Quality and safety improvement in mediation errors while administration by Nurse

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Quality and safety
improvement in mediation
errors while administration by
Nurse
Student's Name:
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Subject:

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Table of Contents
Introduction......................................................................................................................................2
Project proposal/ Problem Statement...............................................................................................2
Relevance of the problem................................................................................................................2
Literature Review............................................................................................................................3
Project aim.......................................................................................................................................4
Current State/ Ideal State.................................................................................................................4
Establishing measures......................................................................................................................5
Project Details..................................................................................................................................5
Dissemination of findings................................................................................................................7
Project Summary.............................................................................................................................7
References........................................................................................................................................8

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Introduction
In healthcare setting medications are determined to be the significant measures that help in
minimizing injuries. However, medication errors made by nurses leads to the economic and
clinical problem to patients. The study will focus on a nursing issue related to a medication error
that negatively affects a patient's quality of life. As a result, it is the responsibility of the nurses
to take appropriate measures to provide quality care by reducing medication errors. This quality
improvement project will determine the evidence-based strategies that will help the nurses to
mitigate this significant issue related to medication errors in healthcare settings.
Project proposal/ Problem Statement
While entering into an acute care facility, the patients expect excellence in every aspect of their
care. However, substantial differences in medication errors are found across the healthcare
settings that create a negative impact on patient's quality of life. During medication
administration, most of the factors relate specifically to nurses like failure to adhere to five
medication rights and technological devices, nursing workload and patient acuity (Kelly,
Harrington, Matos, Turner & Johnson, 2016). The problem of medication error constantly
increases, thus it becomes necessary for the registered nurses (RN) to research, evaluate and
analyze the areas surrounded by medication errors to bring sustained and systematic change that
will eliminate or decrease preventable adverse drug incidents. RN must suggest the idea of
verifying five medication rights and utilizing the technological system as it will help in reducing
medication errors and promote quality care.
Relevance of the problem
Medication errors are determined to be a serious problem across the world and a common
medical issue that negatively affects patient safety and care and may result in death. Providing
drug is one of the most complex and significant processes of nursing care, and it requires the
right functions and knowledge of nurses. Nurses possess the responsibility to provide patient
safety in medication and general administration that enhances the quality of care. Standard 4
based on National Safety and Quality Health Service Standards needs health care professionals
and stakeholders with patients along with their families to minimize adverse events and enhance

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medication safety (Hewitt, Tower & Latimer, 2015). The nurses who do not comply with the five
rights of medication administration such as right route, right time, right dose, right patient and
right drug leads to medication errors that negatively affect patient's quality of care.
Literature Review
At the time of patient hospitalization, safety contains one of their rights as well as utmost priority
of the health professionals, especially the nurses and the physicians. Over the last few decades,
the errors that cause due to nursing interventions have drawn the attention of the health
researchers. As stated by Flynn, Evanish, Fernald, Hutchinson & Lefaiver, (2016), medication
errors refer to the preventable incident that leads to patient harm or inadequate medication usage
when the medication is in control of patient or health professional. It has been reported
medication errors in Australia account 7000 deaths every year. Medication errors are divided into
several categories like extra dose error, wrong technique error, wrong time error, wrong route
error, wrong drug error and omission error that are made by nurses. To avoid such type of errors
made by nurses, it is important to take preventive measures. The nurses who take measures for
reducing medication errors, firstly minimize the incidents of medication errors, ensure safe
medication management and maintain a safe cultural environment within the hospital by
complying with five medication rights. In the words of Hayes, Jackson, Davidson & Power,
(2015), the preventive strategies based on these medication rights taken by the nurses involves
simplification and standardization of medication processes.
These medication rights help nurses within the healthcare setting take several measures to
provide quality care to patients by avoiding medication errors like adhering to scheduled
administration times, a systematic approach to administration, a thorough knowledge of
medications being administered and proper patient recognition. As mentioned by Yung, Yu, Chu,
Hou & Tang, (2016), the RN in hospitals found that implementing and acquiring the utilization
of preventable work carts with the help of technological devices reduces medication errors. A
higher level of trust from nurse managers motivates RN to utilize practices that minimize
medication errors. Following the right route, help nurses to keep them up-to-date and improves
their pharmacologic knowledge regarding the use of new drugs (Durham, Suhayda, Normand,
Jankiewicz & Fogg, 2016). Pharmacologic knowledge helps nurses regarding the safe use of

