Medication Errors in Healthcare Settings

This assignment delves into the critical issue of medication errors in healthcare. It examines various research papers that investigate the factors influencing medication errors, including workplace support, relationships among nurses, interruptions, cognitive load, and organizational safety practices. The analysis aims to understand the multifaceted causes of these errors and explore potential strategies for their prevention.

Running head: LEGAL AND PROFESSIONAL ISSUES IN NURSING
Legal and professional issues in nursing
Name of the student:
Name of the University:
Author’s note

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Table of Contents
Introduction:....................................................................................................................................1
Background, definition and scope:..................................................................................................2
Benefits and challenges:..................................................................................................................4
Impact and implications:..................................................................................................................6
Recommendations:..........................................................................................................................8
Conclusion:......................................................................................................................................9
Reference.......................................................................................................................................11

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Introduction:
Medication administration is an integral part of professional nursing practice, where
execution of medical orders is done for the recovery and care of patient. The manner in which
nurses administer medication to patient is reflective of nursing performance as well as patient
safety. However, medication administration is a high risk activity because it involves complex
medication calculations and strict adherence to administration methods. Medication errors have
become a major issue in nursing practice as nurses fail to adhere to proper guidelines. Besides
this, high workload and several distractions and interruptions become a major factor contributing
to medication error (Cloete, 2015). Medication error results in serious consequences for patient
such as increase in health complications, long duration of hospital stay, increase in mortality rate
and high medical expense. Research evidence has also showed that one-third of the medicinal
complications occur due to medication Error (Cheragi et al., 2013). Hence, there is a need to
explore the reasons and impact of medication error on nursing practice. The main thesis
statement to proceed with the topic of medication error is ‘poor adherence to medication
administration protocol among nurse is the reason for medication error’. The discussion paper
analyzes the topic on the basis of this thesis statement.
Background, definition and scope:
In relation to the thesis statement, some of the arguments that support the thesis statement
can be made after getting background information on the topic of medication error. Firstly, there
is a need to understand what is medication error and what are the different types of medication
errors that commonly occurs in health care setting. Aronson, (2009) defines medication error as

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any preventable event or failure in the medication use that results in harm to patient. It may occur
due to several factors such wrong dosage calculation, inappropriate method of administering
medication, prescription error and many other factors. Although medication error can be caused
by any health care staffs, this paper mainly focuses on the medication error in nursing practice
because nurses are the ones who are mostly involved in executing the medication order (Cheragi
et al., 2013). Hence, exploring the reasons for medication error from the perspective of nurse is
important.
It is necessary to explore in depth about the topic of medication error because this
discussion will have great scope in improving nursing practice both in local province as well as
in health care setting all over Canada. Reports related to adverse events in Canada has revealed
that apart from surgical error, medication error is the second most common cause of adverse
events in hospital setting (McIntyre & McDonald, 2013). In the year 2014-2015, about one in
every eighteen patient were admitted to hospital because of medication error or getting the wrong
drug. Very few events are officially recorded in patient’s chart due to fear of reprisal (Ubelacker,
2018). However, whenever such events occur in clinical setting, nurses become the main focus
of investigation as they are typically involved in administering medication to patients. Their lack
of compliance to physician order and following the right to medication administration becomes
the main reason for medication error. Hence, identify the challenges for nurse in medication
administration and recommending best practice to prevent error will have positive impact on
performance of health care setting across Canada.
The adverse event related to medication error affects not only the performances of nurses,
but it also has great impact on patient as well as the reputation of the health care organization.
For instance, Agyemang & While, (2010) showed that medication error mostly affect nurses and

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both patients. The most potential victim is the patient as they suffer because of complications
causes by drug related errors. It creates major safety issue for patient. In case of nurses, serious
medication error has been found to affect nurses both personally and professionally. Agyemang
& While, (2010) explained that nurses who are involved in medication errors suffer from
feelings of guilt and loss of confidence. They always fear about disciplinary action and this
eventually has an impact on their overall nursing performance. Apart from this, the effect of
medication error on hospital is that high rate of errors results in loss of patient, trust, criminal
charges and civil actions (Wittich, Burkle, & Lanier, 2014, August). Therefore, the reputation
and image of hospital is damaged and it leads to extra cost on health services too. Hence, it can
be said that medication errors has wide and adverse consequences for the whole health care
system.
The above incidences clearly shows that nurses are the main staff involved in committing
medication errors, however they are the ones who can reduce the rate of errors too. So, far
incidence of medication error has occurred because nurses have not taken professional
responsibility to fully adhere to medication administration protocol. For instance, many
evidences has proved that errors occurs because nurse do not follow policies and procedures and
violate the step involved in checking medication and their dose. Calculation difficulty among
nurse and poor knowledge in preparing and administering medication has also become a cause of
medication error (Fleming, Brady & Malone, 2014). These evidences support the thesis
statement that nurses account for failure in drug administration process. However, there is a need
analyze other counter-arguments too that may contradict the thesis statement and this is
necessary to fully justify whether thesis statement can be accepted or not.

