Medication Errors in Hospitals: A Literature Review

This assignment requires students to review literature on medication errors in hospitals, focusing on disruptions to nursing practice during medication administration. The student is expected to critically analyze studies and articles related to this topic, identifying key factors that contribute to medication errors and discussing strategies for improving medication safety. This assignment aims to promote a deeper understanding of the complexities surrounding medication administration and the importance of ensuring patient safety.

URN: QUT174801 | PATIENT: SIMPSON,
Ethel Merle
This case study is based on Mrs. Ethel Simpson who is 64 years old. She attends
the pre-admission clinic with her grand-daughter to discuss her up-coming left
knee arthroplasty. Later, she undergoes the surgery and is then three days post-
operative, in the orthopaedic ward.
You will need to access the Mrs Simpson Simulation Case Study resource in your
Blackboard site to view medical documents and the three videos that tell the story
of Mrs Simpson.

Caring for a patient with dementia and arthritis who is at risk of injury
Setting the scene
Social:
Ethel is 64 years old and lives in a Granny flat attached to her daughter’s
home. She has good support from this daughter and grand-daughter, and her
other two children who visit at least weekly. She was previously a registered
nurse. She has six steps in her house that she needs to negotiate. Her
worsening arthritis, particularly the arthritis in her left knee has made it
extremely difficult for her to leave the house in the last two months. Ethel
complains of poor appetite, difficulty sleeping and not wanting to leave the house.
Ethel was diagnosed with Alzheimer’s dementia a year ago and has been partially independent in all her
basic activities of daily living. She is continent but needs assistance with bathing and household
activities such as cleaning. She can cook basic meals and feed herself. Cognitively she is oriented to
person, place and year. She can recall 3 out of 3 words immediately, but 0 out of 3 words at 5 minutes.
Her attention is intact.
Mrs Simpson and her family sought advice from her GP because of the worsening pain of her arthritis,
particularly in her knee and the impact this was having on her mobility. After being referred to an
orthopaedic surgeon for review, the decision was made for a knee arthroplasty to be done.
Epidemiology / pathophysiology of disease processes
The National Health Priority Areas of Arthritis and Musculoskeletal conditions, Dementia and Injury
Prevention and Control were established with the aim of improving health outcomes in these areas.
Musculoskeletal conditions are conditions of the bones, muscles and their attachments (e.g. joints and
ligaments). Osteoarthritis, rheumatoid arthritis and osteoporosis are the most commonly occurring
musculoskeletal conditions. They have substantial influence on the quality of life and impose a heavy
economic burden on the community.
Injuries are adverse effects on the human body. They are a significant source of preventable illness,
disability and premature death in Australia.
Dementia is defined as the loss of mental processing ability, including communication, abstract
thinking, judgment and physical abilities, such that it interferes with daily living. Conditions
associated with dementia are typically progressive, degenerative and irreversible, for which there is
currently no cure.
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Your Task:
Use the Clinical Reasoning Cycle on the following pages to review the nursing priorities in relation to
the care of Ethel.
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Watch the two videos – Pre-admission Clinic and At home
Gain an initial impression of your patient
Question 1:
Review the anatomy and physiology of the three musculoskeletal
conditions listed above (osteoarthritis, rheumatoid arthritis and
osteoporosis).
What type of arthritis do you think that Ethel has?
Explain the rationale for your answer.
Your Answer:
In accordance with the musculoskeletal conditions listed, each one has their own set of problems and causes due to
which affects a person. In this context, osteoarthritis is a joint disorder that is caused by cartilage loss in a joint.
Further, rheumatoid arthritis is determined to be an autoimmune disease that causes damage throughout body and joint
pain. Lastly, osteoporosis is caused when density of bone decreases (Rohde & Domm, 2018, p. 405). This has
negative impact over strength and structure of bones and increases the conditions of fractures.
Among these, I think Ethel has osteoarthritis as this is a health condition that is faced by old people. Apart from this,
she will be undergoing arthoplasty which is a common surgical intervention for osteoarthritis
Gain an initial impression of your
patient.
