medication administration and patient safety callie...

Running Head: MEDICATION ADMINISTRATION AND PATIENT SAFETY 1

Medication Administration and Patient Safety

Callie Downs

Auburn University

MEDICATION ADMINISTRATION AND PATIENT SAFETY 2

Abstract

Ensuring patient safety and high quality delivery of care is paramount for nurses in today’s

healthcare system. Unfortunately, the integrity of the healthcare profession is being

compromised due to errors occurring during the medication administration process. Medication

errors are responsible for harming millions of people, killing thousands, and costing the nation

billions of dollars in healthcare costs. Following national and organizational safety policies can

prevent the vast majority of these medication administration errors from occurring. However,

there are several risk factors that inhibit nurses from following these guidelines accurately and

providing the best patient care possible. Some of the risk factors include workplace distractions,

ineffective communication, large patient loads, insufficient knowledge of medications, and

exhaustion. In response to these risk factors, there are several interventions that may be

implemented to combat the occurrence of medication administration errors. These include the

use of health information technology, ‘Do Not Disturb’ signs, and the promotion of healthy

lifestyle choices for nurses. This knowledge gives rise to many implications for nurses in

carrying out safe patient care. This paper explores those important implications at length and

encourages nurses to take an active role in developing and changing healthcare policy to greater

support patient safety.


Introduction

Among the vast number of responsibilities that nurses face throughout the workday, the

greatest of these responsibilities is medication administration. Safe and thorough medication

administration is crucial because any mistakes, accidents, or omissions can result in negative

consequences for the patient and the nurse (Popescu, Currey, & Botti, 2011). As defined by the

National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP), “a

medication error refers to any preventable event that may cause or lead to inappropriate

medication use or patient harm while the medication is in the control of the healthcare

professional, patient, or consumer” (NCCMERP, 2010). Medication errors harm 1.5 million

people and kill several thousand annually in the United States. These errors also cost the nation

billions of dollars, lead to unintended extended hospital stays, and severely tarnish the

population’s trust in the health care system (Kim & Bates, 2013). Many things contribute to

nurses and other health care providers making medication errors. Most of these factors stem from

breakdowns in the complex and chaotic system that molds today’s health care institution.

However, in response to these systematic failures there are measures that may be implemented to

prevent medication errors and provide safe, high quality patient care. The purpose of this paper is

to explore the causes of medication errors and how increased quality improvement measures can

enhance patient safety throughout health care organizations.

Medication Administration and Patient Safety

Causes of Medication Administration Errors

Medication administration is a complex process that involves several steps and

ambiguous systems that increase the potential for the occurrence errors. It is a known fact that

humans are naturally prone to error, however the origin of most medication errors can be traced


to a discrepancy in the medication administration system design (Choo, Hutchinson, & Bucknall,

2010). The medication administration system is carried out through an interdisciplinary team

approach that consists of doctors prescribing, pharmacists dispensing, nurses administering, and

patients consuming. Errors can occur at any phase of the administration process and cause

patient harm (Popescu et al., 2011). In light of this fact there is an enormous push in health care

to promote the reporting of medication errors and near misses. In the past, nurses were afraid to

admit to mistakes for fear of blame, reprimand, and job loss (Riley, 2009). However, nurses are

now encouraged by the United States government’s National Medication Error Reporting

Program to always report any errors in order to explore failures in the system and incite dialogue

pertaining to change (Kim & Bates, 2013). It is crucial for organizations to realize that nurses are

the final link in the medication administration chain, but certainly not the only link and

vulnerable areas in the system design must be examined and improved (Choo et al., 2010). The

reporting of medication errors can lead to continuous quality care improvement initiatives and

prevent similar mistakes from occurring in the future.

The focus of this paper is errors that occur during the nurse’s administration of patient’s

medications. The first factor that increases the risk for nurses to commit medication errors is

distractions while attempting to administer medication. Fellow colleagues and patients often

distract nurses, which unfortunately decrease the accuracy in which medications are obtained and

administered (Fore, Sculli, Albee, & Neily, 2013). The second factor is poor communication

amongst team members. The interdisciplinary patient care team consists of many different

interconnected individuals; so effective communication and teamwork skills are required to

prevent lapses in the communication of vital medication and administration information (Choo et

al., 2010). A third factor that makes nurses more likely to make medication errors is heavy


patient workloads. The current nursing shortage and financial downfall in the economy has made

it difficult for health care organizations to sufficiently staff units. When nurses are forced to take

on dangerously large amounts of patients, quality of care is often sacrificed. This unfortunately

leaves room for careless medication errors and increased opportunity for unintended harm to the

patient (Choo et al., 2010).

