Improvement Plan Tool Kit for Medication Administration
Medication therapy is one most common primary intervention for most illnesses and is increasingly growing globally. Patients who receive medications are exposed to several risks as well as benefits in the process. Benefits include successful management of the illness, slackened disease progression, better patient health outcomes with few errors if any. The risks associated with medications can be due to mistakes that are preventable which includes medication errors. With inadequate knowledge among nurses regarding patient safety and quality, fatigues, legibility of provider handwriting, faulty drug dispensing systems, and labelling of drugs, nurses and other health care providers are constantly challenged to ascertain that their clients receive the right medication, at the right dose and time.
Adequate communication regarding these aspects of medication is critical in mitigating errors associated with medication on admission, during hospital stay, and after discharge. The purpose of this improvement plan tool kit is to help nurses, pharmacists and physicians understand the research behind effective and adequate communication of information regarding patient’s medication and how to put it into action. This tool kit has been classified into three categories with four annotated sources each. The categories include; the use of modern technology to help in mitigating medication errors, education of care givers and those in close contact with the patient, setting right the environmental conditions for safe medication administration.
The use of modern technology to help in mitigating medication errors
- Campanella, P., Lovato, E., Marone, C., Fallacara, L., Mancuso, A., Ricciardi, W., & Specchia, M. L. (2016). The impact of electronic health records on healthcare quality: a systematic review and meta-analysis. The European Journal of Public Health, 26(1), 60-64. https://doi.org/10.1093/eurpub/ckv122
This article is a systemic review and meta-analysis of the impact of electronic healthcare records on the quality of healthcare including lowering the number of medication errors. The aim of this article was to evaluate the impact of using EHR to enhance the quality of healthcare. It demonstrates the effectiveness of proper implementation of the EHR system in improving health quality, increasing time efficiency and compliance to guidelines, and reduction of medication errors and adverse drug effects. This source is useful to nurses, physicians, and pharmacists who are involved in the long chain of administration of medication, starting from prescription, dispensing and administration. This resource has valuable information that nurses can apply in their practice regarding the association between the use of electronic health records and improved medication safety.
- Fanning, L., Jones, N., & Manias, E. (2016). Impact of automated dispensing cabinets on medication selection and preparation error rates in an emergency department: a prospective and direct observational before‐and‐after study. Journal of evaluation in clinical practice, 22(2), 156-163. https://doi.org/10.1111/jep.12445
This article is a study on the impact of using automated dispensing cabinets on medication selection and preparation errors rates in an ED of a tertiary hospital. A pre- and post-intervention study was conducted through direct observation of nurses completing medication administration procedures before and after implementing ADCs in the care settings. A comparison analysis was then done between these two periods. The results of this study are useful in contributing to evidence-based practice on improving medication safety, not only in ED setting but also in other specialty areas in the hospital. The findings of the study underscore the importance of using ADCs to mitigate errors related to medication selection and preparation, and is a relevant tool to registered nurses and nursing students as they develop skills in their career path.
- Hernandez, F., Majoul, E., Montes-Palacios, C., Antignac, M., Cherrier, B., Doursounian, L., … & Hindlet, P. (2015). An observational study of the impact of a computerized physician order entry system on the rate of medication errors in an orthopaedic surgery unit. PloS one, 10(7), e0134101. https://doi.org/10.1371/journal.pone.0134101
This was an observational study conducted in an orthopedic surgery unit in a hospital in France, where the capacity is 66 beds. It aimed at assessing the impact of implementing computerized physician order entry (CPOE) on medication errors during the stages of drug management, i.e. prescription, dispensing and administration. Physicians and nurses can use CPOE to improve medication safety by minimizing prescribing errors and administration errors respectively. The study demonstrated significant reduction rates of these errors when using CPOE. In their training, nursing students can use this tool to enhance their knowledge and skills in prescription and administration of medication in any healthcare setting. The application oof this tool is particularly effective in general wards where there are a lot of patients and the chances of making such errors are higher. Based on the study findings, this article can be used to suggest that CPOE is a convenient technological system of enhancing safety in drug administration.