Question 2:
List three variables that put Ethel at risk of injury. Justify your answer.
Your Answer:
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Variable 1: Six steps in house of Ethel.
This is the basic thing which must be avoided by Ethel as she is diagnosed by arthritis under which she is having serve
pain in knees.
Variable 2: Cook basic meals and feed herself
Regularly cooking food for herself which requires for her to continuously stand and then prepare it. So this is not good
and will be causing risk of injury to her.
Variable 3: Cleaning of house
This is also another variable which is causing risk of serve injury to Ethel as it would be requiring more efforts of her.
Cleaning of house will be having more efforts.
Gain an initial impression of
your patient.
Question 3:
Review and recall knowledge from NSB132 on dementia as it is
important to understand the type of dementia that Ethel has.
What statement best describes Alzheimer’s dementia?
a) Occurs through a reduced blood supply to the brain and
accounts for around 20% of dementia cases.
b) Is associated with Lewy bodies and accounts for around
15% of dementia cases.
c) Is associated with shrinkage/atrophy of the brain and
accounts for around 50% of dementia cases.
d) Is associated with tangled bundles of proteins in brain nerve
cells with an earlier age of onset and accounts for around 5%
of dementia cases.
Your Answer:
(c) Is associated with shrinkage/atrophy of the brain and accounts for around 50% of dementia cases
This is describing Alzheimer best (What Is Alzheimer's? 2018). As in 1906 when it was 1st identified by
Diagnosed in Auguste Deter after her death it was noted that her brain was shrink with an abnormal
deposit of around cells. Corticobasal degeneration (CBD) is identified as loss of nerve cell which is
atrophy into cerebral cortex areas of brain. While the primary dementia is forming part of Alzheimer
diseases which is about 50-70% of all cases (Dementia, Alzheimer's, and Aging Brains, 2018).
Gain an initial impression of
your patient.
Question 4:
Aricept is a commonly used medication to treat mild to moderate
dementia caused by Alzheimer’s disease.
a) Briefly describe the mode of action of this medication for
Ethel (1 mark)
b) How should the medication be taken?
c) List two side effects of the medication
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Your Answer:
(A) it is not allow to crush, crew or break the regular tablet of Aricept but rather keeping tablet in blister
pack un till it is ready to intake then open the package by peeling it off then cutting backing from tablet
blister,. Using dry hands to remove tablet and placing into mouth which is not allowed to swallow and
dissolving it without chewing (Parry, Barriball & While, 2015, p. 415). Moderate to severe Alzheimer
disease maintenance dose must be 10 mg once a day after Ethel has started taking a 10 mg dose once a
day at least for 3 months than only.
(B) taking the medication with or without food as per directed by doctor of Ethel normally before going
to bed but if she is experiencing like that of sleeping so she must be talking to doctor.
(C) common side effects of Aricept on Ethel could be as follows:
 Loss of appetite and
 Muscle pain
Gain an initial impression of
your patient.
Question 5:
When the family first became concerned about Mrs Simpson’s
cognitive status, they visited the GP. She referred Ethel to you as a
practice nurse for a further examination of mental status. There are
many cognitive tools available that you might use.
a) Name one that would be applicable to use
b) Justify your use of this tool for Ethel.
Your Answer:
For further examination of Ethel in her mental status Mini Mental State examination (MMSE) which is
30 point questionnaire including clinical and research setting so that doctor could be able to measure
cognitive impairment for Ethel (Martin, 1990). This test could be used for allied health and medicine as
well to screening in for dementia.
Now watch the video Mrs. Simpson – In the Ward
Further background information
Past medical history
 DMII (diagnosed 10 years ago)
 Mild renal failure (diagnosed 2 years ago)
 Hypertension (diagnosed 15 years ago)
 Dementia (diagnosed 1 year ago)
 Arthritis (diagnosed 6 years ago)
Surgical history:
 Hysterectomy
 cholecystectomy.