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Benefits and challenges:
This discussion paper is focusing on the issue of medication error in nursing practice and
finding strategies to medication error is considered necessary to provide benefit to nurses as well
as the health care system. Due to medication error, the reputation of hospital is damaged and
nurses suffer from shame and embarrassment. Hence, if nurse take part in correcting factors
contributing to errors, this will greatly increase their confidence as well as nursing performance.
With the rise in medication error, reporting about medication error is regarded as an effective
strategy for health care organization. Nurses must also take full responsibility to immediately
report about medication error because this will have significant implications on safety of patient.
Another advantage of reporting about medication error is that it helps in identifying limitation in
current practice and implementing additional patient safety standards to prevent future errors.
Error reporting is considered a useful exercise to understand why error occurs, prioritize ways to
prevent such errors and develop long term plans for patient safety (Elden & Ismail, 2016).
Beside this, it is necessary for nurse to hone their medication administration skill to effectively
manage illness, improve patient outcome and save them from demoralizing disciplinary actions
(Smeuler et al., 2015).
When nurses administer medication to patient, the common responsibility for them is to
follow the five rights of medication administration which are right medication, right dose, right
time, right route and right patient (Parry, Barriball & While, 2015). However, in accordance with
the thesis statement that nurses fail to adhere to policies and guidelines thus resulting in
medication error, it can be said that there are several reasons to believe this statement. For
instance, Shawahna et al., (2016) also supported the fact that nurses fail to follow the 5 rights of
medication administration and the checking-rechecking process thus increasing the risk of

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medication errors. Nurses have reported that they face challenges in following these medication
procedures because they get confused in calculating medication dose and understanding the
function of infusion device. Other individual nurse factor that has been found to have links with
medication errors includes miscommunication factors, misreading of medication lable, non-
adherence to proper steps and administration without checking (Karavasiliadou & Athanasakis,
2014). All these points show that nurses neglect vital guidelines and procedures that is necessary
for safe medication administration. Hence, these examples best support the thesis statement and
makes it more plausible. However, evidences of certain organizational cause of medication errors
clearly shows that the thesis statement of nurse neglect alone cannot be believed to be the sole
cause of medication error. These factors are discussed in detail in the next section.
Nurses have been found to be highly involved in medication error because of
organizational challenges too. Review of research literature on causes of medication errors has
revealed that unsafe practices of health care staff alone is not cause of medication error, instead
such events also occurs because of faulty health care structure or health care environment. For
examples, several nurses have reported that they have not got appropriate work environment and
support to effectively adhere to medication administration guideline. Some of the top
organizational factors that prevents nurses from safely administering medication to patients
includes regular interruptions during the process, heavy workload, poor staffing level or nurse-
patient ratio or poor labeling of drugs (Karavasiliadou & Athanasakis, 2014). Heavy workload
creates challenges for nurses because they are often interrupted while performing an activity and
another task arises for them before finishing one intervention. Interruptions in clinical setting
have also been regarded as the most common cause of error in drug calculation because attention
of nurses breaks down during the medication preparation and administration process (Thomas,