- Slight, S. P., Eguale, T., Amato, M. G., Seger, A. C., Whitney, D. L., Bates, D. W., & Schiff, G. D. (2016). The vulnerabilities of computerized physician order entry systems: a qualitative study. Journal of the American Medical Informatics Association, 23(2), 311-316.https://doi.org/10.1093/jamia/ocv135
This study was done to determine the vulnerabilities of using a wide range of CPOE systems to various types of medication errors, and develop a comprehensive understanding of how the system can be improved. Some of the vulnerabilities include failure to detect previously documented medication errors, confusing wordings of alert warnings, and improper timing of the alert warnings. The study reveals that high-alert drug-drug interaction warnings only appeared after the order was placed, instead of before. This study is relevant to physicians, pharmacists and nurse as it informs them of the loopholes in the system, and provokes their creative thinking abilities to come up with ways of making it better and minimizing the vulnerabilities. As young people in the nursing profession, this study is quite useful to nursing students as they get to identify the inadequacies in the system and invest their skills in improving the current CPOE system to minimize medication errors, and ultimately improve safety.
- Siebert, J. N., Ehrler, F., Combescure, C., Lacroix, L., Haddad, K., Sanchez, O., … & Manzano, S. (2017). A mobile device app to reduce time to drug delivery and medication errors during simulated pediatric cardiopulmonary resuscitation: a randomized controlled trial. Journal of medical Internet research, 19(2), e31. doi:10.2196/jmir.7005
This research article was a simulation-based study aimed at determining whether the use of PedAMINES has an effect of reducing drug preparation time and time to delivery, and ultimately medication errors in comparison to the conventional methods. The results revealed that PedAMINES drasticly reduced the drug preparation time as well as the delivery time, thereby minimizing medication errors. Hospital management can incorporate the technology in the health care settings and consequently improve patient safety. The use of this technological feature among nurses will be valuable in reducing workload and subsequent burnout. Additionally, the level of patient safety regarding drug administration will be increased.
Education of care givers and those in close contact with the patient
- Vrbnjak, D., Denieffe, S., O’Gorman, C., & Pajnkihar, M. (2016). Barriers to reporting medication errors and near misses among nurses: A systematic review. International journal of nursing studies, 63, 162-178. https://doi.org/10.1016/j.ijnurstu.2016.08.019
The systematic review aimed to explore and identify the barriers to nurses’ reporting of medication errors and near misses in the hospital. The search results that met the eligibility criteria were retrieved from well recognized websites, validated by a third reviewer, and synthesized through thematic methods. The barriers identified include organizational barriers such as culture, ineffective reporting system, and management behavior. Other barriers are personal and professional including fear and accountability respectively. This article is relevant, particularly to the nursing profession as it highlights the necessary measures that can be implemented at the organizational level to overcome the identified barriers. Hospitals should develop a non-blaming, non-fearful environment to promote a learning culture. Nurse leaders can also contribute to this culture by advocating for and utilizing reporting systems that are anonymous, effective, uncomplicated and efficient. Additionally, through supportive management, nursing staff and students are able to receive open feedback on issues such as medication errors, and this increases their accountability for patient’s safety. The findings of this review are valuable to nurse managers and educators in informing their educational and management approaches in overcoming these barriers.
- Lavan, A. H., Gallagher, P. F., & O’Mahony, D. (2016). Methods to reduce prescribing errors in elderly patients with multimorbidity. Clinical interventions in aging, 11, 857. Doi: 2147/CIA.S80280
This research article discusses the methods that can be implemented to minimize prescribing errors in elderly patients with multimorbidity. It contends that prescriber’s lack of knowledge of geriatric physiology, medicine, and pharmacotherapy is one of the significant contributing factors leading to polypharmacy, inappropriate prescriptions and omission of drugs. The article recognizes and discusses the critical role of education in minimizing prescribing errors. Traditionally, this used to be exclusively a physician’s role, however, with time and increased career paths in the medical field, nurses and pharmacists also get to prescribe. With the dynamic physiological changes at every stage of the human life cycle, it is imperative that medical and nursing students be instilled with the knowledge of prescription from as early as undergraduate programs. The article highlight that junior doctors are twice as like as senor medical consultants to commit prescribing errors. Highlighting these statistics underscores the importance of early and continuous education regarding prescription in minimizing prescribing errors.
- Gorgich, E. A. C., Barfroshan, S., Ghoreishi, G., & Yaghoobi, M. (2016). Investigating the causes of medication errors and strategies to prevention of them from nurses and nursing student viewpoint. Global journal of health science, 8(8), 220. Doi: 5539/gjhs.v8n8p220
This research article is a cross-sectional descriptive study that was conducted on 327 qualified nursing staff and 62 intern nursing students at Khatam-al-anbia Hospital. It was aimed at investigating the causes of medication errors and the appropriate prevention strategies from a nurse’s point of view. The findings of the study were fatigue from increased workload among nurses (97.8%) and lack of adequate knowledge of drug calculation among nursing students (77.4%). The results of this study can be used to implement significant nursing management interventions such as increasing the number of staff with respect to the number and conditions of patients. Additionally, they can facilitate the provision of continuous workshops and in-service education regarding medication preparation and administration. Also nursing education curriculum can incorporate ‘medication calculation’ as a unit on its own to increase the students’ knowledge on drug administration and minimize medication errors.
