The Safety Implications of Medication Errors in Nursing Homes

Question One 

Older adults aged 65 years and above account for more than half the population in nursing homes. A report by the U.S Nursing Home Data Compendium showed that in 2015, senior residents’ facilities had an average population of 1.4 million individuals (Al-Jumali & Doucette, 2017). Most elderly persons suffer from old age diseases, such as dementia and arthritis. Consequently, they require constant nursing attention which incorporates frequent medication use. While observing safety is core, research shows that medication errors resulting from human limiting factors still occur. Aspects such as duplication, drug omissions, unclear information, and contraindications exacerbate medication errors in many nursing homes (Vogelsmeier et al., 2015). Hence, the wrong dispensation of drugs in nursing homes resulting from human limiting factors interferes with the safety of senior residents in nursing facilities. 

Question Two 

Several nurse sensitive outcomes may result from medication errors in nursing homes. First, wrongful administration of drugs exposes patients to an increased risk of infections (Flaig et al., 2016). When a patient receives contaminated medication through their IV line because of a nurse’s carelessness, the older adult may acquire infections. Secondly, medication errors result to a minimization of therapeutic benefit of a drug because of poor handling of drugs by nurses which result in worsening disease which might increase mortality. Third, the prevalence of falls amongst the elderly who ingest erroneous medication may increase. The falls may result from the injurious problems associated with medicated errors, such as dizziness, partial blindness, and extreme ligament pains. Hence, medication errors in nursing homes may cause several negative nurse sensitive outcomes. 

Question Three 

One of the leading causes of the increased prevalence of medication errors in nursing homes is the laxity of safety practices, such as failure to observe medication reconciliation. Nurses who act as caregivers in elderly homes should retrain on how to identify the discrepancies in the dosage and type of new medication, which is ordered to replace a previous type of medication (Vogelsmeier et al., 2015). For instance, an older adult who is on pain management drugs may require higher dosages of a different type of medicine. Nurses should have sufficient reconciliatory knowledge to determine the appropriate dosage of the new medication that they should administer to the convalescence. They must also be able to identify potential threats that the newly introduced medication may cause to a patient. Hence, a nurse must have the necessary medication reconciliatory knowledge to aid in curbing medication errors in nursing homes. 

Question Four 

Reconciliation of medication is a cognitive process that requires a nurse to carefully assess any medication in a bid to determine the risk associated with it. The success of medication reconciliation in nursing homes as a means of reducing medication errors may be evaluated in several ways. First, the nurses who administer medication may measure the rate of reduction in morbidities and mortalities after implementation of the new intervention method (World Health Organization). The caregivers may also use several tools to assess patient experiences after the execution of drug reconciliation in elderly facilities such as questionnaires to document their experiences with the new drugs such as worsening or improvement of symptoms. Moreover, the nursing homes can measure the rate of reduction in blood infections that results from medication errors. Unfortunately, there is no evaluative data on medical reconciliation at the time of this assignment. 

Question Five 

A report by the World Health Organization (WHO, 2016) suggests medication reconciliation as one of the primary preventative measures of medication errors in the clinical setting. WHO asserts that meta-analysis of 38 types of primary care interventions had medication reconciliation as priority interventions. In settings where a registered clinician or pharmacist conducted multicomponent reviews of a drug before authorizing it as safe for a patient, there were increased positive clinical outcomes. Additionally, these reviews reduced the prevalence of hospital admissions. WHO (2016) also describes medication reconciliation as the establishment and documentation of a definitive and consistent list of drugs across change in care and then correcting any resulting discrepancies. Additionally, WHO contends that the prevalence of medication discrepancies is correlated with an increase in the number of prescribed drugs. This increase results from drug related injuries that ensue when an older adult ingests the erroneous medication that did not undergo the reconciliatory process. Hence, the information by WHO affirms the intervention method prescribed by Vogelsmeier et al. 

References 

Al-Jumaili, A. A., & Doucette, W. R. (2017). Comprehensive Literature Review of Factors Influencing Medication Safety in Nursing Homes: Using a Systems Model.  Journal of the American Medical Directors Association ,  18 (6), 470-488. doi:10.1016/j.jamda.2016.12.069 

Flaig, T. M., Budnick, A., Kuhnert, R., Kreutz, R., & Dräger, D. (2016). Physician Contacts and Their Influence on the Appropriateness of Pain Medication in Nursing Home Residents: A Cross-Sectional Study.  Journal of the American Medical Directors Association ,  17 (9), 834-838. doi:10.1016/j.jamda.2016.05.014 

Vogelsmeier, A., Anbari, A., Ganong, L., Anderson, R. A., Oderda, L., Farag, A., & Madsen, R. (2015). Detecting Medication Order Discrepancies in Nursing Homes: How RNs and LPNs Differ.  Journal of Nursing Regulation ,  6 (3), 48-56. doi:10.1016/s2155-8256(15)30785-7 

World Health Organization. (2016).  Medication errors . Retrieved from World Health Organization website: https://apps.who.int/iris/bitstream/handle/10665/252274/9789241511643-eng.pdf;jsessionid=AA093E084B3064AEBA8F88CF53D434AB?sequence=1