annually. Medication errors can result in consequences for both the patient and the nurse; death for the patient and legal troubles for the nurse. By following some basic strategies, nurses play an important role in the reduction of such errors. These strategies include following established safety procedures, utilizing team communication to ensure safety, and using technology to reduce errors.
There are many factors that contribute to medication errors resulting in consequences to both patient and nurse. Factors that can contribute to errors include illegible handwritten drug orders, confusing drug names, and the use of nonstandard or unclear abbreviations (Neal, 2006). For the patient, the effect of drug errors can range from no side effects to death. For the nurse who commits a medication error the consequences can range from additional training and supervision to lawsuits and revocation of licensure. Medication errors can occur at any stage in the process of delivering medications to patients, from the originating prescriber to the pharmacy, but the majority of medication errors occur during administration.
Adherence to established safety procedures by all healthcare professionals can help to reduce medication errors. Errors occurring during the administration process are likely due to one of the steps of the five rights of medication administration being omitted: the right patient, medication, dose, route, and time, with the most frequent errors resulting from omission, wrong dose, and wrong medication (Davidhizar & Lonzer, 2003). Factors that can exacerbate errors include problems with the drug distribution system, inadequate staffing levels, environmental factors (e.g., distraction), nurses working in unfamiliar units, and not following standard policy and procedure. According to Davidhizar and Lonzer (2003), the following strategies are useful in addressing safety issues that revolve around medication errors: 1) reporting and analyzing errors using a multidisciplinary approach; 2) providing adequate staffing and training; 3) establishing and monitoring policies and procedures to ensure effectiveness and safety; and 4) all members of the healthcare team should have an awareness of how medication errors occur and be conscientious when administering medications. Attention to safe drug administration and safety guidelines is of particular importance in efforts to reduce medication errors and increase patient safety; it is an issue that is of concern across the various healthcare disciplines and nurses are essentially the final check and balance in the system.
Communication is a key function for nurses in providing safe and effective healthcare to their patients, and includes communicating effectively with patients and other healthcare team members. Abudato (2004) states that 90% of errors that occur within the healthcare industry are due to communication that breaks down at the nurse-physician level. Often, dysfunctional communication patterns between professionals in healthcare entities results from the organizational structure which determines how professionals interact with each other, who has the power (individual and group), and the cultural norms of the organization. RN’s are accountable to provide safe care to the point of questioning physician orders in order to fulfill the role of patient advocate. This can lead to dysfunctional communication because it represents a challenge to the authority and power of the physician, especially those who feel that they are where the “buck stops” when deciding what is and is not appropriate patient care (Arford, 2005).
Johns Hopkins has adopted a three-step model that focuses on assertiveness as a strategy for communication. This model advocates that when nurses communicate it is appropriate to use the first name of the person they are addressing in order to get their attention. The model further stresses that it is important to not only present the problem, but also present a solution and seek agreement to what has been proposed. Finally, the model suggests that if satisfactory resolution is not attained, move the problem up to the next level of authority (Abudato, 2004). Organizational structure often dictates the way communications occur and it is important to remember that no matter the situation, mutual respect must be maintained. Effective communication among all team members is an important aspect of delivering appropriate patient care and advocating for the patient, and is an area where things can often go wrong.
There is no substitute for common sense and diligence, but technological advances may be of use in helping to prevent medication errors. Technological measures include automated medication dispensing machines, computerized IV administration, and the bar coding of both patients and drugs. A research study conducted among a select group of nursing students at a suburban New York university was designed to answer the question: Does the use of PDAs (personal digital assistants) with drug and medication calculation software improve the accuracy and efficiency of medication administration (Greenfield, 2007)? Results of this study upheld the hypothesis that the use of PDAs and medical software did, overall, improve the accuracy and efficiency of medication administration. The author of the study recommends that all nursing students be required to have PDAs with drug and calculation software on them. There is evidence to suggest that use of technology is helpful in reducing medication errors, nonetheless, a strong human component remains and does not replace the need for carefulness and good judgment.
Medication errors represent a serious issue for the healthcare community as a whole. Errors can result for a variety of reasons; however, the majority of errors occur during administration of the medications. Because the nurse is the final link in the process of administering medications, it is the responsibility of the nurse to ensure accurate delivery of medications to patients. Strategies that the nurse can use to accomplish this include attention to policies and procedures, effective communication with other healthcare team members, and using available technological resources to complement other safeguards and individual competence.
a. Staffing and reporting
i. Staffing
1. Because of the high acuity of patients in the hospital setting today, adequate staffing levels are critical to providing safe patient care. With repeated interruptions nurses may find it difficult to establish and maintain a routine that may be critical to the delivery of appropriate and timely medications. In addition to disruptions in the work flow, the complexity of the work performed by nurses as they balance their workload, along with managing the goals of the organization and goals of patient care, contributes to the problem.