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drugs that includes documentation, patient teaching, patient monitoring, drug actions, proper
administration and indications. In today's healthcare setting the nurse makes efficient utilization
of technology like bar code-assisted administration (BCMA) and smart pump that helps in
decreasing drug dosing errors. Before administering medication errors, nurses use BCMA to scan
a patient's medication code and wristband. As per Schnock et al., (2017), BCMA reduces
medications lacking prescriptions by 72.4%, medication administration errors by 80.7% and
wrong dosage errors by 90.4%. However, the nurses make use of electronic reporting systems to
provide information to quality risk management and managers related to medication errors
electronically.
Project aim
The project aims to explore the preventable measures such as verifying medication rights and
using electronic system taken by RN to avoid medication errors in the healthcare setting. It aims
to implement a tangible strategy that will create a positive impact on decreasing or eliminating
medication errors by nursing staff.
Current State/ Ideal State
Current State
Currently, it has been found that more than 50% of the nurses in surgical units of the hospitals do
not follow the five rights of medication along with institutional and professional guidelines or
policies. Avoiding these guidelines and five rights of medication results in mediation errors. It
has been observed that the nurses fail to check the medication chart that is available online
before treating a patient in a surgical unit (Farag, Blegen, Gedney-Lose, Lose & Perkhounkova,
2017). It has also been noted that single checks lead to fewer distractions and fewer nurse
interaction that affected the patient's quality of care. It is determined that wrong time, and failure
to report medication error electronically is the reason behind medication error in hospitals.
Ideal State
To overcome the issue of wrong timing the ideal state for the nurses is to utilize preventable
medication charts available online that will help the nurses to focus towards their work. The

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long-term objective of the quality improvement project is to create a culture of satisfaction and
safety among the nursing staff to enhance patient quality of care by reducing medication errors
and complying with the five medication rights (Vaismoradi, Griffiths, Turunen & Jordan, 2016).
On the other hand, the nurse must report medication errors electronically that will help in
understanding medication procedures and avoid further incidents.
Establishing measures
As per the study, direct observation helped in identifying more medication administration that is
made by nurses. In order to measure the accuracy of the quality improvement project incident
report, along with direct observations, will be used to identify medication administration and
medication errors. While verifying the rights of the medication and using the technological
system, the patients will be interviewed based on their understanding of the medication they
receive (Lobaugh, Martin, Schleelein, Tyler & Litman, 2017). The measurement will be done
twice, one before the interference and one-two weeks after the adoption of the new strategy.
Therefore, measures will be taken to build collaboration among the nurses and head nurses for
creating a safe work environment within the healthcare setting. Along with verifying medication
rights measures will be taken to use electronic medication system by nurses to derive significant
information related to medications.
Project Details
Plan, Do, Study and Act (PDSA) are determined to be an appropriate cycle for assessing and
implementing small change (Härkänen, Voutilainen, Turunen & Vehviläinen-Julkunen, 2016).
The quality improvement project will make efficient use of the PDSA model to minimize
medication errors in a surgical unit in healthcare settings by involving nurses to take several
measures and patients in the confirmation of five medication rights.
Plan
The purpose of the quality improvement plan is to enhance interaction between patient and nurse
in the surgical unit of healthcare setting at the time of the medication administration procedure.
The project plan to verify five medication rights and using an electronic system to report the
incidents to the Nurse Unit Manager (NUM). By consulting the NUM, two stages of direct

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observation will be executed for several medication administration (Bower, Jackson & Manning,
2015). During the first stage, the nurse and patient interaction will be observed based on
medication rights and using a technological device. Furthermore, patients will be selected top
gain understanding of the medication they received by pre and post-intervention by NUM. For
printing and laminating the posters based on medication rights and technological devices, a small
amount of budget will be created. The data gathered from incident reports and direct
observations within the healthcare settings will be analyzed and collated by NUM.
Do
A workshop will be conducted with the nurses, where the NUM of the healthcare setting will
provide appropriate information regarding the use of technological devices and five medication
rights. The workshop will be conducted on Saturday for one week for making them understand
the motto behind the quality improvement project. Posters based on medication rights and use of
technological devices will be placed in nursing and patient's room as well as in the medication
trolley that presents their role at the time of medication administration procedure (Koehn,
Ebright & Draucker, 2016). The feedback from the nurses and patients will be used to consider
the project efficiency and strategies.
Study
The quality improvement project aims to minimize medication errors in healthcare settings. Its
objective is to enhance nurse-patient interaction at the time of verifying medication rights and
appropriate use of technological devices. To gain success, one of the barriers is to make the
nurses attend the workshop (Yoder, Schadewald & Dietrich, 2015). For the successful
implementation of the project, it is important to gather nurses to give them adequate information.
If the project is implemented within the surgical unit in the healthcare settings, it will increase
trust among the nursing staff and reduce medication errors.
Act
Another cycle of PDSA will be developed in order to attain and maintain the objective of
reducing medication errors by 60% and to make sure that all the nurses attend the workshop.
After the success of this strategy of using the technological device and verifying medication

