Medication Error, Ineffective Communication and Teamwork Among Nurses, Doctors and Patients

This essay discusses the causes and effects of medication errors due to ineffective communication and teamwork among nurses, doctors, and patients. It also provides recommendations to improve communication and teamwork to reduce medication errors.

Final
Medication error, ineffective communication and teamwork among nurses, doctors and
patient
This essay will look at a 50-year-old female who came to the accident and emergency
department with varied abdominal pain in the left lower quadrant. The patient has no medical
history where the symptoms such as, nausea, having headaches, any changes in bowel habit
or fever were recognized Vital signs done, urine sample taken had been taken for analysis of
patient health situation, which has been found to be also specifically essential. The patient
stated having stabbing pain within varied aspects related to past few days in the left lower
quadrant of her abdomen, where it has been found to be also affected abdomen.
The patient rated her pain a nine, on competent scale from one to ten, with ten being
the most severe and one which is the least severe. According to Gregory (2019) pain scale
have been found to be also specific for analyzing patient level of pain among patients based
on managing pain with anglesia. It helps health care providers to estimate how each person
feels on an individual, case by case basis (Gregory 2019). Base on the patient pain score I
decided to help manage pain with analgesia, where i checked electronic drug chart for any
medication prescribed and saw 1gram oral paracetamol and 30 milligrams codeine.
While going back to the patient with the prescribed medication and care specifically,
the five rights of medication administration, ask further questions about any medication that
she might have taken then I administer the medication. The patient took them, where I was
relaxed to go back to computer and gave sign as given for extended new level growth reach.
On my return to the computer, I noticed that the medication was signed properly to further
enhance operative scope based on extended domains.

Upon investigation, I found out that the doctor who invested about patient recovery,
prescribed the medication and had competently administered it.
McDonald, Cabri and Davis (2018) described the above incident as a medication
administration error that occurred when a medication is administered but has not been
recorded as given. This also specifies that staff members may give medication based upon
extended paradigms for larger scale efficiency (McDonald, Cabri and Davis 2018). This
patient received a double dose 2000mg paracetamol and 60mg of codeine. According to the
National Institute for Health and Care Excellence (NICE 2021) paracetamol doses less than
75 mg/kg in any 24-hour period are very unlikely to be toxic, although risk may be increased
if this dose is repeatedly ingested over 2 or more days. Rarely, toxicity can occur with
ingestions between 75 and 150 mg/kg in any 24-hour period, based on extended determinants
for connective rise significantly (National Institute for Health and Care Excellence NICE
2021). However, serious toxicity may occur in patients ingesting more than 150 mg/kg in any
24-hour period.
This patient with a body weight of 60kg the recommended amount of paracetamol
would be 75mg/60kg = 4500 mg within 24 hrs therefore the amount administered to this
patient would not be further classified as toxic / overdose. The patient vital signs are
measured regarding the blood pressure, temperature, pulse rate and respiratory rate, where
her vital signs were within the normal limits, patient condition was assessed before sending to
home for further care.
Although this patient did not faced any harm, the lesson learned from the incident
are related with importance of communication, team work and documentation of signs,
Incident report form completed and sent (Datix). The nurse in charge informed the patient of
the incident and verbally apologized to the patient. According to Mayor (2017) apologizing
and explaining to the patient and their family is morally necessary, even though it might be

difficult. Receiving an apology is important to the patient as it enables error disclosure and
the lack of information and apology are key reasons for patients taking legal action ( Mayor
2017).
Ineffective communication and teamwork among doctors and nurses are some of
major cause of medication errors. When doctors and nurses cease from working as a team and
communicate effectively with each other, patient safety is compromised ( Rosen, McNeese-
Smith & Phillip 2018). Ineffective communication between the doctor and nurse about
patient medication contributes to poor practices and places patients at risk (Sanghera et al.
2006 Brekke & Frydenberg 2012). The medication error led to this patient receiving a
double dose of paracetamol and codeine. According to National Institute for Health and Care
Excellence (NICE 2021). paracetamol doses less than 75 mg/kg in any 24-hour period are
very unlikely to be toxic. This patient with a body weight of 60kg the recommended amount
of paracetamol would be 75mg/60kg = 4500 mg within 24 hrs therefore the amount
administered to the patient would not be classified as toxic / overdose hence the patient
received no harm. However, Letner (2015) state that the medication error could have been
avoided had both the doctor and the nurse been better communicators. Letner (2015) also
mention the importance of doctors communicating clearly with the nurses. Taking the time to
gather and share important information can make a difference within outcomes of patient,
which further signifies the best technical operatives diversely.
Hassan (2020) suggested that to promote safe and effective practice in hospital which
further avoids varied medication error, doctors and nurses should adhere to effective
communication. They need to take responsibility for creating an environment where high
quality health care is practiced (Hassan, 2020). Doctors and nurses are committed towards
effective communication less medication error would occur. Evidence has shown that there
are tools that can effectively improve communication within the health care setting, such as