- Hayes, C., Jackson, D., Davidson, P. M., & Power, T. (2015). Medication errors in hospitals: a literature review of disruptions to nursing practice during medication administration. Journal of clinical nursing, 24(21-22), 3063-3076. https://doi.org/10.4037/ccn2016498
This research article recognizes the impact of interruptions during medication administration on medication errors and the relevant strategies to limit such interruption during drug administration procedures. The aim of the article was to evaluate the effectiveness of evidence-based strategies to reduce interruptions during drug administration, and the subsequent impact of limiting these interruptions. The study was done in three progressive cardiac care units. The results demonstrated a significant decrease in the medication errors following the implementation of evidence-based strategies in limiting interruptions. Avoidable interruptions were minimized by 83% and 53% in PCCU1 and PCCU2 respectively following the implementation of the strategies. The findings in this research article are useful in informing nursing professionals of the significance of minimizing interruptions during drug administration to mitigate medication errors and subsequently promote patient safety. Nursing students can also incorporate these strategies during their clinical placements to ensure that the habit is instilled in them from a young age in the profession.
Setting right the environmental conditions for safe medication administration
- Feleke, S. A., Mulatu, M. A., & Yesmaw, Y. S. (2015). Medication administration error: magnitude and associated factors among nurses in Ethiopia. BMC nursing, 14(1), 1-8. Retrieved from https://link.springer.com/article/10.1186/s12912-015-0099-1
The aim of this research article was to evaluate the magnitude and associated factors of errors during medication administration among nurses at Felege Hiwot Referral Hospital inpatient department. The study highlight that the most dominant error observed is documentation errors. Other errors include reduced staffing levels, frequent interruptions, having less experienced nurses (under 10 years of experience), lack of supervision for young inexperience nurses, and less sleep hours resulting in fatigue. The study concludes that addressing these inadequacies can have a significant impact in mitigating medication errors. Nurse managers can benefit from the findings of this research by implementing strict and continuous supervision of inexperienced nurses, increasing the number of nursing staff, and allocating shifts considerably so that the nursing staff do not have burnout and fatigue. Consequently, this creates a conducive environment for minimizing medication errors and improved patient safety.
- Winsett, R. P., Rottet, K., Schmitt, A., Wathen, E., Wilson, D., & Group, M. N. C. C. (2016). Medical surgical nurses describe missed nursing care tasks—Evaluating our work environment. Applied Nursing Research, 32, 128-133. https://doi.org/10.1016/j.apnr.2016.06.006
The objective of this research article was to explore the nurse work environment by assessing the self-report of missed nursing care and the relevant reasons. The researches used a convenient sample of 168 medical surgical nurses from four different hospitals to complete the survey. The findings revealed that medications administered within a 30-minute window were among the reported missed care among others. Among the reasons for missed care were unexpected increase in work volume including admissions and discharges, limited nursing staff, medications not being available when needed, and existence of more urgent situations. By identifying missed care and the reasons for each, nurse managers can improve the nurse work environment by reducing interruptions and developing departmental cohesiveness, which consequently improves patient safety and outcomes in terms of drug administration. Also, form early in the profession, nurses can incorporate best practices for implementing treatment interventions as soon as they are prescribed, if the resources are available, so they don’t risk forgetting when the workload increases.
- Cloete, L. (2015). Reducing medication errors in nursing practice. Cancer Nursing Practice, 14(1). Doi:7748/cnp.14.1.29.e1148
This research article agrees that medication errors are the most common causes of unintentional harm to patients which contribute to compromised patient safety and increased financial burden in health care institutions. The article contends that prevention of medication errors at every stage of medication management is critical in maintaining a safe healthcare system. The study reveals that one third of medication errors happen at the nurse administration stage and discusses the factors that contribute to it. Among the factors are safety culture in organizations, patient acuity, nursing workload, distractions and interruptions, the complexity of some medication calculations, and methods of administrations, and minimum compliance and adherence to policies and guidelines. By highlighting these factors, the article is relevant to nurses and nursing students who can avoid these mistakes and promote a safe environment that facilitates minimum errors in drug administration.
