Healthcare institutions are faced with many challenges when it comes to offering quality services. These challenges hinder the quality of care a patient receives and ultimately slow down the progression of improvement once the medication is introduced to the client. Despite technological advancements playing a vital role in mitigating medical errors, human error is still significantly prevalent across the healthcare service industry. For instance, cases of wrong route drug administration are common in hospitals, and there is very little that technology can do to solve these issues.
Medical treatment can harm patients, and it is a painful pill that healthcare professionals have had to swallow and accept. Kongkaew et al. (2013) conducted a study on risk factors for hospital admissions associated with adverse drug events and reported that negative medication events are among the chief causes of harm while the patients are admitted in a healthcare facility. Moreover, while medication errors harm clients in an inpatient setting, they also have the potential to render admission to a client who necessarily did not require to be admitted. Medication errors not only harm the patient but also affect other aspects of life such as economic resilience in a bid to cater for the additional costs associated with the drug administration errors.
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The World Health Organization (2016) suggests that about 12% of primary care patients in the United Kingdom are affected by a prescribing or monitoring error in the course of a year. This number is elevated in patients 75 years and older and those receiving five or more drugs during 12 months, with figures shooting up at 38% and 30% respectively. Such statistics suggest the prevalence of medication errors across the medical field, affecting even first world countries; thus necessitating the need for its mitigation. After carefully considering the adversities of medication errors both on the lives of the patients and the costs incurred by healthcare institutions to tackle the problem, this article is geared towards addressing the issues of risk and quality improvement related to medical errors in an aim to safeguard future patients from having their safety compromised.
Keers et al. (2015) conducted a study on medication administration errors in hospitals and reported that these errors are heavily influenced by local working conditions the staff is subjected to. These local working conditions are often error-provoking thus leading to slips and lapses when it comes to drug administration; hence the unsafe acts. The authors describe these local working conditions as containing poorly written communication, problems with medicines supply and storage, high perceived workload, staff health status, and interruptions or distractions during drug administration. All these stated conditions are common scenarios that exist periodically in a healthcare institution, justifying them as essential causes to the problem of medication errors.
Hayes et al. (2015) conducted a study assessing medication errors in hospitals focusing only on disruptions. In this study, the authors note that interruptions during medication administration are the leading cause of medication error. In a typical healthcare setting, some interruptions are unavoidable; hence creating a new dimension of understanding how healthcare professionals manage the interruptions when administering medication. The writers suggest that despite the adoption of new technology in the improvement of quality in service delivery, understanding how practitioners adjust to disruptions will provide feasible recommendations on how to tackle the challenge of human error in healthcare service delivery.
Consequently, the World Health Organization (2016) conducted a comprehensive study on the causes of medication errors and noted that 11% of all patients experiencing a medication error was as a result of poor coordination of care and cost-related barriers to medical services or medicines. Other underlying factors included the increased number of medications, childhood and older age and specific medications for certain chronic diseases. In the study, the elements are categorized into three categories depending on the associated groups, i.e., healthcare professionals, patients, and the work environment. The study gives more weight to the work environment since it affects the other two aspects.
Issues that affect how the work environment functions include distractions, lack of standardized protocols, insufficient resources and physical aspects such as lighting. All these factors affect the ability of healthcare personnel to make rational decisions and administer the right drug by incapacitating one or more of the sensory aspects of the practitioner. Additionally, the WHO article suggests that poor work environments cripple the quality of communication, more so in secondary care patients, which may result in medication associated errors.
From the discussion above, a fishbone diagram shall be used to identify the root cause of the medication error in healthcare delivery, so that various practical recommendations can be made to improve the quality of services being offered in healthcare institutions.
Emotional health issues
Overworked professionals
Inadequate perception of risk
Inadequate training
Personality
Complexity of clinical cases
TECHNOLOGY
Inaccuracy in patient records
Difficulty processing prescription
ENVIRONMENT
Distractions
Lack of standardized protocol
Inadequate resources
PATIENT CHARACTERISTICS
PRACTITIONER CHARACTERISTICS
MEDICATION ADMINISTRATION ERRORS IN HOSPITALS
From the studies discussed and the fishbone diagram above, it is clear that medication errors are standard medical practices that affect even the developed countries. The studies have linked the causes to revolve around the work environment, practitioner and patient characteristics. However, most of the studies lean towards the work environment as the primary determiner of these errors as it controls how the other two factors interrelate. This, together with the Ishikawa analysis done above, affirms that unconducive workplaces are the main contributors of medication errors alongside other medical errors in healthcare institutions. Improving the quality of service and safeguarding future patients, a healthcare facility should ensure that both the practitioners and the patients interact in a harmonious environment to alleviate the occurrence of medical errors across the service delivery continuum.
