Enhancing patient safety while providing care should be at the center of nursing practice. A nurse should provide a safe environment for patients during their interaction to strengthen professionalism and safety to patients. In some cases, however, such does not happen, and injuries, hospitalization, and legal issues tend to arise due to such failures. Medication administration for the old, for instance, provides a unique challenge for nurses and physicians concerning protecting the safety of the patients. Drug administration is part of a process to achieve quality care and patient safety in the hospital. Medications are therapeutic interventions intended to reduce patient suffering, promote healing, and improve health and quality of life, but all medications have potential adverse effects ( Metsälä & Vaherkoski, 2014).
In some cases, during the process of medication administration, errors sometimes occur that could be fatal to the patients. Such errors can lead to either hospitalization death, injuries, or legal issues. Drug Administration errors, thus, by definition, are ‘a failure in the treatment process that leads to, or has the potential to lead to, harm to the patient ( Salmasi et al., 2018). The error may occur during drug dispensing, prescription, documentation, or order.
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Elderly patients provide a huge challenge for nurses regarding medication errors in the healthcare facility. Numerous factors place elderly individuals on the limelight of medication errors. Factors such as the number of drugs these individuals use, the polypharmacy, the drug interactions, and the medication that the nurses and physicians should avoid owing to the states of these patients all clog together bring a lot of issues can easily lead to medication errors. It is, therefore, an obligation of a nurse to ensure that they are keen to eliminate such errors and provide a safe medication and environment for these nature patients.Safety and Effective Care environment are, therefore, critical factors in reducing Medication errors in the hospital with the older population during routine medication administration procedure.
A clinical problem from NCLEX-RN category
A safe and effective care environment is one of the most critical issues in healthcare. It is a component that constitutes the management of care, safety, and infection control. The aim, in this case, is to explore the safety and control of elderly patients in the hospital. Particularly, the aim is to look at drug administration errors among old patients in the hospital. Because medication administration is part of the safety issues in the hospital, and due to the complexities that arise due to the nature of the elderly patients concerning drugs, understanding the drug administration errors among these target populations should be the priority of nurses.
The frequency of the occurrence of medication errors in the healthcare institutions, particularly among the elderly population, warrants a study that focuses on the preventions and programs the nurses can forge to intervene and reduce the rate of such errors. According to a study by Pérez-Jover et al. (2018), the rate of drug administration errors that occur among the elderly because of reluctance of physicians to report them. Also, the authors suggest that most such drug administration errors go unnoticed. In their view, drug administration errors that become apparent are normally fetal. In a study by Pérez-Jover et al. (2018), the authors reveal that medication errors that link to the wrong dosage likely to occur at a rate of 54%. When they occur, the authors assert that they could result in fatal errors that could affect the patients. Furthermore, ( Metsälä & Vaherkoski, 2014) also analyze a study done in Wales and England and reveals the extent of medical drug administration errors. From this study, the author reveals that 15% of the drug administration errors that occur caused slight harm to patients. However, 5% of them result in moderate or severe harm to the patient. The USA Studies also observes similar results. In a US study, 1.7% of prescriptions dispensed from community pharmacies contained errors. The study surveyed a total of 40 000 medication errors in 173 hospitals. Thus it was an excellent example to use while demonstrating the severity of drug administration errors among elderly patients in the healthcare setting.
There are different types of drug administration errors that are notable in the healthcare environment that relate to drug administration to patients of all types and nature. The first is knowledge or competency-based drug administration errors. These come about when the physician or the nurse lacks knowledge on proper medication to use for a specific condition. Such a person ends up prescribing and administering the wrong prescription. The next is the rule-based error, which occurs in a situation where the nurse is unable to match a specific medication or a medication procedure with the appropriate rule of drug administration. The next type of medication error is an action-based error. These are sometimes called slip errors because they occur not because of any mistake but the mistake of picking the wrong medicine from shelve where people keep them. The last type of error is memory-based errors. These are often common, as most nurses tend to assume them. Such errors occur in situations where the nurse can give out medication but forgets about critical information that should be part of that medication process. For instance, giving penicillin, yet the patient is allergic, and the physician knows about the allergic state of the patients but forget and gives out this drug. Understanding these types of errors constitutes a good plan of coming up with safety measures for the patient and creating safe environments that enhance fatty for all patients.
Importance of the topic
Drug administration error in the healthcare system is a topic worth researching due to its weight. According to a survey by Song & Ferris, (2018), the population of the Baby boomers may double in the next five years. It means that the United States may see a massive increase in the number of older people. It also implies that the country's healthcare system may see an increase in the population of elderly patients. A Randomized control trial by Flemming et al. (2019) that analyzed the drug administration errors among the elderly pinpoint reason that makes these populations vulnerable to medication errors. According to these authors, complexities that come with medication for the elderly are critical factors that need to understand when handling such matters. They include the bulk of drugs, nature, and the immune system of these individuals. Polypharmacy and drug interaction are other factors that make these people vulnerable to drug administration errors.
