Medication Error Reduction Strategies

The assignment provided is a critical analysis of medication error reduction strategies in healthcare settings. It draws on a range of studies and research papers to identify key factors that contribute to medication errors, including interruptions during medication administration, and explores the impact of electronic prescribing systems on reducing errors. The document also examines the effectiveness of various interventions, such as 'do not interrupt' policies, and discusses the role of pharmacists in error recovery. A summary of relevant literature is provided, highlighting the need for further research in this area.

Comparative Essay Analysis on
Medication based Errors
Assessment 2
Student Name: Student ID:
Subject Name: Subject Code: NSG2NMR 2018
Facilitator Name: Clinical School:
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Introduction
Healthcare facilities as hospitals administer various medications to patients every day,
where errors occur randomly (Keers, 2013). Researchers and studies have been continuously
focused on ways and means to reduce interruptions to nurses while they are preparing or
administering dosage of medications. While interruptions were analysed, they were found to be
related to medication administration errors (MAEs), which in case reduced could lead to lesser
impact being made on patients. Approximately 36% errors were found to have occurred in the
emergency department during administration phase. The scope of this analysis reviews two
journal articles related to medication errors, comparing them. A comprehensive analysis using
qualitative and quantitative techniques was used to arrive at findings related to the study. Using
data analysis techniques journals, namely J. I. Westbrook, T. D. Hooper, M. Z. Raban, S.
Middleton and E. C. Lehnbom (2017) article, Effectiveness of a ‘Do not interrupt’ bundled
intervention to reduce interruptions during medication administration: a cluster randomised
controlled feasibility study. In the BMJ Qual Saf (Westbrook, 2017). Another journal by F. S.
Blank, J. Tobin, S. Macomber, M. Jaouen, M. Dinoia and P. Visintainer (2011) article, A “back
to basics” approach to reduce ED medication errors. In Journal of emergency nursing analyses
medication related errors in emergency departments (Blank, 2011).
Analysis
Medication related errors are frequent in hospitals as well as across emergency
departments. Aim of researchers had been focused at findings ways and means by which these
errors can be reduced such as to prevent harm caused to patients (Ammenwerth, 2008). There are
two journal that provides insights into medication related errors, however the context of analysis
of both the journals are different in nature.
Aims: Article by Johanna I Westbrook, Ling Li, Tamara D Hooper, Magda Z Raban,
Sandy Middleton, Elin C Lehnbom examines effect for reduction in non-medication based
interruptions to nurses. This study conducted quantitative based analysis by randomly
controlled study in Adelaide, Australia. The study was conducted using feedback from manger
nurses. The study adopted ethical approval from Hospital Research Ethics Committee. Another
article by F. S. Blank, J. Tobin, S. Macomber, M. Jaouen, M. Dinoia and P. Visintainer examines
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ways in which knowledge can impact clinical practice amongst nurses in emergency
departments. Medication related errors taking place in emergency departments mostly due to
overcrowding. Medication given to patients at emergency departments often leads to patient
harm, which can range from being permanent to temporary injuries (Sanderson, 2015). While
previously article concerned examination of entire range of errors that occurs across all
departments of hospitals the second article concerns itself with identification of medication based
errors in emergency departments only. The first article is more concerned with several
interruptions that causes nurses to administer dosage incorrectly (Currie, 2014). The scope of the
other article identifies issues specific in nature that causes errors, as specifically being
overcrowding. Initial study is related to obtaining feedback from nurses and all other
departments while this study adopts a methodology where nurses in emergency departments
were considered for the study.
Methods: In the first study four wards were selected for the purpose of collecting data,
where interventions included wearing vest while providing medications. Primary aim of the
study was to divert attention during the process of interruptions (Hayes, 2015). Various
observations were made over a prolonged time period, which showed that wearing vests was
consuming substantial amounts of their time. It was relevant from the study that nurses
experienced that was not related to medication. This study demonstrated tremendous scope for
improvements in regards to unnecessary interruptions that was causing errors in medication
(Rothschild, 2010). The discussion in this article therefore derived that there was costs associated
with alternative interventions that likely generates impact on long-term sustainability related to
such interventions. Therefore, in order to increase effectiveness related to interventions there
costs associations has to be established such that they can be reduced in a substantial manner.
The second article on the other hand, analyses basic medication administration procedure
within emergency departments for reducing errors. This study adopted methodology whereby
education intervention by way of non-randomized methods of a single group was compared pre
and post outcome (Hopkinson, 2013). The study was conducted using 95 nurses where measures
adopted for intervention included knowledge regarding medication administration process,
behaviour that reflects recommended medication practices and medication administration errors.
This study demonstrates that education based interventions were able to impact medical
administration practices. But nurses with improved knowledge did not change their behaviour
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significantly, hence more research in the area was required in order to impact clinical practices
amongst nurses (Pham, 2011).
Internal Validity and External Validity: In the first study, the scholars used a method of
interruption to nurses by use of vests to distract their attention. The study focused at connecting
findings of medication effectiveness to non-medication based interruptions. There were mixed
ways to interrupt nurses in intervention wards and then results were compared to control wards
in pre and post interventions (Palese, 2009). The study reflected low correlation in intervention
wards as against control wards, reflecting that cost effective measures can be included to reduce
such interruptions. Internal validity of variables in the study is too low and external validity can
be drawn as results are more generalized in nature.
