Report on Medication Errors: Barriers and Resolution Strategies (ME 2)

This report delves into the critical issue of medication errors within the healthcare system, examining their causes, prevalence, and impact on patient safety. It explores various types of medication errors, from prescribing and dispensing to administration and monitoring, highlighting the potential for harm and adverse effects. The report investigates the opinions and beliefs surrounding medication errors, emphasizing their global nature and the significant statistics related to patient harm and mortality. Furthermore, it discusses the appropriate frameworks for analyzing medication errors, including the input, process, and output stages, and identifies key barriers to resolution, such as underreporting and organizational culture. Finally, the report proposes resolution strategies, including adherence to the five rights of medication administration, proper documentation, and the implementation of technology and educational initiatives to enhance patient safety and minimize errors within the Canadian healthcare context. The report emphasizes the importance of a multi-faceted approach involving healthcare professionals, patients, and policymakers to create a safer environment and reduce the incidence of medication errors.

Running Head: ME 0
Medication errors
JANUARY 15, 2020

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Table of Contents
Introduction...........................................................................................................................................2
Opinion and beliefs about Medication error......................................................................................3
Appropriate framework.....................................................................................................................4
Barriers..............................................................................................................................................5
Resolution strategies..........................................................................................................................7
Conclusion.............................................................................................................................................9
References...........................................................................................................................................10

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Medication error
Introduction
A medication error is a failure in the treatment process of a health issue that results in
or has the potential to cause harm to the diseased person. Medication errors can happen when
deciding which drug and dosage regimen to provide (irrational, improper, and ineffective
drug prescription, under prescribing, and overprescribing) (World Health Organization,
2016). A medication error can also occur when writing a prescription, for example,
prescription error counting illegibility. Manufacturing the formulation to be applied may also
become the reason for medication error. It will include wrong strength, impurities or
adulterants, wrong or deceptive packaging. Another type of medication error that may occur
is dispensing the formulation which includes the wrong drug, incorrect formulation, and
incorrect labeling. Administration of medicines is also included in the medication error which
includes errors like wrong dose, incorrect route, incorrect frequency, and incorrect duration.
Choi et al (2016), reported that monitoring the therapy is also considered as a
medication error. A medication error is defined as any error in the process of prescribing,
dispensing, or administration of medicine regardless of whether the error results in adverse
effects or not, as the single most avoidable cause of patient maltreatment. There are two
different sides of medication error. It can be caused by a lack of awareness of the healthcare
professional and lack of information provided by the patient, for example, any previous
allergy, and having other health issues. Olaniyan, Ghaleb, Dhillon & Robinson (2015),

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revealed that a medication error is one of the common problems in nursing which needs to the
reduced to increase patient satisfaction. In this particular report different medication errors,
the barrier to the resolution of these errors, and strategies to address such issues will be
discussed.
Opinion and beliefs about Medication error
According to Parry, Barriball & While (2015), Medication errors can be life-
threatening for the patient and can harm the image of a healthcare setting. a medication error
is a global problem in the healthcare sector. Occurrence rates of medication errors differ
widely, the reason for which can be elucidated by the dissimilar study methods and
descriptions used. It has bene identified that around 7.5 per cent of the patient in the hospital
of Canada were seriously impaired by their care. Approximately 9,250 top 23,750 individuals
died in the Canadian hospital health care setting as the outcome of medical errors (ISMP
Canada, 2015). The frequency of medication errors differs between 2 and 14 per cent of
patients admitted to the hospital setting, with 1–2 per cent of patients in the United States
being impaired as a consequence, and the majority are as a result of poor prescribing. The
Medication error has been projected to kill 7,000 diseased people per annum and accountable
for closely 1 in 20 hospital admissions in the same country (Ferrah, Lovell & Ibrahim, 2017).
The prevalence is likely to be comparable in the Canada. Medication errors (7 percent of all
occurrences) was the 2nd most common occurrence reported (after a patient falls) in a new
National Audit Commission description on patient safety (Sutherland et al., 2020). It has been

