Currently, healthcare systems around the world are faced with challenges associated with patient care. A significant health care issue that affects most healthcare experts encounter is medication errors. The U.S FDA (2018) describes a medication error as any avoidable occurrence that may lead to improper use of medication or cause harm to patients while the medication is in the jurisdiction of a patient or care provider. Medication errors are the third leading cause of mortalities in the U.S (Gnädinger, 2017). Health care professionals have the legal mandate as well as a moral duty to offer safe and quality care to all patients. Therefore, medication errors directly impact patients and can result in either grievous harm or death to patients. For example, medication errors may happen during emergencies, where nurses have to calculate drug doses in a time-sensitive manner.
Elements of the Problem
When patients are receiving care in health care facilities, patients are often at risk of facing harm related to medication errors. Several primary areas usually lead to medication errors. According to Cohen (2018), these include high alert medication, formulary management, drugs that look or sound similar, drug shortages, medication reconciliation, storage of medication, standardizations of concentration, and patient and practitioner education. However, for nurses, according to Wheeler et al. (2017), the two most common sources of medication errors include distractions and inexperience, which often may lead to preventable deaths.
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Cook (2015) states that most cases of medication errors have been witnessed when nurses are distracted, do not adhere to procedures, are overburdened, or undergo burnouts. An example of a situation that can lead to medication errors is when a nurse is obtaining medication from a medication dispensing system while a colleague is trying to initiate a conversation. In this scenario, the focus of the nurse may be shifted and may, in turn, fail to provide the right dosage to a patient, possibly resulting in an error. There are numerous stressors in the hospital setting which healthcare providers need to consider. Therefore, focusing on the health status of nurses is very pertinent.
Medication Error Analysis
As a nurse, my job entails working directly with patients from the time they are admitted into the health facility until they are released from the hospital. In my line of duty, it is essential to be conscious of probable medication errors or near misses, which may compromise the safety of patients. Besides, I directly encounter potential medication risks in prescribing, monitoring, and giving advice stages. Part of discharging my duties is accompanying physicians into the rooms of patients and transcribe patient's progress notes, register diagnosis, and convey verbal orders. Also, I am tasked with the duty of patient education and monitoring the progress of patients. During transcription, errors in prescription may occur due to a lack of clear communication between physicians and nurses or nurses with pharmacists.
The Context for Patient Safety Issues
Medical errors have become unavoidable, especially in high acuity environments. Given the problem of nursing shortages globally and with technological advancements, health care providers are at increased risk of medication errors ( Medication Errors and Adverse Drug Events , 2019). Factors that continue to contribute to patient safety concerns include ineffective education programs for nurses, shortage of nurses in hospitals, and human errors. Human factors remain the most prevalent causes of medication errors ( Medication Errors and Adverse Drug Events , 2019). Every health care team member must remain educated, conversant, and proficient in their areas of specialization or practice. Through constant collaboration with other health care experts, nurses can play a significant role in decreasing and averting errors associated with the medication.
Populations Impacted by Patient Safety Problems
Patients in emergency care units are at a high risk of medication error. Critical care environments are very multifaceted and often demand more of a health care provider (Wheeler et al. 2017). Health experts who find themselves in emergencies are usually required to carry out medication dosing quickly. Besides, Emergency wings of healthcare facilities are typically overcrowded, which puts patients at an increased risk because of nurse exhaustion and burnouts. Moreover, Wheeler et al. (2017) argue that a new healthcare professional is at a high risk of committing medication errors. According to Wheeler and colleagues, physician prescribing mistakes occur mostly in the first year after graduation from medical school.
Considering Options
If the objective of decreasing and averting medication errors is to be achieved, there is a need to improve collaboration and communication, promoting patient engagement and the use of computerized provider order entry (CPOE) (Manias, 2015). Promoting cooperation and communication between all members of a patient's healthcare team is essential in averting medication errors. If healthcare experts are continuously educated on how these errors occur and standardization of collaboration and communication would help in reducing the error. Promoting patient engagement via patient education, although complex, is essential and needs to be tailored to meet the unique needs of each patient. As per Overhage et al. (2016), computerized prescriptions, for example, CPOE, together with clinical decision support systems (CDSS), contribute significantly to averting medication errors.