Medications:
Ibuprofen, Aricept (donepezil), Micardis (telmisartan), temazepam, metformin
Ethel is day 3 post-operative left total knee arthroplasty. She has an IV cannula still in place.
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Her neurovascular obs are fine. The toes of that left leg have been pink and warm with full movement
and sensation, pulses normal.
Her left knee had a waterproof dressing in place however there was visible purulent ooze overnight and
the dressing was removed this morning in the shower and the surrounding skin was inflamed. A wound
swab was taken yesterday evening and sent for culture.
She has been doing deep breathing and leg exercises. She has been resting quietly and has been pleasant
and cooperative with staff this morning.
0500 vital signs: BP 174/80 mmHg; HR 88 BPM; RR 18 BPM; O2 sats 98%; Temperature 37.7 degrees.
Weight: 68kg (down from 71kg one month ago)
(a) Review current information
(b) Gather new information
(c) Recall knowledge (A&P,
ethics, law, cultural safety)
Question 6:
Fall related hospitalisation is particularly common among older
people. Of these more were males than females. True or False?
Your Answer:
False.
As per many research in various countries like that of Australia, India, England and Taiwan by WHO it was noted
that fall related hospitalization is particularly common among older people more are females than that of males.
One of the survey conducted by Australian Government’s Institute of Health and Welfare from 2003-2013. There
was estimated serious types of injuries after fall was in age above 65 which recorded to about 98704 total case.
Among this female accounted to most of these cases which means that fall and hospitalization case where higher
in female than that of male for all age (Trends in hospitalizations due to falls by older people, Australia 2002–03
to 2012–13).
(a) Review current information
(b) Gather new information
(c) Recall knowledge (A&P,
ethics, law, cultural safety)
Question 7:
In the video Ethel is cooperative and forgetful.
a) Name a suitable pain assessment tool you could use to assess
her pain.
b) Justify your choice of this tool, taking into account Ethel’s
responses to the questions in the video.
Your Answer:
(A) In order to examine the pain of Ethel in dementia Pain Assessment in Advance Dementia Scale
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(PAINAD) must be used.
B) As it would be including various pain scale and providing universal method of analysing pain which
is been experience by patient like that of Ethel into later stages of dementia (Raban & Westbrook, 2014,
p. 418).
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Interpret data – what does it all
mean?
It is important to consider the
potential inter-relationships
between dementia,
musculoskeletal problems and
injury prevention.
Question 8:
Ethel has indicated that she currently has a poor appetite and has
lost 3kgs in the last month.
a) What allied health professional would you consider referring
Ethel to?
b) Give a rationale for your answer
Your Answer:
Refereeing Ethel to dieticians is much better in order to gain back her weight which she has loss in one
month. Her weight was 82 kg and her loss 3 kg to 79 kg which was due to her loss in appetite. The
dieticians will be considering her diet of per day and then suggesting her which all diet need to be
included to fulfil her daily food requirements.
Interpret data – what does it all
mean?
Question 9:
There are many myths about older people and dementia. Which of
the following statements is true?
a. All older people will develop dementia
b. Some level of confusion is experienced by most older people
c. Dementia is not a natural part of ageing
d. All older people will lose their short-term memory
Your Answer:
c) Dementia is not a natural part of ageing (What Is Alzheimer's? 2018)
Synthesise all information that
has been collected and
processed.
Question 10:
Select from the list below the three highest priority relevant nursing
diagnoses for Ethel. Justify your answer.
a) Impaired balance
b) Acute confusional state
c) Cognitive impairment
d) Insomnia
e) Pain
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f) Signs of infection in left knee
g) Altered nutrition/hydration
h) Antisocial personality disorder
Your Answer:
Impaired balance- as she is having problem in her leg which is rising risk of balance. As Ethel is having
knee injury which is most dangerous for her to get diagnosed.
Cognitive impairment- as Ethel is having loss of memory and thinking skill so this could be regarded to
as priority in diagnoses for her (Aydon, Hauck, Zimmer & Murdoch, 2016, p. 2471). She is also
suffering from loss of memory which is stating that she should be diagnosed at this stage.