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reported that nearly 28000 people dies every year due to medication errors and these errors
are recognised as the thirst leading cause of death in Canada (Cheng et al., 2017).
Cloete (2015), reported that patient satisfaction is the main priority of any health care
setting as it improves the organization's public image. Continues medication error can affect
the treatment process and reduce the trust of patients and their families in the healthcare
setting. Medication errors not only affects the patient but also affects their families. Loss of a
loved one can be devastating for families in Canada.
The information that their death could have been avoided or prevented makes it even
difficult for the families to come to terms with. The range of adverse effects runs from not
notable impacts on death. In different cases in Canadian hospitals, it can source a new
condition, either short term or long-lasting, for example itching rashes or disfigurement of the
skin. On the other hand, Hayes, Jackson, Davidson & Power (2015), stated that the healthcare
professional who prescribed the wrong medication may experience shame, guilt, and self-
doubt. The negative impacts of medication error can also be psychological as there are
different cases has been reported in Canada in which the senior nurses committed suicides as
they overdosed their patient which led to death. The family members of the patient may also
file a legal case against the healthcare professional which can hinder their professional
growth.
Across Canada there are increasing events of medication errors has been reported
which occurs on a daily, monthly, and annual basis. The errors take place mostly in hospital

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settings may be easily avoidable or preventable, however causes pain and suffering to the
individuals affected. It has bene reported by the safe medication practices Canada that around
98000 preventable medical errors happen throughout the nation annually.
Olaniyan, Ghaleb, Dhillon & Robinson (2015), discussed about the different factors
that can lead to a medication error such as lack of appropriate training, improper drug
information, and experience, improper information of the patient, inappropriate perception of
the risk, overworked or exhausted healthcare providers, physical or emotional health
problems, poor interaction between the healthcare provider with the diseased person. Factor
associated with the patient may also lead to a medication error in Canadian hospitals, for
example, patient characteristics like literacy and language barrier, the complexity of clinical
case counting multiple health issues and high-risk medication and polypharmacy (Tariq &
Scherbak, 2019).
Appropriate framework
According to Nanji et al (2016), drug-associated errors are a global concern; however,
the trouble in reporting them is still recognized as one of the major problems to patient health
and safety, meanwhile underreporting of these actions hinders the assessment of the type,
occurrence, and volume of these faults. Niemann et al (2015), reported that analysis of a
medication error is the initial step to reduce the impacts of medication errors in a health care
setting. to perform the analysis of medication error an indicator framework must be used. A
focused group discussion can help in identifying the key issues sourcing medication errors

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The FGD also helps in identifying the key strategies to overcome these issues in the
healthcare setting. the flow of medication use system including modifications can be sued as
the indicator framework. A set of questionnaires can be provided to the healthcare providers
and their response can be recorded to identify the issue.
Hutchinson, Sales, Brotto & Bucknall (2015), discussed the indicator framework of
the medication error and reported three stages: input, process, and output. The input stage
includes the selection and procurement of drugs like formularies. This stage involves
clinicians and drug administrators. The process stage includes prescribing, preparation and
dispensing, and drug administration. Assessment of the patient is the necessary process to
identify any medical history or allergies.
Another report published by Kelly et al (2016), revealed that determination of the
drug treatment requirements, and drug selection and prescribing should be assessed.
Preparation and dispensing include confirmation and review of drug purchase, drug
preparation, and its distribution to the patient and health care departments. The prescribing,
and prescribing and dispensing assessment involves physicians and pharmacists. They also
reported that drug administration to the patients must also be assessed which includes a
review of the medicines administered and ordered. Drug administration assessment involves
nurses and other healthcare providers. The last stage of this framework is monitoring which
includes an assessment of drug response in the patients, reporting patient outcomes and

