The Role of Nurses in Medication Errors and the Impact of These on the Health Care System - Essay Example

Role of Nurses in Medication Errors Name: Institution: Role of Nurses in Medication Errors Medication errors refers to all preventable events that may lead to or cause inappropriate medication use or harm the patient while the medication is being controlled by a health care professional, consumer or patient. These events are related to health care products, professional practice, health systems and procedures, including prescribing, product labeling, nomenclature and packaging, medical products’ administration, distribution and use (U.S. Department of Health and Human Services, 2012, p.3). Some of the medication administration errors are use of improper concentration, wrong infusion rate, use of expired drugs, inappropriate drug storage, wrong dose, and rapid bolus administration, poor storage of diluted medicines, inappropriate diluents, and mixing of multiple drugs in a syringe. The key factors that are mainly associated with various medication errors include; medications that are rarely prescribed or used, medications with similar packaging or similar names, commonly used medications such as antibiotics that are allergic to many patients, and medications that require tests to be carried out to ensure that proper therapeutic levels are well maintained. Additionally, sound-alike or look-alike medication names may lead to medication errors. Hence, misreading of medications names that look-alike is a common mistake. Also, these medications names that look-alike can lead to wrong medication especially when prescription is done verbally (Blegen & Hughes, 2009, p.2). Nurses are some of the medical professionals that contribute to medications errors. Some of the factors that make nurses to cause medication errors include complicated doctor-initiated order, personal neglect, unfamiliarity with medication, complicated order, being a new staff, heavy workload, insufficient training, unfamiliarity with the condition of the patient, and insufficient hospital training. The most medication-error-prone places in hospitals include; intensive care units, pediatric wards, operating rooms, emergency department units, medical day clinics, dialysis units, and oncology departments (The Royal College of Nursing, 2012, p.10). “Nurses are some of the health care professionals who are mostly involved in medication errors, hence appropriate measures must be put in place to avoid such incidences”. In USA, it is estimated that 7000 deaths occur annually due to medication errors. But, this number only represents those who die, but more people develop various side effects due to medication errors. However, possibility of medication errors resulting to death is approximately 0.1 percent because they are mostly identified before they reach the patients or before they cause permanent harm to the patients. In most cases, patients who fall victims of medication errors requires prolonged hospitalization in order for the doctors to constantly monitor their progress. Furthermore some of the medication errors require urgent and necessary interventions to sustain the patient’s life. Nurses who takes into consideration various preventive measures for medication errors reduces the incidence of medication errors and cultivates a culture of safety in the hospital environment, hence ensuring safe medications management. A research conducted in the USA in 2012 revealed that preventive measures for all medication errors are directly with administration and preparation of medications, dosing calculation skills, oral medication orders, nursing education, and the interdisciplinary collaboration (Athanasakis, 2012, p. 774). Studies have shown that collaborative improvement projects aimed to improve medication safety can reduce incidences of medication errors. Thirteen hospitals in one of the US’ states participated in collaborative projects to promote and improve medication safety. These teams were supposed to make changes in their medication processes based on medication systems. Data collected from eight of the hospitals after a given period of time showed that there was 27% reduction in medication errors, 13 percent increase in error prevention and detection, and 24% increase in formal-medication error reports that reached the patients. Moreover, a hospital in Argentina implemented different to reduce medication errors in babies and children, and improve its safety culture. These interventions concentrated on promoting good safety culture. Consequently, the rate of medication errors decreased from 11 percent to 7 percent within a period of 2 years. During this period, nurses and other medical personnels were trained on how to improve their safety skills (The Health Foundation Inspiring Improvement, 2012, p. 8). There has been increase in the number of medication errors incidences involving new- borns in Indiana and California, hence the need for nurses to participate in prevention of medication errors. Low birth-weight and premature infants are usually critically ill, hence requires intensive treatments, and prolonged length of stays. In 1999, a report by the Institute of Medicines revealed that medical errors resulted to 98,000 deaths annually and most of these errors were associated with medication management. Further, it confirmed that adverse drug incidences in adults inpatients are costly, common, frequently preventable, and often severe. It is clear that physicians, nurses, pharmacist tend to make medication errors, which are common across the nation (Koeppel, 2008, p.73). Many medication errors occur due to miscommunication among nurses, pharmacists and physicians. Thus, communication barriers must be eliminated and the drugs information must be always verified. One of the ways that can be used to improve communication among medical personnel is SBAR method (Situation, Background, Assessment, and Recommendations). A