Signs of infection in left knee- this is the main problem that is been faced by Ethel which must be
recovered.
As a nurse, what are your
desired outcomes for Ethel?
Question 11:
From the list below choose the three most important short-term
goals for Ethel’s management at this time: Justify your answer.
a) For Ethel’s weight to stabilise
b) For Ethel to sleep for eight hours/night
c) For Ethel’s pain to be managed
d) For Ethel to be more social
e) To ensure the prevention of injury for Ethel
f) For Ethel to be placed in a residential aged care facility
g) For Ethel’s wound infection to be treated.
Your Answer:
g) For Ethel’s wound infection to be treated: The wound should be treated first as the chances of cross
infection is high. It can increases the pain and thus further cause negative circumstances (Roughead,
Semple and Rosenfeld, 2016 p. 116). The treatment of wound infection needs to be put first for Ethel's
management at this time.
e) To ensure the prevention of injury for Ethel: Any further injury to Ethel might lead to more damages
as she is aged women. This should be considered as most important task in short-term goals for Ethel
Management as she is suffering from Alzheimers' dementia and arthritis.
a) For Ethel’s weight to stabilise: From the diagnosis report, it was identified that her weight was
drastically reduced to 3 kg in one month (Hayes et.al., 2016 p. 3069). It is essential for healthcare
professionals to stabilise her weight in order to prevent further diseases.
Question 12:
Two nurses took a telephone order for antibiotics, Cefalotin 1 gm
and Flucloxacillin 1 gram. Please assume this order was
documented correctly on the medication chart.
a) Did they meet the current guidelines for receiving this
order?
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What action/interventions will
you do? b) Justify your answer.
Your Answer:
a) If the nurses have documented the order correctly this implied that they have meet the current
guidelines (Parry, Barriball and While, 2015 p. 407). The current guidelines states that nurses needs
when order for medicines on telephone, they have to document it precisely.
b) According to Management of medicine regimens 7.9.2, the registered nurse or or enrolled nurse taking
an emergency medicine instruction by telephone should verify the prescriber, write the instruction in
permanent ink directly onto the person's medicines chart, confirm the instruction with the prescriber, and
sign and date the chart (Heneka et.al., 2018).
What action/interventions will
you do?
Question 13:
Match the below rationales for care to the corresponding nursing
action
Nursing actions:
a) Document all nursing observations and actions accurately
b) Reassess cognitive status regularly
c) Monitor psychomotor activity
d) Encourage family to assist in cares
e) Communicate Ethel’s progress to her family
f) Encourage strategies for medication administration
Rationales:
1) To prevent injury due to impaired mobility
2) To ensure medication safety
3) To ensure clear, accurate and timely communication
between all health professionals caring for Ethel
4) To ensure clear, accurate and timely updates are received by
family from all health professionals
5) To determine Ethel’s level of cognition
6) To ensure a family centred approach to care
Your Answer:
Nursing Action a) = Rationale …3…
Nursing Action b) = Rationale …5…
Nursing Action c) = Rationale …1…
Nursing Action d) = Rationale …6…
Nursing Action e) = Rationale …4…
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Nursing Action f) = Rationale …2…
What action/interventions will
you do?
Question 14:
Cognitive interventions for Ethel may involve cognitive stimulation
which involves
a. Checking up on a person’s memory and correcting them
until they get the facts right
b. A break for the person with dementia and for their family
members
c. Practising skills that help independent living
d. Failure-free learning in a supportive and fun atmosphere
Your Answer:
d) By providing failure-free learning in supportive and fun atmosphere, the mental and psychological
condition of Ethel can be improved efficiently (Raban and Westbrook, 2014 p. 419).
What action/interventions will
you do?