Understanding the drug administration errors among the patients will be the only option to provide a safe and healthy environment for the growing number of baby boomers in the country. In this sense, the nurses must be ready to create a safe environment for interacting with these patients. They must, therefore, understand the nature of these patients with regards to their vulnerability to drug administration errors and create a safe treatment environment for them. Also, understanding this topic is critical for the nurses because it will help in detecting the errors and reacting to them before they take place. Furthermore, this topic is also important because it creates awareness among the nurses on the need to fight drug administration errors among these patients. Note that the incidence of drug administration errors are numerous, and most of them go unnoticed. In this sense, it is creating an environment that allows the nurses to understand the incidences of such errors, and helping them create a plan to combat them could be a huge step towards finding a solution to this matter.
Furthermore, reducing medication administration errors will also reduce the number of hospitalization that sometimes occur due to medication errors in hospitals. According to a survey by Tawfik et al. (2018), the research reveals that about 56% of drug administration errors that occur and result in fatal injuries lead to hospitalization. In a research study where there was a total of 35000 cases of medication administration mistakes under analysis, the research reveals that the rate of hospitalization among these individuals was standing at 1.3%. A reduction of drug administration errors among older adults during the process of drug administration is, therefore, a valuable tool that the hospital can use to reduce the rate of hospitalization in healthcare. Note that the core of this topic is to create a hospital environment where the patients feel a sense of security. It aims to create a hospital environment where there is a high level of dependency on safety measures that prevent injuries and wrong medication that lead to fatal injuries in hospital environment.
The hospital facilities must encourage the nurses to try and find a solution to this matter at all costs. Without reducing the drug administration errors that occur among these patients, there will be a high rate of hospitalization among the elderly. Note that the pieces of evidence researchers reveal that the drug administration errors are just the tip of the iceberg. The problem is enormous, and without a proper solution to reduce the rate of drug administration errors among the elderly, the rate of hospitalization, the rate of death, and even legal issues will still rise, and this would have a massive impact in the healthcare environment.
The target population/patients
The research study focuses mostly on elderly patients. Most countries consider sixty-five years old as the elderly age. One of the main reasons that increase medication errors among the elderly is the high rate of different conditions that they face at this age. The elderly individuals face numerous and diverse medical conditions, which include hearing loss, cataracts, and refractive errors, back, and neck pain and osteoarthritis, chronic obstructive pulmonary disease, diabetes, depression, and dementia. According to Lavan, Gallagher & O'Mahony (2016), physicians diagnose 76% of hospitalized elderly individuals with three or more diseases. In this manner, it makes it easy for nurses to confuse the medications during the process of drug administration.
Lavan, Gallagher & O'Mahony (2016) reveal that most of the nurses who have had the opportunity to interact with the older people and provide them with medication have confessed that they find it difficult to cope with numerous types of drugs these individuals take in a single dose. Another fact that also increase the rate of drug administration error among older adults is their culture. The older patients have a lot of issues regarding culture that alienates them from using one type of drug and preferring alternative drugs. Their knowledge of the type of medication or the background information about the previous medications is also another significant factor for consideration. The patient honesty culture and their ability to communicate are some of the issues that will lead to medication errors during the drug administration process. As a nurse, therefore, understanding the nature of the patient, the culture, attitude, and other factors that could interfere with proper medication could be critical while dealing with errors that occur during the drug administration process.
Solution
In this case, a comprehensive inter-disciplinary medical care plan(MCP) could be what the nurse needs to reduce the rate of medication errors among the elderly population. The MCP will include clear strategies to mitigate the case of medical mistakes in the hospital. It prevents errors associated with incorrect doses and noncompliance with regulations and laws. The first step under the MCP strategy would be to conduct an assessment of the existing data on the hospital to understand the scope of the problem. According to Tawfik et al. (2018), this would provide the team with areas that are prone to medication errors. These would also include mapping out areas where the medicine for the old comes from and the channel they follow until their administration. It will also include mapping out the number of old patient that takes the drugs within the hospital and those who take them at home.
The next step is to form a team that will assess the drug administration within the hospital and a team that will do follow-up for the elderly individuals at home to understand how they take their drugs. Lavan, Gallagher & O'Mahony (2016) assert that the purpose of this team will be to check the current medication for the elderly at the hospital against the documented record by the physician to assert that what they take is what physicians prescribe for them. A similar procedure will be right for old patients at home. After conducting s research and publishing the research, the team will come up with an education program that aims at the nurses. Sensitization would be part of this process as it will be critical for the nurse to understand areas where they mess-up.
After sensitizing the nurses, the next step would be to draft a policy that ensures that physicians double-check the drugs before prescribing them to the patient. These could be a team of nurses that ensure that the drug is correct before administering it to the patients. Besides, the policy would ensure that there is no oral administration of the drugs, which means the physicians must write down the drug prescription. The MCP will integrate technology to achieve the process. The organization will implement the technology at all departments where caregivers will prescribe, store, and administer drugs for the elderly. These techniques will also have color codes that will match the drugs on the shelves. These will ensure that the nurse does not confuse the drugs and does not also confuse the names of the medications prescribed by the physician. The last part will be availing a physician at each area of prescription to double-check drugs and to be present to answer some questions that may lead to confusion during the drug administration process ( Metsälä & Vaherkoski, 2014).