For the second study, internal validity was also established to be low. As nurses that were
subjected to the study pre and post increasing their knowledge reflected on very low effects in
regards to their clinical practice. External validity can be obtained in this study as results are
more generalized in manner. Nurses showed significant increase in knowledge levels post the
study however there were no impacts on results.
Results: The scope of the first study did not try to impact result, rather was interested in
findings related to interventions that causes harm on patients. The second study was more
focused on enhancing ways in which medication related errors could be reduced. While the first
study was conducted using all departments within the hospital, the second one was focused on
emergency department. In the first study a methodology was adopted to collect feedback from
two separate groups as a control group and experimental group. The second study knowledge
was imparted uniformly to nurses in ED so as to impact their outcomes (Sasangohar, 2014).
Medication administration process was not a matter of concern in the first case as it was merely
concerned with examining ways intervention can impact medication administration. The second
study was moreover focused in nature with understanding impacts of knowledge on the process
of medication administration.
Trustworthiness of Each Paper: Both the papers had been conducted using data
collection and their analysis. The findings related to the first study can be generalized as it was
conducted through all departments. However, the interventions cannot be used for instrument
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design. In the second study conducted, it was done only in emergency department hence cannot
be generalized or findings adopted across other departments. The research design adopted cannot
be for purpose of instrumentation design. The scope of the studies had been limited to single
hospitals only, which is the main limitations or drawbacks associated with the study. However,
the scholars has derived findings for the study in relation to various attributes that makes these
studies important in nature. Moreover, implications of these studies can be used across in
developing more studies for further research in the domain. While both the study has certain
limitations but the study has been derived from well researched studies conducted in the past.
Therefore, both the papers can be regarded as trustworthy and capable of conducting further
studies on.
Conclusion
Analysing medication related errors can reveal facts regarding various impacts that patients
suffer. while aim and focus on healthcare centers and hospitals is to reduce such errors by
appointing capable nurses and providing adequate training it often remains ineffective. The
scope of these two journals have provided an extension to previously conducted studies in the
area aimed at reducing interruptions and providing knowledge to improve medication
administration procedure. While both the articles have provided in-depth insights into the topic,
they have not been effective in suggesting ways in which medication administration
effectiveness can be attended. Therefore scope of further research in the area will still reamin
prevalent.
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Reference Lists
Ammenwerth, E., Schnell-Inderst, P., Machan, C., & Siebert, U. (2008). The effect of electronic
prescribing on medication errors and adverse drug events: a systematic review. Journal of
the American Medical Informatics Association, 15(5), 585-600.
Blank, F. S., Tobin, J., Macomber, S., Jaouen, M., Dinoia, M., & Visintainer, P. (2011). A “back
to basics” approach to reduce ED medication errors. Journal of emergency
nursing, 37(2), 141-147.
Currie, L. (2014). Reducing interruptions during medication administration: the White Vest
study. Journal of Research in Nursing, 19(3), 262-263.
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.
Hopkinson, S. G., & Jennings, B. M. (2013). Interruptions during nurses' work: A state‐of‐the‐
science review. Research in nursing & health, 36(1), 38-53.
Keers, R. N., Williams, S. D., Cooke, J., & Ashcroft, D. M. (2013). Prevalence and nature of
medication administration errors in health care settings: a systematic review of direct
observational evidence. Annals of Pharmacotherapy, 47(2), 237-256.
Palese, A., Sartor, A., Costaperaria, G., & Bresadola, V. (2009). Interruptions during nurses' drug
rounds in surgical wards: observational study. Journal of nursing management, 17(2),
185-192.
Pham, J. C., Story, J. L., Hicks, R. W., Shore, A. D., Morlock, L. L., Cheung, D. S., ... &
Pronovost, P. J. (2011). National study on the frequency, types, causes, and consequences
of voluntarily reported emergency department medication errors. Journal of Emergency
Medicine, 40(5), 485-492.
Rothschild, J. M., Churchill, W., Erickson, A., Munz, K., Schuur, J. D., Salzberg, C. A., ... &
Jaggers, R. (2010). Medication errors recovered by emergency department
pharmacists. Annals of emergency medicine, 55(6), 513-521.
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Sanderson, P. M., & Grundgeiger, T. (2015). How do interruptions affect clinician performance
in healthcare? Negotiating fidelity, control, and potential generalizability in the search for
answers. International Journal of Human-Computer Studies, 79, 85-96.
Sasangohar, F., Donmez, B., Easty, A., Storey, H., & Trbovich, P. (2014). Interruptions
experienced by cardiovascular intensive care unit nurses: an observational study. Journal
of critical care, 29(5), 848-853.
Westbrook, J. I., Li, L., Hooper, T. D., Raban, M. Z., Middleton, S., & Lehnbom, E. C. (2017).
Effectiveness of a ‘Do not interrupt’bundled intervention to reduce interruptions during
medication administration: a cluster randomised controlled feasibility study. BMJ Qual
Saf, 26(9), 734-742.
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