Question 15:
Whilst Ethel’s knee pain from arthritis will be resolved with the
surgery, she also has ongoing mild to moderate pain in both ankles
also due to arthritis. In addition to taking the prescribed Non-
Steroidal Anti-Inflammatory Drug, as a nurse you should also
instruct her to:
a. Start a regular exercise program
b. Avoid foods high in citrus acid
c. Keep legs elevated when sitting
d. Rest her feet and ankles as much as possible to decrease
inflammation
Give a rationale for your answer to Q15?
Your Answer:
Assess the effectiveness of
actions
Question 16:
List two signs and symptoms that would indicate that Ethel’s goals
are being achieved:
a) Ethel has no falls.
b) Weight reduced.
c) Ethel’s pain reduces.
d) Ethel’s cognitive status improves.
e) Ethel is less aggressive
f) Ethel’s agitation increases
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g) Ethel is comfortably situated in a residential aged care
facility.
h) The inflammation around the suture line and the purulent
ooze will resolve within 3 days.
Your Answer:
h- The inflammation around the suture line and the purulent ooze will resolve within 3 days.
c- If her purulent ooze will resolve, her pain will eventually get reduced (Rohde and Domm, 2018).
Assess the effectiveness of
actions
Question 17:
Prevention of injury is an important part of education for Ethel and
her family. Due to Ethel’s impaired mobility, wearing the right
footwear is important. What is the ideal footwear?
a. Firm back and cover with adjustable fastening, ankle support
and non-slip sole
b. Soft leather sole which is flexible
c. Soft, cushioned material with a tight fit
d. Loose footwear
Your Answer:
a
Selection of precise footwear is essential especially people who suffered from impaired mobility. Firm
back and cover with adjustable fastening allow comfortable experience to patient and ankle support and
non slip sole will guarantee that patient ankle is safe and they will not slip on slippery surface (Hayes
et.al.,2015 p.985)
What have you learned from
this experience?
Question 18:
Why is medication administration a specific challenge when dealing
with dementia patients?
Your Answer:
For medical professionals and administration it is often considered as biggest challenge to provide care to
patient suffered from dementia. Alzheimer’s in people develop condition of dementia and other related
disease which have a progressive biological brain disorder that creates it more and more difficult for
people to remember things (Kaur et.al., 2016 p 13). These people often forget to take their medicines and
their health status. Apart from this, people with dementia forgot their caregiver and consider them as
strangers. Patient suffered from dysphagia, arthritis and other disease oftened alarmed when caregiver
approach them for medication which becomes challenge to healthcare provider to provide medication
administration (Rohde and Domm, 2018).
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What have you learned from
this experience?
Question 19:
What are the specific considerations in regards to patients with
arthritis in regards to management and prevention of pressure
injuries?
Your Answer:
People suffering from arthritis find it that it affects their lives in some ways. It can affect their everyday
chores, job, financial resources, and relationship with family and friends. People living with arthritis
required effective and care support from healthcare providers which helps in enhancing their psychology
and reducing pain. Pressure injury prevention (PIP) is an essential and improtant area of patient safety
(Heneka et.al., 2018). In order to prevent pressure injury in patient, care giver must encourage patient to
participate in the healthcare activities as it can enhance adherence to treatment plans and outcome.
Patient in acute healthcare setting can participate more activitely in PIP. Management needs to encourage
patients so that they can be provided with better treatment and care which helps them in reducing their
issues and problems (Raban and Westbrook, 2014 p. 414).
What have you learned from
this experience?
Question 20:
Ethel is taking Ibuprofen for pain.
a) Discuss the mode of action of this medication
b) Discuss the side effects and contraindications of ibuprofen
that Ethel is taking
c) Do you think this is the best medication for Ethel? Why?
Your Answer:
a) The mechanism of Ibuprofen is a non-selective inhibitor of an enzyme called cyclooxygenase (COX).
