University Essay: NSG2NMR Assessment 2 - Medication Error Critique

This essay critically examines two research articles focused on medication errors in healthcare settings. The first article, employing a qualitative approach, investigates the factors influencing nurses' decisions to question medication administration in a neonatal care unit, exploring themes such as working environment, responsibility, and knowledge. The second article, using a quantitative method, evaluates a collaborative, safety-focused intervention involving nurses and pharmacists to improve the accuracy of medication histories, highlighting the use of a standardized assessment tool. The essay provides summaries of both studies, assesses their methodologies, internal and external validity, and trustworthiness. It compares and contrasts the findings, discussing the implications for clinical practice and patient safety, and considering the contributions of each study in the context of the overall clinical issue. The essay also acknowledges the limitations of each study and suggests potential improvements to enhance their validity and reliability, ultimately emphasizing the importance of evidence-based practices to reduce medication errors and improve patient outcomes.

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Name of the Author
Name of the University

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Introduction
One of the most common and serious problems in the world that affect patient safety and
may even lead to the death of the patient is medication error (Gorgich, Barfroshan, Ghoreishi &
Yaghoobi, 2015). A large number of research studies have been performed to find ways so that
medication errors can be reduced. For proper implementation of the best practice, nurses should
critique earlier findings of the research.
Two articles on medication error will be examined through this essay. After providing a
summary of both articles, these articles will be critiqued based on their reliability and legitimacy.
Ultimately, the contribution of these articles in improving medication errors will be assessed.
Summary
The first article that will be examined by this essay is titled “Factors influencing a nurse’s
decision to question the medication administration in a neonatal care unit”. The main purpose
was to determine the key factors impacting the decisions of a nurse to question the important
aspects of administration of medication within a NCCU (Aydon, Hauck, Zimmer & Murdoch,
2016).
In this experiment, a qualitative exploratory approach was applied to find the influence of
factors on a nurse decision in a NCCU. All nurses who were employed in the NCCU in the two
hospitals in Western Australia were asked to contribute in the experiment. Around one hundred
and three nurses have participated in the experiment in which they were introduced to a critical
incident design. To complete this experiment, they had to concentrate and question on a clinical
incident which was related to an issue about medication. During the experiment, two questions
were asked to the participant nurses. According to the first question, they had to explain a

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clinical situation in which they had decided to question the feature of medication administration.
According to the second question, they had to describe a situation in the hospital in which they
had decided not to enquire about the feature of medication administration. This interview was
taken in a silent room in a setting of the hospital. These interviews were noted by a digital voice
recorder. Every interview lasted for about five to seven minutes. Additionally, demographic data
were also gathered consisting of the level of education, the status of employment, experience in
neonatal clinic, and experience of working within the unit.
Based on the results of the experiment conducted, among one hundred and three nurses
participated in the experiment, around 47 were working full time, 39 of them had a qualification
of undergraduate nursing, 33 nurses had more than 10 years of experience of working in NCCU,
and 46 of them had experience of working in neonatal nursing for more than ten years. A total
number of incidents that were questioned by the nurses described were about one hundred and
three. A total number of incidents that were not questioned by the nurses described were about
sixty-two. Around forty-one nurses had no incidents to describe as they had always enquired the
medication administration.
Based on the findings of the experiment, about three themes and thirteen subthemes were
revealed in the initial thirty-six categories. Three themes included working environment, doing
the right thing, and knowledge about medication. The first theme “working environment” has
covered the positive and negative impact of the relationships between working staff and issues
regarding workload. According to the second theme, nurses described their responsibility in the
hospital and answerability of the care which they offer to the patients. Based on the third theme,
the nurses have described their experience in nursing and confidence in providing resources.

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Some of the nurses described the positive impact of their workload and relationship with the
working staff and some of them described the negative impact.
According to a survey, the impact of the working environment contributed a lot in
influencing medication administration errors. Therefore, it is important to raise awareness
against this issue among nurses and for secondary tasks, additional nurses must be assigned with
secondary tasks to lower workload (Getnet & Bifftu, 2017). This will improve the knowledge of
the nurses regarding medication administration also (Zarea, Mohammadi, Beiranvand, Hassani &
Baraz, 2018).
As the second theme suggested, the nurses frequently questioned about certain
medication administration before performing it so that they could do the right thing and take care
of the patients properly. A research study has suggested that nurses should have a balance
between responsibility and accountability. To reduce errors in medication administration, the
authority of the nurses must be balanced with other things. It can be done by the determination
and application of the rights of the nurses for medication administration (Jones & Treiber, 2018).
Also, the nurses should feel comfortable in questioning about the medication before
administrating it to the patient to provide proper care to prevent medication errors. This is due to
the increasing seriousness of medication errors and its outcomes (Huynh et al., 2016).
Based on the third theme, the nurses described they mostly follow protocols and revise it
time to time to administer medication properly with reduced errors. Another research study also
described that incorrect calculation and dosing of medication may cause severe effects on the
patients’ health. Therefore, the nurses must be provided with the proper training to understand
safety issues and the impact of incorrect dosing (Shamsuddin & Shafie, 2012).