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incidence of errors. This stage involves all the practitioners and patients and their family
members.
Barriers
According to Poorolajal, Rezaie & Aghighi (2015), there are different approaches that
have been used to reduce medication errors, however, it is still existing in the healthcare
sector. There are also some different barriers or challenges that hinder the approaches to be
successful. Lack of reporting about the medication error is the major barrier to resolution.
The severity of medication error was one of the main barriers leading to abstaining from
reporting mistakes, as cited in different studies. When a mistake was probably to cause
patient maltreatment or when it is severe, healthcare professionals like nurses tried to hide
that error. Another subgroup associated with the general class of barriers was conserving
reputation. According to the researchers, conserving reputation and evading profession
outrage was among aspects producing non-reporting mistakes.
Vrbnjak, Denieffe, O’Gorman & Pajnkihar (2016), reported that conserving nurse’s
reputation and place also affected the choices of nursing supervisors concerning the
accountable nurse and reporting mistakes. Negative organizational error is another factor
affecting non-reporting errors. With the presiding punishable culture, nurses tried not to
discuss their errors. Another subgroup is the facilitators of reporting errors which are shaped
in relation to the main objectives of different researches and included the subsequent
subcategories: preceding positive experiences, being new nurse, namelessness of reporting

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system, nurse’s individual values, and positive helpful atmosphere. These aspects inspire
nurses to report mistakes. Yung et al (2016), reported that being new is the most important
subgroup of facilitators of faults. Work experience is among aspects affecting response to
errors, as cited by nurses. With growing work experience, nurses are less motivated to report
mistakes, and moderately tried not to discuss them, and resolve the mistake themselves, with
the intention of no one would ever recognize. The anonymity of the error reporting system is
another aspect facilitating reporting of a medication mistake, and this has been ignored in
different healthcare departments.
An ambiguity of mistake cause might also ascend where it is indistinct whether
variations in prognosis or treatment are the outcome of an unnecessary error per se or
basically an unanticipated difficulty of the disease itself. For example, predictable but
statistically changeable problems in caregiving can happen despite physicians keeping
acceptable values of care in their performance. Therefore, it becomes problematic to establish
causal associates between the incidence of errors and concluding results of patient health
(Olaniyan, Ghaleb, Dhillon & Robinson (2015). Other barriers associated with nonreported
errors in Canada is the lack of education and understanding of policies in patients (Louie et
al., 2010). The patient from communities like Indigenous people are less likely to understand
the errors happened in their treatment process. Some of them might not be able to
communicate with higher authorities to report the errors. Another important category of
barriers captures those debates which inspect the problematic choices doctors and nurses

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often experience as to whether diseased persons are essentially better off knowing all features
of their treatment or whether additional harm than good might result from disclosure. For
instance, doctors are much less probable to disclose mistakes if the error is noticed and
altered for in the procedure of care prior to being transformed into harm, or if the mistake
eventually has no consequence on the medical treatment of the patients' disease (Soydemir et
al., 2017).
Resolution strategies
According to Miller, Haddad & Phillips (2016), there are different strategies can be
used by a healthcare professional to reduce medication error in the healthcare setting. the first
strategy is making sure that the five rights of medication administration are being followed.
Nurses must ensure that the institutional policies associated with the medication transcription
are applied. They must ensure that the right medicines are prescribed to the right patient, in
the right dosage, through a correct route, and at the right time. Documenting everything while
handling medicines is another approach. This includes appropriate medication labeling,
readable documentation, or appropriate recording of ordered medication. A lack of
appropriate documentation for any medicine can outcome is a mistake. For instance, a nurse
overlooking to document an as required medication can outcome in another dose being
provided by another nurse as no documentation representing earlier administration exists.
Another best practice is Reading the medicine label and expiration date of the medicine

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(Durham et al., 2016). An accurate medication can have an improper label or vice versa, and
this can similarly lead to a medication error.
An automated information system can also be used. A review of different randomized
trials conducted on computerized interventions revealed a decrease in medication errors in 50
percent of the investigation. An example of this approach is Computerized provider order
entry (CPOE) with the decision support might be effective if targeted at a restricted number
of possibly inappropriate medicines and is planned to decrease the alert load by concentrating
on clinically-relevant cautions.
Amato et al (2016) discussed about another approach and discussed that there is
considerable evidence that provisions the usage of CPOE to reduce the incidence of
medication faults in the healthcare setting. One research found that the probability of error
incidence was reduced by 48 percent when an order was handled via CPOE. Though, there is
further research needed to link a reduction in medication mistakes to a reduction in patient
maltreatment. An assessment of computerized instruction on drug dosage comprised more
than 40 studies in the primary care setting and the hospital. Different studies found
advantages with respect to medication groups, for example, anticoagulants and the
aminoglycoside type of antibiotics, but not others, for example, insulin, immunosuppressant
transplant type of drugs or antidepressants. The Canadian hospital authorities must
understand that providing education to the healthcare providers and changing the punishing
nature can directly reduce medication errors and increase error reporting. The healthcare