Implementation
There are more than 4 billion prescriptions filled every year in the United States. Therefore, computerized prescribing is a feasible solution for decreasing medication errors (Overhage et al., 2016). However, implementing computerized prescribing would require a substantial amount of funding, time, and training for physicians. Given the time it will take to transfer data into the new system and the additional training required, it will affect patient care due to the lengthy process required. Increasing staffing of nurses will help in reducing human errors caused by burnouts, stress, depression, and exhaustion.
Ethical Implication Analysis
Multiple ethical problems may arise due to medication errors such as harm to patients, whether to disclose the error, erosion of trust, and affect the quality of care. The principles of non-maleficence, patient autonomy, and beneficence guide the nursing practice. The principle of n on-maleficence requires nurses to avoid needless harm or injury that can take place through omission or commission "negligence" ( Haddad & Geiger, 2019). Besides, nurses are also required to apply the principle of beneficence, which is a moral obligation that requires them to act for the benefit of others. However, there are instances where the nurse has to decide between what the patient needs and what they want. Patient autonomy requires that the NP leaves the treatment decision to the patient ( Haddad & Geiger, 2019). However, this autonomy could be another cause of medication error as the patient may desire a wrong drug or dosage. The nurse has to evaluate the situation and make a decision without saliently denying the patient their right to autonomy.
Conclusion
Medication errors have continued to be a health care problem that affects patient safety worldwide. Healthcare experts should improve communication and collaboration with other members of the healthcare team, encourage patient engagement, and effectively use technology to minimize and prevent medication errors. Healthcare experts need to be aware of potential medication errors and readily report any mistake to promote a culture of safety.
References
Cohen, M. R., Smetzer, J. L., & Vaida, A. J. (2018). ASHP guidelines on preventing medication errors in hospitals: Advancing medication safety to the next level. American Journal of Health-System Pharmacy , 75 (19), 1444–1445. https://doi.org/10.2146/ajhp180283
Manias, E., Rixon, S., Williams, A., Liew, D., & Braaf, S. (2015). Barriers and enablers affecting patient engagement in managing medications within specialty hospital settings. Health Expectations , 18 (6), 2787–2798. https://doi.org/10.1111/hex.12255
Medication Errors and Adverse Drug Events . (2019, September 7). Ahrq.Gov. https://psnet.ahrq.gov/primers/primer/23/medication-errors
Medication Errors Related to CDER-Regulated Drug Products . (2018). Fda.Gov. https://www.fda.gov/Drugs/DrugSafety/MedicationErrors/default.htm
Overhage, J. M., Gandhi, T. K., Hope, C., Seger, A. C., Murray, M. D., Orav, E. J., & Bates, D. W. (2016). Ambulatory computerized prescribing and preventable adverse drug events. Journal of Patient Safety , 12 (2), 69–74. https://doi.org/10.1097/pts.0000000000000194
Cook, P. (2015). Avoiding medication errors. Kai Tiaki: Nursing New Zealand , 20 (6), 32.
Gnädinger, M., Conen, D., Herzig, L., Puhan, M. A., Staehelin, A., Zoller, M., & Ceschi, A. (2017). Medication incidents in primary care medicine: a prospective study in the Swiss Sentinel Surveillance Network (Sentinella). BMJ Open , 7 (7), e013658. https://doi.org/10.1136/bmjopen-2016-013658
Goedecke, T., Ord, K., Newbould, V., Brosch, S., & Arlett, P. (2016). Medication errors: new EU good practice guide on risk minimization and error prevention. Drug safety , 39 (6), 491-500.
Wheeler, J. S., Duncan, R., & Hohmeier, K. (2017). Medication Errors and Trainees: Advice for Learners and Organizations. Annals of Pharmacotherapy , 51 (12), 1138–1141. https://doi.org/10.1177/1060028017725092
Haddad, L. M., & Geiger, R. A. (2019). Nursing Ethical Considerations. Retrieved from https://europepmc.org/books/n/statpearls/article-92/