- Copanitsanou, P., Fotos, N., & Brokalaki, H. (2017). Effects of work environment on patient and nurse outcomes. British Journal of Nursing, 26(3), 172-176. https://doi.org/10.12968/bjon.2017.26.3.172
This research article highlights the effects of work environment on patient and nurse outcomes. According to this study, a number of parameters of nurse’s work environment have implications such as complications and burnout on nurses. This article aimed at analyzing research data related to the effect of nurses’ work environments on health outcomes of both patients and nurses. The study revealed that patients hospitalized in units with good work environment for nurse had better health outcomes and satisfaction levels compared to those who were hospitalized in health settings where nurse perceived the work environment to be poor. This article is relevant to nurse managers and nursing staff who are responsible for creation of a good work environment that fosters patient safety at all levels. A good work environment is a significant determinant of the quality of healthcare and improved outcomes for patients and nurses.
Campanella, P., Lovato, E., Marone, C., Fallacara, L., Mancuso, A., Ricciardi, W., & Specchia, M. L. (2016). The impact of electronic health records on healthcare quality: a systematic review and meta-analysis. The European Journal of Public Health, 26(1), 60-64. https://doi.org/10.1093/eurpub/ckv122
Cloete, L. (2015). Reducing medication errors in nursing practice. Cancer Nursing Practice, 14(1). Doi: 10.7748/cnp.14.1.29.e1148
Copanitsanou, P., Fotos, N., & Brokalaki, H. (2017). Effects of work environment on patient and nurse outcomes. British Journal of Nursing, 26(3), 172-176. https://doi.org/10.12968/bjon.2017.26.3.172
Fanning, L., Jones, N., & Manias, E. (2016). Impact of automated dispensing cabinets on medication selection and preparation error rates in an emergency department: a prospective and direct observational before‐and‐after study. Journal of evaluation in clinical practice, 22(2), 156-163. https://doi.org/10.1111/jep.12445
Feleke, S. A., Mulatu, M. A., & Yesmaw, Y. S. (2015). Medication administration error: magnitude and associated factors among nurses in Ethiopia. BMC nursing, 14(1), 1-8. Retrieved from https://link.springer.com/article/10.1186/s12912-015-0099-1
Gorgich, E. A. C., Barfroshan, S., Ghoreishi, G., & Yaghoobi, M. (2016). Investigating the causes of medication errors and strategies to prevention of them from nurses and nursing student viewpoint. Global journal of health science, 8(8), 220. Doi: 10.5539/gjhs.v8n8p220
Hayes, C., Jackson, D., Davidson, P. M., & Power, T. (2015). Medication errors in hospitals: a literature review of disruptions to nursing practice during medication administration. Journal of clinical nursing, 24(21-22), 3063-3076. https://doi.org/10.4037/ccn2016498
Hernandez, F., Majoul, E., Montes-Palacios, C., Antignac, M., Cherrier, B., Doursounian, L., … & Hindlet, P. (2015). An observational study of the impact of a computerized physician order entry system on the rate of medication errors in an orthopaedic surgery unit. PloS one, 10(7), e0134101. https://doi.org/10.1371/journal.pone.0134101
Lavan, A. H., Gallagher, P. F., & O’Mahony, D. (2016). Methods to reduce prescribing errors in elderly patients with multimorbidity. Clinical interventions in aging, 11, 857. Doi: 10.2147/CIA.S80280
Siebert, J. N., Ehrler, F., Combescure, C., Lacroix, L., Haddad, K., Sanchez, O., … & Manzano, S. (2017). A mobile device app to reduce time to drug delivery and medication errors during simulated pediatric cardiopulmonary resuscitation: a randomized controlled trial. Journal of medical Internet research, 19(2), e31. Doi:10.2196/jmir.7005
Slight, S. P., Eguale, T., Amato, M. G., Seger, A. C., Whitney, D. L., Bates, D. W., & Schiff, G. D. (2016). The vulnerabilities of computerized physician order entry systems: a qualitative study. Journal of the American Medical Informatics Association, 23(2), 311-316. https://doi.org/10.1093/jamia/ocv135
Vrbnjak, D., Denieffe, S., O’Gorman, C., & Pajnkihar, M. (2016). Barriers to reporting medication errors and near misses among nurses: A systematic review. International journal of nursing studies, 63, 162-178. https://doi.org/10.1016/j.ijnurstu.2016.08.019
Winsett, R. P., Rottet, K., Schmitt, A., Wathen, E., Wilson, D., & Group, M. N. C. C. (2016). Medical surgical nurses describe missed nursing care tasks—Evaluating our work environment. Applied Nursing Research, 32, 128-133. https://doi.org/10.1016/j.apnr.2016.06.006
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