Ethics
Part of the plan is to remain within the ethical boundaries to reduce legal and ethical issues that may arise due to such issues in the hospital. Part of the plan is also to include a request for consent for any information that the management would use as part of this plan. Further, confidentiality is also other areas that would be critical in this plan. Justice for all patients to ensure that their medications are double-checked by they take it will also constitute this plan. Such ethical issues will be critical to ensure that the plan is healthy for patients and medical practitioners.
Goals
Short term goals
The first goal would be to determine the department that associates with the elderly and understand the extent of medication errors in these departments. The organization will measure this by the report from the research that will be done by the team as constituted in the first step of the MCP plan. The second goal will be to come up with an education plan and team for the nurses. The management will measure the outcome with the duration taken to form a team to sensitize nurses and preparation of the major areas that will be of focus during the education session. Another short term goal would be to form a team within the department to check the prescriptions.
Long term goals
The long term goal will be to reduce the medication errors among the elderly by ten percent within the first three months. The number of strategies will use these goals. The institution will perform research to reaffirm the status of medication errors in this department and compare the result with the present data before the MCP to understand the achievements of the MCP.
Barriers
Change resistance will be the main barrier to the implementation of the MCP project. Due to a change that would occur to this department, there can be some resistance by the nurses. The solution to change resistance to educate the nurses on the importance of such change and make them understand its scope and importance to both the patients and nurses. Another barrier would be the cost of the change as it will be cost full to install the technology in the department. The solution to cost is to have a budget plan, do assessment and come up with a list of issues that must be addressed first to make the change successful. Prioritizing the issues would ensure that there is a reduce cost of implementing plan and this would be critical for its success.
Benefits
The benefit, however, would be easy access to data, consultation, reduced errors, and evidence-based work in the department. The nurses will easily access the medication data, and this will make their work easier. They will also benefit from the consultation and also form team of people that will make their work easier. To the patient, they will benefit from safety and evidence-based practice that will be safe, quality and effective for them.
The team
The implementation team will include all the nurses in the department affected, the nurses in charge, the nurse educators, the medical record officer, the pharmacists, and the Informational technology specialist. The nurses will be vital because they are at the center of the procedure of drug administration. The pharmacists will be in charge of providing information during education, together with the nurse educator about the right prescription fora specific drug (Song & Ferris, 2018). The physician will also be available for consultation. IT specialists will be available to provide a technical aspect of technology integration. They will be assisted by the medical record officer to ensure that the technology aspect works better and well.
Conclusion
With clear evidence from different research articles suggesting that there is an increase in medication administration errors among elderly individuals, it is becoming critical for the nurse to the developed procedures to avoid such errors. The MCP is a clear concept that is based on the interdisciplinary action and research to identify the need and provide a solution to the medical mistakes at the hospital. Solving this problem using MCP will reduce the rate of medication administration errors and also increase steps to provide a safe environment for healthcare provision.
References
Flemming, J. A., Dewit, Y., Mah, J. M., Saperia, J., Groome, P. A., & Booth, C. M. (2019). Incidence of cirrhosis in young birth cohorts in Canada from 1997 to 2016: a retrospective population-based study. The Lancet Gastroenterology &Hepatology , 4 (3), 217-226.
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 , 857–866. doi:10.2147/CIA.S80280
Metsälä, E., & Vaherkoski, U. (2014). Medication errors in elderly acute care–a systematic review. Scandinavian journal of caring sciences , 28 (1), 12-28.
Pérez-Jover, V., Mira, J. J., Carratala-Munuera, C., Gil-Guillen, V. F., Basora, J., López-Pineda, A., & Orozco-Beltrán, D. (2018). Inappropriate use of medication by elderly, polymedicated, or multipath logical patients with chronic diseases. International journal of environmental research and public health , 15 (2), 310.
Salmasi, S., Wimmer, B. C., Khan, T. M., Patel, R. P., & Ming, L. C. (2018). A quantitative exploration of medication errors among older people: a systematic review. Drugs & Therapy Perspectives , 34 (3), 129-137.
Song, Z., & Ferris, T. G. (2018). Baby Boomers and beds: a demographic challenge for the ages. Journal of general internal medicine , 33 (3), 367-369.
Tawfik, D. S., Profit, J., Morgenthaler, T. I., Satele, D. V., Sinsky, C. A., Dyrbye, L. N., ... &Shanafelt, T. D. (2018, November). Physician burnout, well-being, and work unit safety grades in relationship to reported drug administration errors. In Mayo Clinic Proceedings (Vol. 93, No. 11, pp. 1571-1580). Elsevier.