2. Aebersold, M., Kalish, B.J. (May/June 2006). Overcoming barriers to patient safety. Nursing Economics 24(3), pp. 143-155. Retrieved from ProQuest on February 2, 2008.
ii. Reporting of errors
1. Reporting of errors relies on voluntary reporting. Traditionally, the nursing profession has operated based on a culture of fear and blame that focuses on individual culpability rather than looking at problems from a system-wide perspective. There can also be some ambiguity with regards to what actually constitutes a medication error (e.g., is late delivery of a dose a medication error?) and there is often reluctance to report errors that do not result in patient harm. Often nurses feel that reporting medication errors will be personally and professional damaging and are also reluctant to report errors made by others such as physicians, pharmacists and other nurses.
2. Groves, M., Pafford, L., Stetina, P. (June 2005). Managing medication errors – a qualitative study. MEDSURG Nursing 14(3), pp 174-178. Retrieved from Expanded Academic ASAP on April 6, 2007.
j. Communication & organizational structure
i. Interpersonal communication
1. Historically, health care has been organized in a hierarchical fashion with physicians at the top of the hierarchy being seen as the ultimate authority when it comes to patient care. This type of culture has become so ingrained in our health care system that we don’t even question it. According to Abudato (2004), the acceptance of this culture can result in physicians subconsciously ignoring important information provided by nurses because they view them as subordinate. When this type of response is the norm, nurses may feel irrelevant and stop communicating, which only serves to further dysfunctional communication styles and may have an impact on the quality of patient care, including medication administration.
2. Abudato, S. (2004, September). Making the communication connection: To minimize miscommunication with colleagues and patients, get assertive. Nursing Management 35(9), pp. 33-35. Retrieved from ProQuest on October 24, 2007.
ii. Organizational structure
1. While each nurse should have accountability in delivering safe and competent care including medication administration, often the organization itself which creates problems. It is the organization that provides the context in which nurses and physicians communicate because it directs the behavioral norms and determines how nurses and physicians communicate with each other. Conflict can arise in the context of nurses performing their roles as independent practitioners resulting in dysfunctional nurse-physician communication when individual authorities are challenged. Organizations often do not provide environments that are conducive to fostering teamwork and collaborative communication between nurses and physicians.
2. Arford, P.H. (2005, March-April). Nurse-physician communication: An organizational accountability. Nursing Economics 23(2), pp. 72-77. Retrieved from Expanded Academic ASAP on April 6, 2007.

 
References
Abudato, S. (2004, September). Making the communication connection: To minimize miscommunication with colleagues and patients, get assertive. Nursing Management 35(9), pp. 33-35. Retrieved from ProQuest on October 24, 2007.
Aebersold, M., Kalish, B.J. (May/June 2006). Overcoming barriers to patient safety. Nursing Economics 24(3), pp. 143-155. Retrieved from ProQuest on February 2, 2008.
Arford, P.H. (2005, March-April). Nurse-physician communication: An organizational accountability. Nursing Economics 23(2), pp. 72-77. Retrieved from Expanded Academic ASAP on April 6, 2007.
Davidhizar, R., Lonser, G. (2003, July-September). Strategies to decrease medication errors. Health Care Manager 22(3), pp. 211-218. Retrieved from Expanded Academic ASAP on April 6, 2007.
Greenfield, S. (2007, March). Medication error reduction and the use of PDA technology. Journal of Nursing Education 46(3), pp.127-131. Retrieved from ProQuest on April 6, 2007.
Groves, M., Pafford, L., Stetina, P. (June 2005). Managing medication errors – a qualitative study. MEDSURG Nursing 14(3), pp 174-178. Retrieved from Expanded Academic ASAP on April 6, 2007.
Harrington, S., Lilley, L., and Snyder, J. (2007). Pharmacology and the nursing process (5th ed.). St. Louis: Elsevier Saunders.
Neal, T. (2006, September 19). Preventing medication errors. The Seattle Times. Downloaded from seattletimes.nwsource.com on April 6, 2007.