SBAR. SBAR (which stands for situation, background, assessment and recommendation), is
associated with evolving pace and development of critical thinking skills and communication
styles between nurses, doctors and others ( Hautz et al, 2018). It also provides for the transfer
of vital, clear and relevant information about a patient’s condition in an organized manner
(Swift 2017). The nurse could have used the SBAR (situation, background, assessment and
recommendation) tool to communicate with the doctor about assessment of the patient and
recommendation, where the doctor can also provide appropriate training to nurses for
avoiding overdosing of medicine.
Ineffective communication between patients, doctors and nurses is also one of the
major problems causing medication error (Spiridonor 2017). Health care professional
sometimes fail to communicate with patient effectively. According to Kraft (2016) health
care professional sometimes use medical jargon to explain medication details to patients and
assumed that they understand the language used. Kraft “found that the major communication
error is to assume the communication has taken place and gotten through”. Kraft (2016) also
highlighted that the use of medical jargan to inform patients about their medication should be
minimized to reduce the risk. Aung et al (2017) also stated that it is the responsibilities of
health care professionals to communicate with the patient in clear and simple manner. In the
case of this patient the nurse ensure that communication about previous medication taken and
the 5 rights (the right drug, right dose, right route, and right patient, at the right time) of
medication administration was clear and concise before the medication administered. After
the 5 rights was carried out the patient did not provide appropriate parameters, based on
significant aspects connected to leverage determined rise. Patients had previous medication
hence the medication administered i.e. 1g paracetamol and 30mg codeine. According to
Edward and Axe (2018) the 5 rights of medication administration help to reduce the risk of
medication errors, where medical principles were to further ensure the right drug, right dose,

right route, and right patient, at the right time (Edward and Axe 2018). However, Grissinger
(2010) argue that the frequency of a medication error is not solely a matter of adhering to the
five ‘R’s. Grissinger ( 2010) states that the use of checklists such as the five ‘R’s does not
address the problems related to the causes of medication errors ref needed, where it further
also correlates towards extended efficacy paradigms.
Armstrong et al (2016) also argues that medication errors can occur due to the
inability of doctors and nurses to work as a team. In the case of the medication error that
occurred, it could have been caused from an Inability of the nurse and the doctor to work as a
team. Effective team working has been shown to reduce medical errors, increase patient
safety, and improve patient mortality rates.( Ahn & Hwang 2014) additionally an effective
team has common goals and objectives, looks out for each other and hold others accountable
essentially creating a successful and efficient team (Ahn & Hwang 2014). It also leads to
better staff outcomes including reduced stress and improved job satisfaction, where proper
competent vision plays keen role to enhance waking efficacy. Also, Dagroot Vermeir, &
Vandijek (2017) state that poor leadership and lack of coordination also has been found to be
the most common causes of poor teamwork among nurses and doctors. Royal College of
Physician (2016) documented poor teamwork as a contributing factor to teamwork failure. In
their study, the underlining problem was the failure to identify and follow the correct protocol
to patient care (Royal College of Physcians 2016).
The Royal college of nursing (2019) state that health care professionals responsible
for prescribing and administering medication to patient sometimes fail to follow new correct
medication protocol of documenting after a drug which signifies best scale working aspects
diversely (Royal College of Nursing, 2019). In the case of this patient the nurse after looking
at the prescription on the electronic drug chart collect the medication then go back to the
electronic drug chart to recheck the medication with the prescription and allergy status before

administering the medication. The nurse returns to complete the electronic documentation i.e
signed the electronic drug chart noticed that the medication signed for as given coincidently
while gone to administer the medication to the patient. The Royal College of Nursing (2019)
mention that wherever possible the actions of prescribing and administering are performed
based on fundamental priorities. Also, it can be understood that administering medication to
patient have been found that based on significant goals for technical diverse range of goals.
Medication errors increased when health care workers were under stress and when there was
a significant amount of work that they were possibly struggling to manage (Salem 2018).
Also, if the task was tedious or the staff felt tired this increased the chance of drug error
(Salem 2018) has been increased for significant extended technical specifics.
Recommendations
Effective communication is important to help in the reduction of medication errors
among nurses and doctors. My recommendation for nurse’s to use the SBAR communication
tool to communicate patient care with the doctor, where further intricate procedures which
will further evolve on towards developed paradigms based on extended domains. While using
the SABR model, it has been found that communication goals will be properly evolved for
untapped abilities based on fundamental scale targets.
To use the SBAR communication tool the nurse after their assessment of patient
should further discuss with doctor recommendation, both parties would agree with the
decision of care. According to Swift (2017) structured communication tool, such as SBAR
(Situation, Background, Assessment and Recommendation) will help remove errors faced in
coordination from the nurses and doctors. It could provide a framework to facilitate easy
organization and communication of information between doctors and nurses.