Other factors that contribute to the risk for nurses to commit medication administration

errors are insufficient knowledge of medications, inaccurate documentation, calculation errors,

and exhaustion (Popescu et al., 2011). It is the nurse's responsibility to be thoroughly informed

regarding all medications they are administering, to always provide current evidenced based

care, and to strictly follow organizational policies. However, the previously stated factors often

interfere with the nurse’s ability to provide the best possible patient care. This is when new

health care policies and procedures must be implemented in order to ensure high quality care and

patient safety.

Prevention of Medication Errors

There are currently policies in place to prevent medication errors from occurring, but

unfortunately nurses sometimes deviate from best practice guidelines. These guidelines include

the five rights of medication administration (right medication, right patient, right dose, right

route, right time) and organizational medication error preventative measures, performing

appropriate documentation, and watching patients consume medication (Popescu et al., 2011).

Several studies have researched medication errors and made educated, evidence-based

recommendations for policies that would make medication administration a safer practice. These

recommendations include utilizing the patient as a vital member of the health care team, using

the latest health care technology, minimizing workplace distractions, and actively taking a role in


one’s own health and self care management. Implementing these safety recommendations will

increase adherence to existing guidelines and ultimately increase patient safety.

The five rights (5 R’s) of medication administration were developed for use by nurses to

intensify safety measures during the dangerous practice of administering medications to patients.

However, medication administration is no longer solely the 5 R’s, but a process of many

interconnected individuals including the patient (Macdonald, 2010). The practice of fully

involving patients in their care has only recently been implemented, but proves to be an

important measure in reducing errors. When nurses build therapeutic relationships with patients

and provide extensive education on medications, patients will have a better understanding of

medications therapeutic actions and potential side effects (Macdonald, 2010). Popescu, Currey,

and Botti (2011) state “well-educated patients can act as the final safety net in the medication

process when nurses encourage patient participation in care.” Inspiring patient-centered care has

the potential to significantly lower medication errors and greatly increase patient safety

(Macdonald, 2010).

The nationwide effort to decrease health care errors that fall within the nursing scope of

practice has spawned a new age of health information technology. Health information

technology has the potential to not only increase patient safety, but to improve continuity of care,

and change the way healthcare is currently delivered (Moreland, Gallagher, Bena, Morrison, &

Albert, 2012). In fact, the United States recently allocated $20 billion to health information

technology in the hopes that promoting uniformity in the documentation process will reduce

human medication errors and healthcare costs (Moreland et al., 2012). These technologies

include the electronic medical administration record (eMAR) and bedside barcode scanner.

Electronic MAR’s allow medication information to be readily available and enhances


collaboration between disciplines, such as physicians and pharmacists. Barcode scanning permits

the nurse to scan patient armbands and medications at the bedside in order to catch last minute

medication errors concerning wrong patient, wrong dose, wrong medication, or wrong time.

Studies show that the use of eMAR’s and barcode scanners in hospitals reduces error rates by as

much as 56%, which led to more stable patients and increased nursing job satisfaction (Waneka

& Spetz, 2010). Overall, the increased use of health information technology in hospitals has

proven to be effective in eliminating medication errors and creating safer environments for

nurses and patients.

In nursing, distractions in the workplace are inevitable. The health care profession is

unpredictable and chaotic and nurses must be prepared to assist team members and patients at a

moments notice. Distractions during important activities such as medication administration

increase the chance for careless mistakes and medication errors (Fore et al., 2013). Two

inexpensive, simple interventions that should be implemented to decrease unimportant

distractions during medication administration are orange medication administration vests and

‘Do Not Disturb’ signs. Wearing the orange vests and placing ‘Do Not Disturb’ signs on the

medication cart during medication administration illustrates the importance of the nurse’s

activities to colleagues and therefore minimizes distractions and maximizes concentration (Fore

et al., 2013). These simple interventions have successfully proven to decrease interruptions

during medication administration and consequently increased patient safety (Fore et al., 2013).

Finally, a key component in avoiding medication errors is ensuring the nurses physical

and mental health. The human mind has limitations and when a nurse is exhausted the results can

be a poor or flawed memory and severely decreased concentration (Choo et al., 2010). Therefore,

it is imperative for healthcare organizations to encourage healthy employee lifestyles, such as


adequate sleep, proper nutritional intake, physical activity, and stress reduction activities.

Organizations should also set limits to hours worked per shift, hours worked per week, and to the

number of patients a nurse may care for at one time. A happy, healthy, and positive workforce

can have major implications to patient safety and the reduction in medication errors. Thus,

implementing seminars and teaching sessions that promote employee health and proper self-care

activities should be an essential part of the healthcare system (Choo et al., 2010).

Implications for Nursing

Knowledge of the causes and preventive measures of medication administration errors

has important implications for nursing within the context of the current state of health care.

Patient safety is always the number one priority in health care and it is the nurse’s responsibility

to follow current policies and procedures that protect the patient and their families (Riley, 2009).