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rights, the strategy will be shared with other units in the healthcare settings along with the
stakeholders through publications and newsletters (McTier, Botti & Duke, 2015). A regular
training workshop will be conducted on every Saturday to make sure that the nursing staff
members are aware of the new strategy that is being implemented to enhance quality care.
Dissemination of findings
The study used a qualitative research method by conducting interviews with nurses and patients
in healthcare settings. It has been noticed that after the implementation of the PDSA cycle, the
data gathered from nurses and patients will be analyzed and evaluated. The findings state that the
most common reason behind the occurrence of medication error is the failure to comply with five
medication rights and report medication errors, workload and wrong time (Lapkin, Levett‐Jones,
Chenoweth & Johnson, 2016). The findings suggest that nurses make efficient use of
technological devices to understand medication procedures. It has been observed that verifying
five medication rights will help in reducing medication errors by 60%.
Project Summary
The quality improvement project determines the efficient role of nurses in reducing or
eliminating medication errors. It outlines the adoption and vigilance of precaution measures that
are must be taken by nurses for preventing medication errors. In order to create an effective
foundation for bringing positive change, the project involves the use of the PDSA cycle. The
project presents an appropriate and effective medication administration that is significant for
providing quality care to patients in acute settings. Thus, the project stated the use of
technological device and verification of five medication rights that helps nurses to reduce
medication errors.

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References
Bower, R., Jackson, C., & Manning, J. C. (2015). Interruptions and medication administration in
critical care. Nursing in critical care, 20(4), 183-195.
Durham, M. L., Suhayda, R., Normand, P., Jankiewicz, A., & Fogg, L. (2016). Reducing
medication administration errors in acute and critical care: multifaceted pilot program
targeting RN awareness and behaviors. JONA: The Journal of Nursing
Administration, 46(2), 75-81.
Farag, A., Blegen, M., Gedney-Lose, A., Lose, D., & Perkhounkova, Y. (2017). Voluntary
medication error reporting by ED nurses: Examining the association with work
environment and social capital. Journal of Emergency Nursing, 43(3), 246-254.
Flynn, F., Evanish, J. Q., Fernald, J. M., Hutchinson, D. E., & Lefaiver, C. (2016). Progressive
care nurses improving patient safety by limiting interruptions during medication
administration. Critical care nurse, 36(4), 19-35.
Härkänen, M., Voutilainen, A., Turunen, E., & Vehviläinen-Julkunen, K. (2016). Systematic
review and meta-analysis of educational interventions designed to improve medication
administration skills and safety of registered nurses. Nurse Education Today, 41, 36-43.
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.
Hewitt, J., Tower, M., & Latimer, S. (2015). An education intervention to improve nursing
students' understanding of medication safety. Nurse education in practice, 15(1), 17-21.
Kelly, K., Harrington, L., Matos, P., Turner, B., & Johnson, C. (2016). Creating a culture of
safety around bar-code medication administration: An evidence-based evaluation
framework. JONA: The Journal of Nursing Administration, 46(1), 30-37.

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Koehn, A. R., Ebright, P. R., & Draucker, C. B. (2016). Nurses' experiences with errors in
nursing. Nursing outlook, 64(6), 566-574.
Lapkin, S., Levett‐Jones, T., Chenoweth, L., & Johnson, M. (2016). The effectiveness of
interventions designed to reduce medication administration errors: a synthesis of findings
from systematic reviews. Journal of nursing management, 24(7), 845-858.
Lobaugh, L. M., Martin, L. D., Schleelein, L. E., Tyler, D. C., & Litman, R. S. (2017).
Medication errors in pediatric anesthesia: a report from the wake up safe quality
improvement initiative. Anesthesia & Analgesia, 125(3), 936-942.
McTier, L., Botti, M., & Duke, M. (2015). Patient participation in medication safety during an
acute care admission. Health Expectations, 18(5), 1744-1756.
Schnock, K. O., Dykes, P. C., Albert, J., Ariosto, D., Call, R., Cameron, C., ... & Husch, M. M.
(2017). The frequency of intravenous medication administration errors related to smart
infusion pumps: a multihospital observational study. BMJ Qual Saf, 26(2), 131-140.
Vaismoradi, M., Griffiths, P., Turunen, H., & Jordan, S. (2016). Transformational leadership in
nursing and medication safety education: a discussion paper. Journal of nursing
management, 24(7), 970-980.
Yoder, M., Schadewald, D., & Dietrich, K. (2015). The effect of a safe zone on nurse
interruptions, distractions, and medication administration errors. Journal of Infusion
Nursing, 38(2), 140-151.
Yung, H. P., Yu, S., Chu, C., Hou, I. C., & Tang, F. I. (2016). Nurses’ attitudes and perceived
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management, 24(5), 580-588.