The Literature Review: A Few Tips On Conducting It

Running head: LITERATURE REVIEW
LITERATURE REVIEW
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Literature Review1
Introduction
Keeping records of medications and using the clinical knowledge plus reasoning to
understand the role and timing of a medication is critical and very much imperative in the
clinical scenario (Taxis, K., Kochen et al. 2017). In acute care departments such as intensive
care and intensive coronary care unit, the patients are prescribed with a lot of medications to
address the multisystem or multi-symptomatic needs of the patient (Lichtner et al. 2019).
Similarly in the critical care departments and high dependence units, the use of analgesics
along with sedatives and other medications to treat the aggravating symptoms and
complications of the patient is very crucial. It is to be noted that the right medication should
be prescribed by the doctors to treat the exact condition and address the clinical needs of the
patients is very much important and any errors in these areas can prove very costly and life
threatening for the patient (Singh et al., 2019).. Similarly, the role of the registered nurses is
to administer in the right medications in the right time and in right combination with other
drugs or medications, as exactly mentioned in the prescription (Truitt et al. 2016). The route
of medication administration and the mode of medication administration is also a very critical
clinical aspect that needs to be taken into consideration by the nurse in order to administer a
specific medication to a specific patient correctly and appropriately, thus promoting
medication safety (Rishoej et al. 2017).
Scope of the problem
In the new graduate nurses who lacks the psychological safety, the necessary skills,
experience and expertise to provide the right medication to the patient in the right way
possible creates or rather leads to issues with medication safety (Al Dweik et al. 2017). The
new graduate nurses are more prone to workplace disruption and have chances of
demonstrating a disruptive behavior in relation to self-skills, intrapersonal skills and
communication plus collaboration skills that can create a lot of barriers to the right way of

Literature Review2
medication administration, thus leading to decrease in the medication safety (Howlett, Cleary
& Breatnach 2018). Medication incidents refers to the various adverse drug events arising
from the lack of safe medication practice in a patient centered care scenario and these
incidents can arise from lack of evidence based medication administration practice, lack of
proper medication disposal, misuse plus disuse of drugs and prescription of a certain
medication to an different patient as well as lack of proper filling up of medicine charts and
clinical documentation (Strudwick et al. 2018)
Overdose and omission of the important medications can led to severe complications
in the patient such as central nervous system depression, shock, respiratory failure,
cardiovascular complications and these areas of medication safety disruption can also prove
fatal for the patient (Hotham et al. 2018). Communication and clinical decision making by the
doctors and the nurses especially who are actually involved with the prescription and
administration of medications – are the two most important aspects that are to be taken into
consideration to improve medication safety on a day to day basis in a clinical scenario
(Oxelmark et al. 2018).
According to the report ‘An Integrated Approach to Patient Safety Surveillance by
WA Health Service Providers, Hospitals and the Community’ (2018), there are various issues
that lead to the causation of adverse medication events or medication incidents that affects
both the quality of care being delivered by the health care staffs and the clinical outcomes of
the patient (Yung et al. 2016). According to this this report, in the year of 2017-2018, a total
of out of reported 7,797 medication incidents, about 7172 cases were confirmed cases and
about 24.4 per cent of the total clinical incidents were alone accounted by medication
incidents only. The female patients were found to be administered with the wrong
medications more than the male patients (52 percent of females versus 48 percent of the
males). In the report, there were five medical departments that were identified with the most

Literature Review3
confirmed cases of medication incidents and errors. The departments with highest to lowest
number of medication incidents followed as general medicine (14.2%), psychiatry (5.9%),
general surgery (5.3%), rehabilitative medicine (4.8%) and oncology (3.5%). The main types
of identified medication incidents were medication administration failure, inappropriate dose
of medication given, incorrect fluid and medication given, overdose or extra dose
administered and extravasation. Opioids that are used as narcotic analgesia were the dugs that
were mostly involved in the causation of the medication incidents (n=853) and errors while
the congestive heart failure treating drugs presented with the least number of medication
incidents (n=169). Mostly, as mentioned in this report, the psychotropic drugs, sedatives and
the pain killers were the major drugs that were involved with the adverse medication
incidents. Of all the causes that led to the causation or rather the presentation of these
medication incidents, the main reasons identified in this report was lack of safety
communication (30.2%), lack of compliance with evidence based procedures, guidelines and
practice policies (25.9%), problems in the competence, skills and knowledge (20.4 %),
problems and issues with work scheduling and disruptive work environment (10.1%) and due
to the factors related to the patients (8.1%).
In the other report ‘An Integrated Approach to Patient Safety Surveillance by WA
Health Service Providers, Hospitals and the Community’ (2017) – different sets of findings
were revealed relating to the same above mentioned areas of medication incidents. According
to this report, in the year of 2016-2017, about 6,996 medication incidents had been reported
and out of them, there were confirmed cases of 6,445 and about 23.2 per cent of the total
clinical incidents were accounted by the presentation of medication incidents only. The
female patients were found to be administered with involved in majority of the medications
incidents as compared to the male patients (50.7 percent of female patients were involves). In
the report, there were five medical departments that were identified with the most numbers of