Due to the adversities that medication errors have on both the patients and healthcare institutions, tackling this challenge is fundamental in quality improvement. The World Health Organization (2016) suggests several potential solutions to addressing the problem. For starters, the article indicates that medication reviews and reconciliations can significantly reduce errors. From the study, a medication review is a multisectoral process in which patients’ medicines are evaluated to improve health outcomes and mitigate drug-related problems. In a multisectoral review, each of the relevant departments is consulted before a drug is administered to a patient. A review of 17 studies on primary care interventions designed to reduce medication-related events reported that pharmacist-led medication reviews reduced the number of hospital admissions (Mekonnen, McLachlan and Jo-anne, 2016).
Other factors that affect the environment are distractions. While distractions are unavoidable in a typical healthcare setting, teaching the practitioners on strategies to increase awareness and prevention of medication errors is the best strategy. Latimer et al. (2017) conducted a study on the approach as mentioned above, but only focussed on the nursing students. In the study, the authors suggest that a curriculum that exposes nursing students to factors associated with medication errors is the first step to prevention of the problem. Besides, the nursing curriculum should ensure that all the students have undertaken a mandatory course in pharmacology to provide basic knowledge on drug-related issues. Moreover, the curriculum should not only focus on the theoretical aspects of nursing care but also encourage practical problem-solving skills. The authors acknowledge the importance of such a curriculum in the bid to tackle medication administration errors.
In the same line of developing practitioner competencies in dealing with the issue of medication administration errors, Hayes et al. (2015) note that early exposure to clinical experiences in a safe and controlled environment, simulation technologies have been shown to create positive learning experiences. This is a particularly useful strategy for undergraduate students who spend some of their time in a hospital setting to acquire relevant clinical experiences. The approach has further been reported to improve deductive reasoning and analysis, both of which are vital skills in responding to interruptions. Hayes’ study also compounds Latimer et al. in that heightened awareness of disruptions and their impacts on the medication administration process serves to prepare nursing students for the practice better.
Gorgich et al. (2016) report that the issue of understaffing is a focal area that needs to be addressed before tackling medication administration errors. The authors argue that with the nurses’ perception of being understaffed, mistakes are likely to happen due to the illusion of being fatigued, leading to medication errors. Furthermore, the human resource team is also tasked with providing its employees with workshops and in-service education about preparing medications and pharmacological knowledge to mitigate remedy related errors. Consequently, the authors introduce a new aspect of using electronic medication cards to reduce medication errors. This idea is compounded by Forrester et al., (2014) which suggests the use of computerized provider order entry with decision support to curb the issue of medication error.
All these discussed solutions have the potential to curb the issue of medication errors significantly. However, having a clear role outlined for each of the staff in a healthcare facility serves to reduce cases of redundancy and improve responsibility for each action the patient is subjected to. The Top-level management should adopt standard operating procedures when it comes to drug administration, that is mandatory for all departments in the institution to comply with. These SOPs should be unique and practical in a given healthcare institution and communicated periodically to all staff to ensure everyone is aware of their expectations. Overseeing that the procedures are followed should be done by the Top-level management team, with corrections suggested as deemed fit. Additionally, this team is responsible for ensuring that the facility has access to essential resources that can be utilized by the staff to execute quality services to their clients.
Next in line is the human resource team, which should work closely with the Top-level management team as both of these two groups have significant influence over an organization. As initially stated earlier, the human resource team is tasked with employing adequate practitioners to do away with the analogy of understaffing completely. This will boost the morale of available healthcare providers as they shall feel the load of service delivery has been lessened, thus less often will they make medical errors. Also, the human resource team can organize on the job training for the staff to promote their awareness of medication administration errors and impact them with useful knowledge in reacting quickly to such errors. Finally, the human resource team can organize audits on the staff on matters about the quality and safety of the patients as discussed in training.
When it comes to the service providers, they should create a culture of confirming before assuming that the person before them had done it right. They should adopt a system that is often used in manufacturing industries whereby one believes that they are the final hand to touch an item before it reaches the consumer. Such a culture promotes quality delivery of services as it eliminates the analogy that the next person in line will countercheck for any errors before delivering the service to the client. The practitioners should also make it a norm to attend the continuous medical education sessions as organized by the HR department. Additionally, periodic consultations from the various hospital departments when administering a drug can be arranged to lessen the occurrence of medication errors. The pharmacy department should spearhead the agenda of prescription and administration of medications to the patients.
