MEDICATION SAFETY2 Medication Safety Introduction Medication errors are prevalent in healthcare institutions and affect the lives of patients and healthcare providers. Chiefly, medication errors can occur in the handling, storage or administration of drugs. Medicines are linked to many adverse events since they are commonly used in healthcare settings. Australia is addressing the problem of medicine errors through system based approaches such as medication chart. Nurses can also address the issue of medication errors by complying with codes of conduct and professional requirements. This paper discusses the causes of medication errors, their effects, national strategies and nursing roles in reducing medication errors. The main cause of Medication errors Medication errors are mainly caused by human factors and can occur in any healthcare setting. Most of the medication errors in Australia occur because of a lapse error or slip error and about 2 per cent and 5 per cent of Australian drug charts have prescribing errors (Roughead & Bedford, 2012). Low or lack of pharmacological knowledge is a major cause of medication errors (Cheragi, Manoocheri, Mohammadnejad & Ehsani, 2013). The use of abbreviations instead of the full name of a particular drug can result in a medical error (Cheragi et al., 2013). In most cases, this kind of medical error occurs when the provider administering the drug has low pharmacological knowledge. The use of similar drug names can also cause a provider to commit an error while administering the medicines. Further, medication errors can occur due to long working hours and lack of adequate rest. One study involving 327 nursing staff and 62 nursing students found that 97.8 per cent of medication errors were caused by tiredness because of increased workload (Gorgich, Barfroshan, Ghoreishi & Yaghoobi, 2016). Among the nursing
MEDICATION SAFETY3 students, approximately 77.4 per cent of medication errors were linked to drug calculation (Gorgich et al., 2016). According to Bari, Khan, and Rathore (2016), medication errors occur due to inadequate experience and fatigue caused by long duty hours. Effects of medication errors Medication errors lead to adverse consequences for both the healthcare providers and patients. Primarily, medication errors result in undesirable implications for patients such as prolonged hospitalization, a high cost of hospitalization, and severe injury (Gorgich et al., 2013). In some instances, medication error might lead to disability and even mortality for the affected patients (Gorgich et al., 2013). Patients who experience drug errors might develop distrust in the health care system that prevents them from seeking medical care at a future date. Studies conducted in various places across Australia indicate that medication errors lead to adverse outcomes for patients. A study based on Victorian hospitals found that 3.3 per cent of overnight hospitalizations in 2004 were linked to adverse drug reactions (Roughead, Semple & Rosenfeld, 2016). Another study in Victoria found that medication errors grew by 0.5 per cent for each additional day in hospital (Roughead et al., 2016). One study done in Melbourne found that about 7.2 per cent of hospitalizations were linked to medication problems (Roughead et al., 2016). On the other hand, medical errors among healthcare providers are related to personal distress. Bari et al. (2016), assert that healthcare providers feel guilty, disappointed and inadequate if they commit a medical error. In fact, the authors note that 100% of medical professionals, which represents a sample of 128 providers, develop negative emotions because of their errors (Bari et al., 2016). Strategies of the Australian Commission on Safety and Quality Health Care (ACSQHC)
MEDICATION SAFETY4 The Commission has initiated five strategies that aim to enhance medication safety across the country. The first standard is governance and system for medication safety, which requires healthcare institutions to prescribe safely, dispense, supply, administer, store, manufacture and monitor the consequences of drugs (ACSQHC, 2018). Further, the second standard requires healthcare providers to accurately document patients’ medication history including all episodes of care. Another standard of the commission is the management of medication process. Based on this standard, healthcare providers are supported to prescribe, dispense, administer, store, manufacture, compound and monitor medicines. In this regard, the clinical workforce has access to information and tools to support decisions concerning medicines (ACSQHC, 2018). There also guidelines to improve the safe storage of medicines as well as handling of high-risk medicines. The fourth standard is the continuous management of medication, which entails the handing over of a patient’s medicine records to the receiving health care provider. The last standard established by the commission is to communicate with the patient and carers (ACSQHC, 2012). In this case, the healthcare professionals should advise the patient about the available choices, involved risks, and responsibilities for the chosen drug management plan. The role of nurses in minimising medication errors Nurses can minimise the incidences of medication errors by complying with codes of conduct and professional regulatory requirements. Based on the principle of legal compliance, nurses are expected to embrace lawful behaviour. They should adhere to pertinent poison legislation and local policy in regards to safe usage, administration, prescription, sale, supply and storage of medications (NMBA, 2018). In addition, nurses should adhere to the same cautions when handling all therapeutic products. Nurses can mentor and assist colleagues to deliver safe care (ACSQHC, 2017). They can supervise junior clinicians to ensure they adhere to
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MEDICATION SAFETY5 professional conduct and deliver high-quality care. Furthermore, nurses are expected to partner with patients and clinicians to make sure the patient gets suitable information and care (ACSQHC, 2017). A nurse should report incidences of near misses when they occur and embrace safety learning opportunities. These strategies can reduce medical errors because the nurse will adhere to medication guidelines, get more medication knowledge and prevent adverse drug events. Conclusion Medication errors are associated with human errors, which can be reduced through appropriate strategies. Fatigue, lack of medication knowledge, long working hours and inexperience are predictable problems that can be addressed in an effort to reduce medication errors. Nurses should always adhere to professional requirements and code of conduct to avoid committing medicine errors. In essence, the reduction of medication errors will prevent adverse drug events in healthcare settings.
MEDICATION SAFETY6 References ACSQHC. (2012). 4. Medication safety. Retrieved from http://nationalstandards.safetyandquality.gov.au/4.-medication-safety ACSQHC. (2017). Clinical governance for nurses and midwives. Retrieved from https://www.safetyandquality.gov.au/wp-content/uploads/2017/12/Clinical-governance- for-nurses-and-midwives.pdf ACSQHC. (2018).Safety and quality improvement guide 4: Medication safety. Sydney. Retrieved from https://www.safetyandquality.gov.au/wp-content/uploads/2012/10/Standard4_Oct_2012_ WEB.pdf Bari, A., Khan, R. A., & Rathore, A. W. (2016). Medical errors; causes, consequences, emotional response and resulting behavioral change.Pakistan journal of medical sciences,32(3), 523-528. Cheragi, M. A., Manoocheri, H., Mohammadnejad, E., & Ehsani, S. R. (2013). Types and causes of medication errors from nurse's viewpoint.Iranian journal of nursing and midwifery research,18(3), 228-231. Gorgich, E. A. C., Barfroshan, S., Ghoreishi, G., & Yaghoobi, M. (2016). Investigating the causes of medication errors and strategies to prevention of them from nurses and nursing student viewpoint.Global journal of health science,8(8), 220-227. NMBA. (2018). Code of conduct for nurses 2018. Retrieved from http://www.nursingmidwiferyboard.gov.au/documents/default.aspx? record=WD17%2F23850&dbid=AP&chksum=L8j874hp3DTlC1Sj4klHag%3D%3D
MEDICATION SAFETY7 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(3-4), 113-122. Roughead, L., & Bedford, G. (2012). Medication safety: Will adverse drug events be reduced?. Retrieved from https://www.safetyandquality.gov.au/wp-content/uploads/2012/01/NatRep-Windows.pdf