study reveals that 60% medical errors events reported annually are caused by poor communication. In a certain case that occurred in 2001, a patient lost her life after hydralazine, extended-release nifedipine, and labetalol were crushed and given to her by NG tube. In medical applications, crushing extended-release type of medication assists in immediate absorption of a dosage. Consequently, the patient experienced hypotension and profound bradycardia that lead to cardiac arrest. Fortunately, the patient was successfully resuscitated, although she was given the drugs in the same way the following day. This happened because the clinicians failed to communicate to other medical personnel that her she experience cardiac arrest after receiving the medications improperly (Anderson & Townsend, 2010, p.24). Moreover, another key factor that makes nurses to cause medication errors is fatigue. According to a medication safety survey conducted in 2008, the nurses who participated admitted that fatigue was one of the key factors that contributed to medication errors. Over the years, researchers have explored workplace fatigue from different perspectives (Rogers & Scott, 2008, p.119). A research was carried done to explore performance of different-age groups during twelve-hour rotations. The researchers discovered that older workers were not fully capable of adjusting their circadian rhythms and had more sleep disruptions than their counterparts aged 20s. Sleep deprivation and fatigue are linked to decrease in memory, vigilance, information processing, decision making, and reaction time. Thus, a nurse who works in a 12-hour shift rotation and takes time before reaching the workplace, is forced to stay awake for about 18 consecutive hours. Interestingly, according to studies conducted by United States army, staying wake for about 17 hours is equivalent to 0.05% blood alcohol level, thus when one is awake for 24 hours, the blood alcohol level equates to 0.10%. Some nurses who work in a 16-hour shift rotation stays awake for approximately 19 or 20 hours, especially for the long-commuters. Therefore, when a nurse fails to sleep for one night, he or she experiences short-term memory deficits resulting to medication errors. Fatigue diminished the ability of the nurse to recognize significant patient changes, hence he or she may fail to notice a bad reaction to a given drug quickly enough to minimize chances of a devastating outcome. Fatigue also causes inattentional blindness. In a certain case, a nurse misread drugs labels due to fatigue. She was nearing the end of her 16-hour shift when she reached a medication cabinet to get furosemide I.V. but she picked potassium chloride vial instead. The drug was correctly labeled and she even read the label before administering it to a patient. Immediately after it was administered, it caused a severe arrhythmia. The potassium chloride and furosemide labels had similar printing and colors. The nurse expected to see a “furosemide” on the container label, hence her mind automatically processed what she wanted or expected to see. Therefore, such inattentional blindness cases takes place is not able to distinguish something that in normal cases can be easily discerned. To prevent overloading of information, the brain tend to “search and sweep” until an event grabs its attention. Hence, this made the nurse to carry out a medication error (Anderson & Townsend, 2010, p.25). Coombes & Henderson (2005) conducted a research to assess nurses’ abilities to identify medication errors and employ appropriate strategies to prevent adverse effects of such incidences. All the newly employed nurses were requested to administer medications to patients in six scenarios containing errors that could cause harm to the patients. The feedback was provided to the nurses at the end of every scenario. However, the key outcome measures were; modification of practices in accordance with knowledge and skills depending on the error detected. 63 to 85 percent of the nurses said that they would have detected the medication errors and taken the right actions. However, 11 to 30 percent of the nurses knew some concepts about the errors but would have not detected them, but 2 to 7 percent of the errors were new concepts. 32 percent of them had potential to identify medication errors in all the six scenarios and take appropriate actions. In general, nurses were frequently unable to detect medication errors in this study. Therefore, there is need to train nurses on practical medication errors awareness, and also how to conduct a pharmacist review of any form of medication in order to improve safety of medication processes and systems. Furthermore, effectiveness of the nurses as the final defense mechanism in prevention of medications errors’ incidences assumes that they; are able to identify medication errors, will act effectively by discussing the errors with pharmacy, medical, and other colleagues, and they are able to identify any form of medication errors involved in any medication procedure (Coombes & Henderson ,2005, p. 190). Another way in which nurses play a key role in medications errors is by not following proper medication protocols. Nurses sometimes tend to bypass guidelines and protocols to accommodate patients’ immediate needs or use their time efficiently (Avery & Barber, 2012, p.230). For instance, a certain doctor in Sweden wanted to ensure that a patient understood a given medication regime because she was going for a short-term leave. Therefore, she wrote the regime on a paper, but she wrote the wrong doses. Consequently, the patient followed the regime and got too much anti-arrhythmic drugs for a whole week. In defense, the nurse said that her Swedish was not very clear, hence she wanted to clarify everything by writing down all the details on a piece of paper. In some cases, some of the nurses are drugs addicts who tend to abuse medical drugs available within their working