The nursing care department is a comprehensive wing of a hospital that is strongly intertwined with all the other service delivery departments. The nursing personnel is more often in contact with the patients as compared to the other caders. Additionally, in many healthcare institutions, the nurse is responsible for administering medication, and this makes them the ideal candidate with the potential to control the issue of medication error. As such, the nursing department is tasked with cross-checking a patient’s prescription and applying the pharmacological knowledge to assess the effectiveness of a given order. Moreover, the nursing care personnel are also expected to abide by the set standard operating procedures when handling a client’s medicine.
With the potential that technology has to impact the issue of drug administration positively, as evidenced by software such as CPOE that eradicate drug-related complications, the ICT personnel is tasked with ensuring the system works as expected. As initially discussed in the paper when it came to factors that promote medication errors, technology was mentioned since it has its limitations. The ICT team is responsible for maintaining all technological equipment to ensure the accuracy of the data provided to eliminate prescription errors. In cases where the staff is unfamiliar with the system, the ICT group is expected to train the staff and offer necessary skills on how to utilize the system to promote quality services.
After such roles are stipulated, the organization is then faced with the challenge of creating a culture that the staff can follow to ensure quality and safety is upheld and improved. Organization culture is responsible for emphasizing the organization’s aspects that can be shared among the employees. David, Valas, and Raghunathan (2018) discuss four types of organizational culture that include the clan, adhocracy, market and hierarchy cultures that are all at the disposal of the management team. The clan culture is based on the theory of effectiveness in that human development and participation produces efficiency. Quality strategies employed by this theory include empowerment, team building, employee involvement, and open communication. In this culture, the organization gives importance to loyalty and teamwork and emphasizes concern for people and customers.
In the adhocracy culture, the organization focuses on being ahead of its competitors by committing to research and innovation. The value drivers are innovative outputs, transformation, and agility. The theory of effectiveness is that innovativeness and new resources produce efficiency. When it comes to market culture, the organization focusses on reputation and name by being aggressive and ambitious. Value drivers here include market share, goal achievement, and profitability, all based on the theory of effectiveness that aggressive competition and customer focus produce efficiency. In the last approach, the organization is keen on its smooth running by having well-derived rules and policies that are unique to the style of the institution. The value drivers for the hierarchy culture include efficiency, punctuality, consistency, and uniformity.
Looking at the different types of cultures an organization can choose to adopt, the hierarchy culture seems to have more weight when it comes to health care organizations. To achieve this culture, a healthcare firm needs to have a formalized structure in place that is concerned with the span of control. Additionally, procedures and policies control the workflow, necessitating the need for the management to plan and have written down standard operating procedures for every activity in the institution. Also, in this culture, weight is given on planning and uniformity, which ensures that quality services can be reproduced throughout the continuum of service.
In departments where confusion may arise due to the existence of multiple procedures in doing things, the organization should discuss and assign a standard system that all employees are expected to follow, to promote the issue of planning and uniformity. Furthermore, the leaders in the organization should be in a position to coordinate, monitor and organize tasks efficiency to reduce costs and promote effective resource utilization. The team should be in a position to detect errors in the system, control the process and exercise systematic problem-solving skills.
In conclusion, healthcare institutions are faced with many challenges when it comes to offering quality services to their clients. However, medication administration error is a problem that affects all hospitals, leading to impaired patient outcomes even after a drug has been initiated. This issue affects not only developing countries but also first world countries, with data showing that around 12% of primary care patients experience the phenomena in a period of 12 months in the United Kingdom. Studies have reported that drug administration error leads to lengthened hospitals stays and also admissions to patients who necessarily did not need it. Extended hospital stays and admissions lead to increased healthcare costs to both the patient and the hospital.
Medication errors have been associated with practitioner characteristics, patient characteristics, and environmental factors. Despite all these, much emphasis is placed on the environment since it dictates how the other two factors interact. Recommendations have been made on how to mitigate this issue, ranging from staff training, increased labor force to adoption of technological equipment to assist decision making. All these recommendations have the potential to benefit the institution, though much weight lies in the organizational culture. Culture is crucial as it improves quality and safeguards future patients since the different activities can be reproduced without alterations. All in all, the issue of quality and performance in a healthcare institution relies heavily on the management team efforts and the amount of control it exerts on the institution as a whole.
References
David, S. N., Valas, S., & Raghunathan, R. (2018). Assessing Organization Culture–A Review on the OCAI Instrument. In International Conference on Management and Information Systems September (Vol. 21, p. 22).
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Latimer, S., Hewitt, J., Stanbrough, R., & McAndrew, R. (2017). Reducing medication errors: Teaching strategies that increase nursing students' awareness of medication errors and their prevention.
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