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11.10.2018

Medication error is a significant issue in healthcare sector, and it is adversely impacting the ability of nurses to efficiently providing care to patients. This article covers important strategies that can be used to reduce the medication error and provide best quality care to patients.

INTRODUCTION:

In this era of healthcare the primary focus of the healthcare professionals is on patent’s safety and quality of care. This requires the nursing leaders and other clinical leaders to have high skills and interventional capabilities that can be employed to motivate as well as engage the clinical team into proper risk assessment and improving the quality of care continuously at every level. Among various risks in clinical set up the medication error forms the significant area of concern. An adverse medication event can be defined as any harm that resulted due to drug administration and it is estimated that approximately more than 3 million cases across the globe is reported annually that ate associated with adverse drug events.

A medication error can be any error irrespective of the fact that whether a patient is experiencing adverse consequence or not. The nursing leaders in the healthcare have moral and ethical obligations to ensure that the patients are given high quality of care and that their safety is given highest priority. The issue of medication error as one of the most significant risk factor in healthcare and the role of nursing leaders to address this issue is significant. Important strategies can help the nursing leaders to address this issue positively.

 

ROLE OF NURSING LEADER IN SAFE ADMINISTRATION OF MEDICINES

The medication errors in healthcare setup significantly contribute towards the avoidable death of the patients. Nurses have prominent role to play in the drug administration and the good nursing practice reduces significantly the adverse events that results from wrong prescription, monitoring of medicines and administration. Although addressing the challenge of the medication error needs involvement of all the clinical staffs and their collaborative approach but ensuring the medication safety forms the central core of the nursing responsibilities which in turn requires adequate theoretical and practical knowledge. The medication safety is routine task but it is a complex intervention as well that might sometime lead to some serious consequences. Some of the factors that leads to medication error includes the non-availability of the drug, wrong dose given, administration of the medicine through wrong route, administration of unauthorized drug, giving extra dose, administration of wrong formulation, giving late dose, missing a dose, failure in checking potential adverse side effects such as allergies before continuing the medicine and the failure in interpreting the vital signs and symptoms after administration of the medicines.

Improving the medication safety and providing safe healthcare services is based upon the expansion of the nursing roles. The nursing leaders should demonstrate their commitment for the patient safety by reforming the outdated structures and creating new strategic plans that can help them to provide appropriate quality care. The nursing leaders both at education and practice level have vital role in the risk assessment and management along with the provision of safe and competent nursing. The next section of the essay will discuss two nursing strategies one traditional and another contemporary for minimizing the medication errors.

STRATEGIES FOR MINIMIZING THE MEDICATION ERRORS:

  1. The “Five Rights” approach

This is the traditional approach of safe nursing practice in order to avoid any medication errors. The five rights refer to the following:

  1. The right patient
  2. The right medication
  3. The right dose of medication
  4. The right route of administration
  5. The right time of administration

Each of these elements are considered as the goal of the medication safety

It is important to ensure and cross check that the right medicine is being administered to right patient. This can be done by crosschecking the patient’s documents before administration of medicine. Often after a short period physicians changes medication of the patients therefore it is important to go through the documents so that any such changes is known to the nurses. The right medication refers to right formulation, right drug and that the medicine should not be outdated. It is important to ensure that the medication which is being given to the patient should not be outdated and should be of right formulation to avoid any kind of adverse reactions in the body. With right dose it means that accurate medicine with accurate amount should be administered to the patient as prescribed by the physician.  Not all medicines are administered by same route. The efficacy of some medicines depend upon the route through which it is being administered hence it is important to carefully note the route of administration. For example some medicines are given intra-venous but some are given subcutaneous.

Lastly the each medicine has some specific time for administration like some medicines should be given before meal while some are given after meal and their mode of action also depends upon the timing hence it is important to know which medicine should be given at which time. These “five right” approach is considered although as traditional approach but it has been the basis for medication safety practiced by the nurses till date. However it should be the responsibility of the nursing leaders to ensure that basics of this approach should be taught in the curriculum of the nursing education and that the newly registered nurses should also include this during their practice. They should always analyze their practice of mediation safety through this “five right” strategy that whether they are administering right medicine at right dose through right route to the right person at right time or not. Time to time evaluation of newly registered nurses regarding application of this approach by the nursing leader will also help them to identify the gaps between the education components and the practical limitations.

  1. Adequate nurse staffing and education

It has been found in few independent studies that less number of nursing staffs in a hospital also results into medication error. This is due to the fact that since basic care delivery to a patient is carried out by nurses and they are also responsible of maintaining the entire health records of each patient they are attending, therefore work overload and less staffs increases the chances of medication error. Studies have shown that when the nurses are distracted or are having several competing demands usually tend to omit to follow the five rights and also fail to adhere to the best practice guidelines. These lead to development of many risk factors which also includes medication errors.

The nurses under tremendous work pressure and increased demand develop compensatory behavior thus leading to several errors. This therefore shows the importance of adequate nurse staffing in a hospital. Along with increased nurse staffing it has also to be ensured that the nurses recruited gets proper training and education regarding each aspect of patient care in particular the administration of medicines as medicines forms the most vital aspect of healthcare and wellbeing of a patient during hospital stay. This not only include knowledge regarding how, what and which medicines are to be given to patients but also to know the ethical and moral aspects of maintaining the safe environment for the patients.