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The qualitative research approach is the method which is utilized to understand the
experiences, behaviour, beliefs, attitudes, and interactions of the people. This approach is the
best way to gain improved attention across various fields (Pathak, Jena & Kalra, 2013).
Internal and external validity refers to the appropriate use of processes, tools, and data in
the experiment. It defines whether the research query is effective for finding the results (Leung,
2015). In this experiment, the questions asked to the nurses were appropriate and valid to find the
factors influencing a nurse’s decision in medication administration. However, the setup of a
digital recorder was not the appropriate tool to record the interview as many nurses may have
answered incorrectly in its presence.
As the nurses were asked to recall the incidents, this can have limited the strength and
length of the interview. Thus, the outcomes of the experiment can be biased. The limitations to
the external validity of this experiment were the involvement of the nurses of only two hospitals
which represent a small sample of the population. Hence, the result cannot be generalised for
every nurse.
The second article, which is examined by this essay is titled as “an evaluation of a
collaborative, safety focussed, nurse pharmacist, intervention for improving the accuracy of the
medication history”. The main purpose was to assess the effect of utilizing a standard method to
gather the history of medication on the correctness of the list of the admission medication
(Henneman, Tessier, Nathanson & Plotkin, 2014).
The history of medication is very significant to collect properly to reduce errors in
prescribing medicines and chances of risks to the patients’ health. The errors in collecting the
history of medication list while admitting a patient are very common. An inaccurate medication

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history may lead to the incorrect decisions about the treatment of the patient (Nickless & Davies,
2016)
To conduct this experiment, a new tool was developed and introduced in the clinical
setting to promote an organised way to collect the history of medication. Using this tool, the
patients were asked to provide the sources of medication data to create a list that included
medications and health problems both. This tool was first implemented on the nursing students
and then, in a clinical setting. According to a research study, the standardization of any method
can improve the health and treatment process of the patient (Citty, Kamel, Garvan, Marlowe &
Westhoff, 2017).
This experiment was performed in three phases quantitatively. In the first phase, the
nursing students were divided into two groups; intervention group and control group. The mock
patients were asked to provide their medication history only when they were asked about it.
These students were given thirty minutes to complete the interview. The list obtained by the
students while interviewing was cross-checked with the list obtained before the interview to
check the accuracy of the medication history.
The second phase utilized for this experiment included the implementation of a refined
tool with two general units in a training hospital and two acute care unit in a municipal hospital.
The education for using this tool was provided to the nurses by using the six-step tool and
posters of the tool. The rates of medication errors and medication discrepancies before and after
three months of using this tool were compared with the electronic data collected.
A survey was conducted in the third phase on a sample of nurses after the completion of
the intervention period of one month. They were asked about the utilization of the tool and its

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method, the amount of time required to gather medical history and any suggestion for further
variations in the tool.
All data collected was measured by using statistical analysis tools like the Chi-Square
test. According to the findings of the first phase, the students using tool for the collection of
medication history were more accurate than the data collected without utilizing the tool. Around
sixteen students participated in this method in which seven were allocated to the treatment group
and nine to the control group.
As the findings of the second phase suggested, the medication errors fell to 33% after the
three-month intervention program. There was no significant observation of rates of medication
errors in academic teaching hospital post-intervention. The rate of medication discrepancies was
also reduced to a greater extent of post-intervention.
According to the survey in the third phase, the tool used was useful but more time-
consuming because this tool collected information for every single medication history and health
issues in detail. One recommendation obtained during the survey was to implement this tool
earlier in the stay of the patient by the nurse during admission. This experiment suggested the
use of the tool is effective in minimizing medication errors. As suggested by one research study,
checking medications before admission is always useful and prevent patients from medication
errors (Athanasakis, 2015).
The validity of this experiment is not appropriate as the result obtained have not reached
the statistical significance. Also, several nurses reported that this tool was very similar to the
learnings of the nursing school. However, some students reported that this would have been

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useful if it was learned earlier. Thus, the results obtained vary largely. Hence, the results were
not trustworthy to decide the effectiveness of the tool.
Conclusion
The first article examined was conducted with a qualitative approach and the second one
was conducted with a quantitative approach. The comparison of both approaches is important to
understand the issue perfectly. As suggested by study one, many factors are affecting a nurse’s
decision and increasing medication errors. Hence, nurses need to improve their awareness of
medication errors to reduce the risk of complication in the patient’s health (Pournamdar & Zare,
2016). The second study suggested that a standard tool when implemented properly can reduce
medication errors. Although some limitations were identified in both studies, there are some
steps which can be taken to improve their validity and trustworthiness.

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References
Athanasakis, E. (2015). The Method of Checking Medications Prior To Administration:
An Evidence Review. International Journal of Caring Sciences, 8(3), 801.
Aydon, L., Hauck, Y., Zimmer, M., & Murdoch, J. (2016). Factors influencing a nurse's
decision to question medication administration in a neonatal clinical care unit. Journal of
Clinical Nursing, 25(17-18), 2468-2477. doi: 10.1111/jocn.13277
Citty, S., Kamel, A., Garvan, C., Marlowe, L., & Westhoff, L. (2017). Optimizing the
electronic health record to standardize administration and documentation of nutritional
supplements. BMJ Quality Improvement Reports, 6(1), u212176.w4867. doi:
10.1136/bmjquality. u212176.w4867
Getnet, M., & Bifftu, B. (2017). Work Interruption Experienced by Nurses during
Medication Administration Process and Associated Factors, Northwest Ethiopia. Nursing
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Student Viewpoint. Global Journal of Health Science, 8(8), 220. doi: 10.5539/gjhs. v8n8p220
Henneman, E., Tessier, E., Nathanson, B., & Plotkin, K. (2014). An Evaluation of a
Collaborative, Safety Focused, Nurse-Pharmacist Intervention for Improving the Accuracy of the
Medication History. Journal of Patient Safety, 10(2), 88-94. doi: 10.1097/pts.0b013e318294890c

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Huynh, N., Snyder, R., Vidal, J., Sharif, O., Cai, B., Parsons, B., & Bennett, K. (2016).
Assessment of the Nurse Medication Administration Workflow Process. Journal Of Healthcare
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