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Donohue-Porter & Fishbein, 2017). Interruptions from patient also increased dilemma for nurses
(Cheragi et al., 2013). These evidences offers counter-examples and opposing views related to
the thesis and indicates about the challenges for nurse too.
Impact and implications:
The explanation regarding the organizational and work environment related challenges
offers good counter arguments to criticize the thesis statement. It clears argues that nurses cannot
engage in safe medication administration unless they get the right environment and devices to do
so. If medication error has occurred due to labeling or packaging issue, the organization or the
manager is at fault and not the nurses. Secondly, if error occurs due to heavy workload and
understaffing issue then the hospital is to be blamed for keeping faulty structure and work
process and not the nurse. Two strength of the counterargument is that health care setting is a
complex environment where multi-professional team works together for the care of patient. So,
counter argument has strength because health care providers have the responsibility to provide
right resource and environment to nurses to work efficiently (Sahay, Hutchinson & East, 2015).
Another strength of the counter argument is that organizational factors play a key role in
reducing medication errors because if strict protocols and penalty exist for negligence, then such
event will not arise at such alarming rate. However, the weak point of the counterargument is it
cannot totally defend the action of nurses because if nurses are accountable enough to understand
their responsibility in medication administration, then they can overcome all disruptions too.
Hence, the thesis statement of non-adherence to protocol as the cause of medication error should
be give more importance because nurses are more involved in medication administration than
any other staffs (Shahrokhi, Ebrahimpour & Ghodousi, 2013). Therefore, nurses are better
placed to reduce rate of error if all barriers in the way of medication administration is eliminated.

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It is also necessary to give full attention to the issue of medication error in nursing
practice because it has great impact on nurses and their daily practice. Nurses suffer from
feelings of low self-esteem and poor confidence in their skills when they commit medication
error. One study investigating about impact of medication error on nurses revealed that such
experience was devastating for them both personally and professionally. The event of
disciplinary action and exposure to criticism from managers created feelings of same in patient.
Some nurses even faced difficulty in finding another job because of shame and embarrassment.
Even if nurses continued practice in the same setting, feelings of incompetence remained with
them and they always had the fear of making new mistakes (Agyemang & While, 2010).
Medication errors indirectly affects human resource management too because incidence
of error creates stress for nurse. They develop feelings of guilt which affect their performance.
High level of stress due to committing mistakes again often forces nurses to think about quitting
the job (Vogus et al., 2014). Hence, a health care setting which experience challenges already
due to poor staffing level and workload, will have to spend additional time in hiring and looking
for new and skilful nurses. Other negative implications of medication error include negative
emotions among patients, family members and lack of trust with the health care system (Bari,
Khan, & Rathore, 2016). Evidence also points out to rise in bioethical issues for hospitals
because of medication errors. dos Santos Dalmolin & Goldim, (2013) argued that ethical
dilemma and bioethical issues for health care provider and staff increases due to medication
error.

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Recommendations:
This discussion paper analyzed the issue of medication error in nursing practice with the
thesis that non-adherence to medication protocols among nurses lead to medication error. If this
statement is true, then the consequence of the issue is huge. This is because if nothing is done to
develop the skills of nurses or eliminate barrier in following the protocol, then such incidences
will continue to happen and patient safety will be seriously hampered. So, to avoid adverse event
in health care setting and protect nurses from embarrassing disciplinary actions, there is a need to
identify strategies to improve medication safety practices. The health care provided, nurse
manager and multi-professional team needs to get involved to work together to curb the rate of
medication errors in clinical setting.
As this discussion paper has showed that certain organizational factors create disruption
for nurses during medication preparation and administration, hence it is necessary to modify the
workplace structure and environment. Supportive workplace climate should be provided to nurse
to reduce adverse event. As lack of skills and confusion in medication administration is also an
issue for nurses, there is a need to provide education and learning support to nurses. Education
training programs related to independent drug dose calculation has been found to decrease
medication error (Alsulami, Choonara, & Conroy, 2014). Provision of budding and dividing
workload may also sustain supportive work climate and foster skill acquisition and professional
development in nurses (Sahay, Hutchinson & East, 2015). Nurses must also understand the
importance of medication protocols and they must always observe the contraindications of
medications before administration. Lastly, a system should be in place by which nurses can
easily report about errors without any fear. Error reporting system should be improved to
improve current practice and prevent future incidences of medication error.

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Conclusion:
The essay gave insight into the incidence of medication errors and the potential impact of
such event on nursing practice and health care system. The main thesis statement for discussion
and argument was ‘poor adherence to medication administration protocol among nurse is the
reason for medication error’. To support the thesis statement, evidence of non-adherence to five
rights and checking-rechecking process was provided. However, counterarguments to the thesis
also pointed to the fact that organizational factors like understaffing, high workload and
interruptions in the procedures also affects attention of nurse during medication administration.
Considering the negative implication of medication error on patient, nursing practice and health
care organization, it is recommended that key members of the health care organization work
together to provide education and learning support to nurses. The improvement in error reporting
system has also been proposed to reduce rate of medication errors and burden associated with it
for nurses.

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