It is required to synthesis of prostaglandins via arachidonic acid pathway. COX is needed to convert
arachidonic acid to prostaglandin H2 (PGH2) in the body (Hayes et.al. 2016 p. 3063).
b) Ibuprofen can cause a number of side effects. The common side effects of ibuprofen are nausea or
vomiting, constipation or diarrhoea, headache or dizziness, bloating, high blood pressure, inflammation
of stomach (gastritis), stomach ulcer and alergic reactions (Roughead, Semple and Rosenfeld, 2016 , p
122).
c) No, NSAID medications are not first recommendations for elderly patients as it possess side effects
and their age derived vulnerabilities. Thus, it should not be considered as optimum choice for Ethel
(Parry, Barriball and While, 2015 p. 2475).
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REFERENCES
Aydon, L., Hauck, Y., Zimmer, M., & Murdoch, J. (2016). Factors influencing a nurse's decision to
question medication administration in a neonatal clinical care unit. Journal of clinical nursing,
25(17-18), 2468-2477. Retrieved from
http://onlinelibrary.wiley.com/doi/10.1111/jocn.13277/full
Hayes, C., Jackson, D., Davidson, P. M., & Power, T. (2015). Medication errors in hospitals: a literature
review of disruptions to nursing practice during medication administration. Journal of clinical
nursing, 24(21-22), 3063-3076. Retrieved from
http://onlinelibrary.wiley.com/doi/10.1111/jocn.12944/full
Hayes, C., Power, T., Davidson, P. M., Daly, J., & Jackson, D. (2015). Nurse interrupted: Development
of a realistic medication administration simulation for undergraduate nurses. Nurse education
today, 35(9), 981-986. Retrieved from http://www.nurseeducationtoday.com/article/S0260-
6917(15)00272-5/abstract
Heneka, N., Shaw, T., Rowett, D., Lapkin, S., & Phillips, J. L. (2018). Exploring Factors Contributing to
Medication Errors with Opioids in Australian Specialist Palliative Care Inpatient Services: A
Multi-Incident Analysis. Journal of palliative medicine. Retrieved from
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Kaur, G., Phillips, C. L., Wong, K., McLachlan, A. J., & Saini, B. (2016). Timing of administration: for
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http://www.mdpi.com/1999-4923/8/2/13
Martin, D.C., 1990. The mental status examination.
Parry, A. M., Barriball, K. L., & While, A. E. (2015). Factors contributing to Registered Nurse
medication administration error: A narrative review. International journal of nursing studies,
52(1), 403-420. Retrieved from http://www.journalofnursingstudies.com/article/S0020-
7489(14)00173-4/abstract
Raban, M. Z., & Westbrook, J. I. (2014). Are interventions to reduce interruptions and errors during
medication administration effective?: a systematic review. BMJ Qual Saf, 23(5), 414-421.
Retrieved from http://qualitysafety.bmj.com/content/23/5/414.short
Rohde, E., & Domm, E. (2018). Nurses’ clinical reasoning practices that support safe medication
administration: An integrative review of the literature. Journal of clinical nursing, 27(3-4), e402-
e411.Retrieved from https://sigmapubs.onlinelibrary.wiley.com/doi/full/10.1111/jocn.14077
Roughead, E. E., Semple, S. J., & Rosenfeld, E. (2016). The extent of medication errors and adverse
drug reactions throughout the patient journey in acute care in Australia. International journal of
evidence-based healthcare, 14(3: Medication Safety Issue), 113-122. Retrieved from
https://journals.lww.com/ijebh/Abstract/2016/09000/The_extent_of_medication_errors_and_adv
erse_drug.3.aspx
What Is Alzheimer's? 2018. [Online]: Accessed through:
https://www.alz.org/alzheimers_disease_what_is_alzheimers.asp
Dementia, Alzheimer's, and Aging Brains. 2018. [Online]: Accessed through:
<https://www.onhealth.com/content/1/dementia_memory_brain_disorder>.
Trends in hospitalizations due to falls by older people, Australia. 2002–03 to 2012–13. [Online]: Accessed
through: <https://www.aihw.gov.au/getmedia/5f84eadd-6f25-4429-82fc-5e9072278335/aihw-
injcat-182.pdf.aspx?inline=true>.
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