It could also enable nurses to quickly and effectively prepare for conversations with
the doctors and nurses would be more equipped to communicate vital information in an
organized manner (Retna, 2019 & Swift, 2017 ). Following a structured communication tool
can also help overcome some language barriers, especially when it comes to medical jargon
(Retna, 2019 & Swift, 2017). In addition Kraft (2018) believes that an organisation should
put intervention in place to ensure effective communication between health care providers.
Intervention such as an organization culture which is patient centered and focused on safety,
open communication and promote the use of communication tools between health care
providers ( Kraft, 2018). Once interventions are in place to break down the patterns of poor
communication patient centered care can occur, which may hamper competencies rapidly
(Kraft, 2018 ).
My next recommendation is that both the doctor and nurse establish a care plan for
the patient, once a patient is assigned to a doctor, where establishing care plan manual or with
technology innovation will further enhance operative vision. For example, procedure needed,
analgesia, bloods, etc, Once the care plan is established, both parties should follow through
with the care plan, updating each other where necessary of any changes. To work effectively
and help reduce medication errors from occurring, there has to be specific specialization
adopted. The research by (Dutta & Tweedie (2017), & Benishek et al, (2018) advised to set
common and shared objectives and goals. Where teams are clear about their plans the quality
of their work improves and makes them more productive. In addition ensuring that team
members understand their roles and responsibilities can lead to an increase in job satisfaction
( Dutta & Tweedie, 2017, & Benishek et al, 2018). For everyone to work together as a team
they need to exhibit the following skills: Openness, trust and respect. It is also essential for
each team member to understand culture of the department, values and mutual respect where
it further impacts team dynamics to grow (Boyd, Cumal & Weller, 2014). Researchers have

found that working together reduces the number of medical errors and increases patient safety
( Ajeigbe, McNeese-Smith, & Phillip, 2013). In addition addressing need for teamwork
training for healthcare professional is important and developing ways to communicate
information among team members can also contribute to effective teamwork (Bell et al,
2014 ).
Effective communication and teamwork are essential for optimum delivery of high
quality and safe patient care. Having a clinical expert who actively promotes optimum
importance of appropriate communication and team collaboration which are extremely
valuable assets to an organization (Rosenstein & O’ Daniel, 2008 ).The emergency
department could have a clinical expert to promote these valuable skills. The clinical expert
would observe the communication between the nurses and doctor and how effectively they
work as a team and from there observations provide feedbacks and recommendations for any
improvements, this could be done weekly or monthly. Also the nurses and doctors shall
further evolve on new range of optimum vision, for fostering mutual cooperation,
collaboration and improve communication skills (Bianca et al, 2017). To prevent medication
error from occurring in the future, the emergency department could include mandatory
training for nurses using examples of previous medication error and the likelihood of these
errors occurring (Rogers et al 2017). Providing feedback on medication errors should be
compulsory to improve the current practices, and advance up specifics for technical working
efficacy diversely (Rogers et al 2017). The Bio Med Central Health Service Research found
that receiving survey from a patient could provide useful information about the team
performance and this feedback can used to achieve effective teamwork between the
healthcare staff (Killipatrick et al 2019). Moreover it could help prevent medical errors from
occurring in the future (Royal College of Physcian, 2017).

Health care professionals i.e nurses and doctors are very important parts of the health care
system. Therefore having strategies that can help them to effectively communicate and work
as team would be highly beneficial to them and improve their performance ( Rosen,
McNeese-Smith & Phillip, 2018).
Conclusion
From the above summarized aspects, it has been concluded that ineffective
communication and teamwork between doctors, nurses and patients are some leading cause
of medication errors. When doctors and nurses cease from communicating effectively with
each other, it sometimes hampers working efficacy varied based on significant prioritizes.
Patient care that is based on assumption may be found dangerous and can lead to errors i.e
minor or severe to avoid errors from happening, it is important for doctors and nurses to
communicate effectively among each other to eliminate or reduce the chance of minor or
serious medication errors. Also, it is important for doctors and nurses to work effectively as a
team. Doctors and nurses are supposed to work together to provide the best care for the
patient. If they fail to work cohesively with each other, it puts the patient life at risk. Hence, it
is important for medical professionals to work together in one accord for bringing the best
productive interest of patient. To promote safe and effective practice in hospitals and avoid
medication errors, health care professional i.e doctors and nurses should adhere to effective
teamwork and communication among themselves and with the patients. Finally nurses and
doctors are highly important parts of the health care system, and platforms for strengthening
wider new fundamental goals informatively. Thus, designing strategies such as effective
communication and teamwork will help influence the quality of healthcare services and
patient outcomes.