These include the five rights of medication administration and national or organizational

medication error preventive measures. It is also the nurse’s responsibility, as patient advocate, to

take an active role in policy changes that will improve patient safety and decrease errors.

Identifying risk factors that lead to medication errors and researching solutions to eliminate those

risks is the nurse’s duty in potentiating change and caring for patients safely (Macdonald, 2010).

Finkelman (2012) states “Health care policy is critical because it determines what health care

services are provided, who provides the services, and who can receive services, reimbursement,

quality care, improvements, and requirements.” Organizations must focus on making policy

changes that benefit the good of the patient and nurses play a huge role in creating and

implementing those changes (Finkelman, 2012).

Another implication for nurses in carrying out safe patient care during medication

administration is the ability and readiness to engage in open, therapeutic relationships with


patients. Encouraging an open dialogue about medications and being available to answer

questions is crucial in promoting a safe medication administration process (Popescu et al., 2011).

Patient-centered care is a cornerstone in health care today and nurses must be willing to include

the patient in every aspect of his or her care (Macdonald, 2010). This will increase patient

satisfaction with care and allow patients to act as the final safety net before medication

consumption (Popescu et al., 2011).

There are also several important implications for nurse leaders and managers. It is crucial

for nurse managers to ensure high quality care and patient safety by establishing a high reliability

organization. A high reliability health care organization provides safe care and is specifically

aimed at minimizing errors (Riley, 2009). This requires strong leadership skills in order to

cultivate a culture of honesty and continuous quality improvement among interdisciplinary team

members. As previously mentioned, medication errors should always be reported in order to

stimulate change and improve healthcare policies and procedures. This is a prime example of

actions that occur in a high reliability health care organization. Other examples include the

promotion of effective communication skills among team members and the encouragement of

continuous education in individual staff (Riley, 2009).

Conclusion

In conclusion, patient safety takes highest precedent in the health care delivery system.

Nurses and nurse leaders must take responsibility for the care and safety of patients by adhering

to organization policies and procedures. Nurses are also held accountable for reporting

medication errors and actively seeking solutions for breakdowns that occur in the system.

Practicing effective communication and teamwork skills also plays a huge role in the promotion

of patient safety and nurses should constantly strive for continuous self-improvement.


Throughout my extensive research of patient safety related to medication errors, I learned

the overwhelming prevalence of medication administration errors and the incredible amount of

harm they cause to patients. I realize the importance of always following organizational safety

policies and the five rights of medication administration and the consequences that can come

from acting carelessly. I will utilize the safety measures in place to provide high quality, safe

patient care that reflects the advanced skills of the nursing profession. I also learned the

importance of actively engaging in policy changes in order to improve the health care system and

patient safety. As a BSN educated nurse I want to use my critical thinking and leadership skills

to positively influence health care by finding solutions to major systematic issues.


References

Choo, J., Hutchinson, A., & Bucknall, T. (2010). Nurses’ role in medication safety. Journal of

Nursing Management, 18(7), 853-861. doi: http://dx.doi.org/10.1111/j.1365-2834.2010.

01164.x

Finkelman, A. (2012). Health care policy, legal issues, and ethics in health care delivery. In P.

Fuller & E. Garofalo (Eds.), Leadership and management for nurses: Core competencies

for quality care (pp. 29-61). Upper Saddle River, NJ: Pearson.

Fore, A., Sculli, G., Albee, D., & Neily, J. (2013). Improving patient safety using the sterile

cockpit principle during medication administration: a collaborative, unit-based project.

Journal of Nursing Management, 21(1), 106-111. doi:10.1111/j.1365-2834.2012.01410.x

Kim, J., & Bates, D. (2013). Medication administration errors by nurses: adherence to guidelines.

Journal of Clinical Nursing, 22(3/4), 590-598. doi: 10.1111/j.1365-2702.2012.04344.x

Macdonald, M. (2010). Examining the adequacy of the 5 rights of medication administration.

Clinical Nurse Specialist, 24(4), 196-201. doi: 10.1097/NUR.0b013e3181e3605f.

Moreland, P., Gallagher, S., Bena, J., Morrison, S., & Albert, N. (2012). Nursing satisfaction

with implementation of electronic medication administration record. Nursing Informatics,

30(2), 97-103. doi: 10.1097/NCN.0b013e318224b54e.

National Coordinating Council for Medication Error Reporting and Prevention. (2013). About

medication errors. Retrieved from www.nccmerp.org/aboutMedErrors.html

Popescu, A., Currey, J., & Botti, M. (2011). Multifactorial influences on and deviations from

medication administration safety and quality in the acute medical/surgical context.

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Riley, W. (2009). High reliability and implications for nursing leaders. Journal of Nursing

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Waneka, R., & Spetz, J. (2010). Hospital information technology systems’ impact on nurses and

nursing care. The Journal of Nursing Administration, 40(12), 509-514. doi:

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