environment. Therefore, just like in any other profession, nurses who abuse drugs must undergo through appropriate counseling and rehabilitation procedures in order to ensure he or she does not get involved in medication errors while on duty (Karlsson & Ulfvarson, 2012, p.3). Medical professionals such as nurses must implement medical standards as governed by health policies and laws. To start with, they must implement patients’ safety programs. Also, they should ensure that leaders in different health care facilities create a safety culture that will be passed from one generation to another (Anderson & Frith, 2012, 294). In addition, they should prevent medical errors’ events through redesigning of vulnerable patient systems. Furthermore, it is the responsibility of the hospital to inform patients if they have been harmed by the health care provided (Washington State Nurses Association, 2012, p.2). Nurses should encourage other heath care professional carry out more researches on the causes of medication errors. This way health care mangers and professional with lay down effective strategies to prevent or reduce occurrence of medication errors (Bailey & Engel, 2005, p.2). Therefore, minimizing cases of medications errors caused by nurses will assist them to attend to the patients more comfortably and professionally. This is because, conducting medications errors can be overwhelming to the nurses, hence they may feel upset, guilty, and terrified, thus fail to work well. Proper medications errors’ safety measures give the nurses confidence to work and show utilize their abilities (Duncan, 2004, p. 212). In conclusion, to eliminate or reduce the number of medication errors reported annually worldwide, nurses must practice to the fullest their training and education on their daily medical responsibilities and duties. Additionally, nurses must attain higher levels of training and education through improved education systems that promotes effective academic progression. Moreover, nurses should uphold teamwork with all other health care professionals in order to improve the quality of health care given to the public. Further, effective policy making and workforce planning requires better information and data collection infrastructure. References Avery, T. & Barber, N. (2012). Investigating the prevalence and causes of prescribing errors in general practice, 1, pp. 1-259. Retrieved from http://www.gmc-uk.org/Investigating_the_prevalence_and_causes_of_prescribing_errors_in_general_practice___The_PRACtICe_study_Reoprt_May_2012_48605085.pdf Anderson, P. & Townsend, T. (2010). Medication errors: Don’t let them happen to you, 1, pp. 23-29.etrieved from http://www.americannursetoday.com/assets/0/434/436/440/6276/6334/6350/6356/8b8dac76-6061-4521-8b43-d0928ef8de07.pdf Anderson, E. & Frith, k. (2012). Nurse Staffing Is an Important Strategy to Prevent Medication Errors in Community Hospitals, 30(5), pp. 288-294. Retrieved from http://www.nursingeconomics.net/necfiles/specialissue/2012/Frith_Staffing.pdf Athanasakis, E. (2012). Prevention of medical errors by nurses in clinical practice, 6(4), pp. 773-783. Retrieved from http://www.hsj.gr/volume6/issue4/6416.pdf Bailey, C. & Engel, B. (2005). Medication Errors In Relation To Education & Medication Errors In Relation To Years of Nursing Experience, 3, pp. 1-8. Retrieved from http://www.lagrange.edu/resources/pdf/citations/nursing/Medication%20Errors.pdf Blegen, M. & Hughes, R (2009). Medication Administration Safety, 1, pp. 1-61. Retrieved from http://www.ahrq.gov/professionals/clinicians-providers/resources/nursing/resources/nurseshdbk/HughesR_MAS.pdf Coombes, I. & Henderson, A. (2005). Identification of Medication Errors by Nurses during a Simulated Ward, Medication Safety Orientation Program, 35 (3), pp. 190-194. Retrieved from http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=20&ved=0CIEBEBYwCTgK&url=http%3A%2F%2Fwww.researchgate.net%2Fpublication%2F37619112_Identification_of_medication_errors_by_nurses_during_a_simulated_ward_medication_safety_orientation_program%2Ffile%2F79e4151411a764bece.pdf&ei=oUEWU9vEJITdtAbD0IDwCg&usg=AFQjCNGUCkq6bYnxsVFWztqSfbMT01xk_A&sig2=oLd-DXNOcPfr3jliFx8cMg&bvm=bv.62286460,d.Yms Duncan, D. (2004). Nurse Perceptions of Medication Errors: What We Need to Know for Patient Safety, 19(3), pp. 209-217. Retrieved from http://www.nursingcenter.com/lnc/journalarticle?Article_ID=514523 Karlsson, E. & Ulfvarson, J. (2012). Medication Errors by Nurses in Sweden-Classification and Contributing factors, 1(11), pp. 1-4. Retrieved from http://omicsonline.org/scientific-reports/2167-1168-SR-527.pdf Koeppel, R. (2008). What Nurses Can Do Right Now to Reduce Medication Errors in the Neonatal Intensive Care Unit, pp. 72-82. Retrieved from http://www.nursingconsult.com/nursing/journals/1527-3369/full-text/PDF/s1527336908000354.pdf?issn=1527-3369&full_text=pdf&pdfName=s1527336908000354.pdf&spid=20680101&article_id=827145 Rogers, A. & Scott, L. (2008). Role of registered nurses in error prevention, discovery and Correction, 17, pp. 117-121. Retrieved from http://medqi.bsd.uchicago.edu/documents/rnroleindetectingerrorqshc4_08.pdf The Health Foundation Inspiring Improvement (2012). Reducing prescribing errors, pp.. 1-33. Retrieved from http://www.health.org.uk/public/cms/75/76/313/3337/Reducing%20prescribing%20errors%20-%20evidence%20scan.pdf?realName=3bXWvp.pdf The Royal College of Nursing (2012). Medication Errors, 1, pp. 1-16. Retrieved from https://www.rcn.org.uk/__data/assets/pdf_file/0016/250801/KostasMedication_Errors.pdf U.S. Department of Health and Human Services (2012). Safety Considerations for Product Design to Minimize Medication Errors, 1, pp. 1-18. Retrieved from http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guid ances/UCM331810.pdf Washington State Nurses Association (2012). Medical Errors and Patient Safety, 1, pp.1-10. Retrieved from http://www.wsna.org/practice/publications/documents/pp.errors.pdf Read More