Due to less number of nurses and increase in healthcare demands often the nurses had to go through fatigue, overtime and nursing burnout. This leads to job dissatisfaction as well as low concentration while attending a patient. All these factors inevitably results into number of errors by the nurses while delivering care and particularly the medication error. Therefore according to the capacity of the hospitals and number of patients that can be admitted the nursing staffs should be appointed. Correct number of nursing staffs eliminates the over workload thus enabling the nurses to concentrate upon their responsibilities and on each patient they are attending. This significantly helps in reducing the medication error along with several other errors. Apart from this they are also able to monitor the activities of their colleagues so that they can report any unethical activity or errors done by them. At Nursing Assignment Help, we maintain sufficient number of nurses to ensure that this issue of medication error never happens.

IMPLEMENTATION OF STRATEGIES IN THE PEDIATRIC WARD:

Working in pediatric ward requires high skills and attention as the patients nurses are dealing with cannot express their physical situation clearly. Therefore any kind of error from the nursing staffs can lead to unpleasant outcomes. In order to implement above mentioned strategies in the pediatric ward first it is important to ensure that the governance system of the organization is strong and enhances the clinical outcomes. The “Five Rights” strategy can be implemented at two stages, first during education and training of the nursing staffs and secondly during practice. In the traditional method the nurses were inadequately led due to which they now face various challenges as the trend in healthcare changes from time to. In order to reduce the incidences of medication errors by the nurses it is important that the new nurses should be educated in such as way that they develop analytical and critical thinking abilities. Also nursing role expansion needs a high level of leadership along with clinical judgment, ability of critical thinking and practical experiences.

All these together help the nurses to meet the requirements of increasing complexity of pediatric ward. A learning model developed by Kolb guides the education for the nursing students with respect to creation of the changes in behavior and practicing. It helps to merge the theoretical knowledge and the psychomotor skills that help in facilitating the overall development of critical thinking ability of the nursing students. At the education level teaching the nursing students the medication safety needs a close collaboration between various medical staffs including the educators, the managers and the policy makers. The requirements of the policy makers and the nursing managers greatly influence the nursing curriculum so as to strengthen the investments in the medicines, its management and develop skills of the nurses so as to ensure that the nurses are able to provide safe and competent services.

The “five rights” can be well recognized and included in day to day nursing practice. There should be posters clearly mentioning the “Five rights” associated with medication errors behind each bed of the patient or at the entrance of the ward. This will help the newly registered nurses or student nurses to follow the steps during administration of the drugs. If there is any kind of discrepancy observed by the nurses with their colleagues in medication then they should immediately report that to their senior as well as direct their colleagues about it.  The nurses should be very confident and should be able to clearly communicate their vision to the staffs along with identification of the constraints within their role and to find alternative method to overcome their limitations.

It is the duty of the nursing leaders to timely analyze the nursing workforce and the amount of work load upon each and their overall functioning. At regular intervals the nursing leaders should conduct performance analysis as well as through small surveys they must try to know what all are the lacunas at the workplace that might be affecting the performance level of the nurses. Recruitment of new nursing staffs with adequate skills as and when required helps in reducing the workload and distributing work that will help in improving their performance level. Time to time evaluation, implementation of tools and framework to find out causes of medication error, factors associated with nursing individuals committing error, development of training materials and setting examples for workforce is expected from a nurse leader in this context. It must be noted, as a nurse leader it is imperative to understand the healthcare domain is highly pressurized environment. Therefore, it requires high focus in work to avoid any mistakes.

Empowerment of the nursing leaders is another fundamental component of nursing practice. The productivity of the nurses increases and they are able to operate at all levels of the organization. This can be done either by conducting separate training classes to make them learn everything regarding medication safety and what all are the possible barriers for the medication safety or they can be associated with experienced nurses so that they learn from their experiences and handle some real time cases. This not only imparts knowledge to them regarding medication safety but also helps them to think and analyze critically any particular situation. In regular intervals the newly registered nurses should be assessed by the nursing managers regarding their knowledge of medication safety. This helps the nursing manager to identify the loop holes or the gaps present in knowledge and applying those knowledge in real life cases.

There can be certain barriers in implementing the above mentioned strategies and they are as follows:

  1. Budget constraint: Although appointing new nursing staffs would help in reducing workload and improve performance of the existing nurses but it would also result into increase in the budget of the organization in the form of salary and maintenance.
  2. Poor Governance: As mentioned above strong governance is very important for successful implementation of any strategies. If there is lack of monitoring system at regular time intervals, there is no proper strategic direction and the nursing leaders are not empowered to take decision then it leads to failure in implementing any effective strategy.

 

CONCLUSION

Drug administration errors or medication errors form a major safety issue in Australia. The high prevalence rate of medication errors and adverse outcomes implicates, there is a clear gap between policies formed, guidelines developed and practiced. Although code of professional conduct Australia directs nursing professionals to maintain highest competency standard and prevent any type of harm, drug administration error leads to unnecessary trouble for patients as well as the working individual. In drug or medication error process, the nurse is the last person who will be involved in the process. However, she must have the right knowledge of drug, indications, interactions, rationale of giving as well as implications for practice. However, developing this as a culture warrants nursing leadership and transformational leadership.

Ward managers or in charge need to be more cautious with this regard and provide training to the newly registered nurses. Assigning mentor and helping them to provide quality services shows the potential of leadership that can positively influence the nursing workforce. Similarly, leadership trait must be passed to new generation in order to save the patients from any type of harm related to drug errors. Empowerment of nurse leadership and facilitating them with more powers can reduce the effect of medication error on patient safety. Secondly, transformational leadership is warranted in reducing medication errors because the employees need to be motivated and incorporate this culture in their work practice.

Article last time updated on 11.10.2018.

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