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management authorities must ensure that proper training and education is provided to all
nurses and other healthcare providers.
The Canadian hospital must provide effective training session to the health care
providers. Effective training enhances effective medicine administrations (Mira et al., 2015).
With changing the punishable nature of the hospital setting the managers can allow the nurses
to report the errors. Timely reporting of medication errors can increase the chances of
correcting the mistake before it leads to patient harm. The healthcare professional must have
knowledge about different cultures which will improve the effective communication between
the healthcare provider and patient and ultimately reduce medication error. Another important
approach that must be used by the healthcare providers is including the patient and their
families in the decision-making process about the treatment (Di Simone et al., 2016).
Conclusion
A medication error is defined as the failure or errors in the treatment process of a
disease. Medication errors can be negative for both the patient and the healthcare providers.
Medication errors in nursing are common problems. Nurses are a core member of a
healthcare setting therefore they must understand the impacts of medication errors on the
patient and their families. It has been identified that due to medication errors around 7000
individuals are died every year. Medication errors affect the patient, their families and the
image of the healthcare setting. A focused group discussion can help in assessing medication
errors. A set of questionnaires can be provided to the healthcare providers like nurses, and

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patients. The indicator framework can be used to assess the medication errors which includes
three different stages that are input process and output. Reduction of Medication errors
should be the priority of every healthcare provider. However, there are some barriers that
hinder the resolution of medication errors such as the severity of medication error, negative
organizational approach to deal with the culprit, high work experience, lack of education,
nurse’s personal values, and being new in the department. There are different approaches or
strategies can be used by the healthcare providers to address or reduce the medication error.
Some of the strategies are documenting everything, medication labeling, following the five
rights of medication administration, using computerized provider order entry, using effective
communication, and including the patient and their families in the healthcare setting.

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References
Alanazi, M. Q., Al-Jeraisy, M. I., & Salam, M. (2015). Prevalence and predictors of antibiotic
prescription errors in an emergency department, Central Saudi Arabia. Drug,
healthcare and patient safety, 7, 103.
Amato, M. G., Salazar, A., Hickman, T. T. T., Quist, A. J., Volk, L. A., Wright, A., &
Adelman, J. (2017). Computerized prescriber order entry–related patient safety
reports: analysis of 2522 medication errors. Journal of the American Medical
Informatics Association, 24(2), 316-322.
Cheng, R., Yang, Y. D., Chan, M., & Patel, T. (2017). Medication Incidents Involving
Antiepileptic Drugs in Canadian Hospitals: A Multi-Incident Analysis. Healthcare
quarterly (Toronto, Ont.), 20(2), 54-62.
Choi, I., Lee, S. M., Flynn, L., Kim, C. M., Lee, S., Kim, N. K., & Suh, D. C. (2016).
Incidence and treatment costs attributable to medication errors in hospitalized
patients. Research in Social and Administrative Pharmacy, 12(3), 428-437.
Cloete, L. (2015). Reducing medication errors in nursing practice. Cancer Nursing
Practice, 14(1).
Di Simone, E., Tartaglini, D., Fiorini, S., Petriglieri, S., Plocco, C., & Di Muzio, M. (2016).
Medication errors in intensive care units: nurses' training needs. Emergency Nurse
(2014+), 24(4), 24.

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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.
Ferrah, N., Lovell, J. J., & Ibrahim, J. E. (2017). Systematic review of the prevalence of
medication errors resulting in hospitalization and death of nursing home
residents. Journal of the American Geriatrics Society, 65(2), 433-442.
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.
Hutchinson, A. M., Sales, A. E., Brotto, V., & Bucknall, T. K. (2015). Implementation of an
audit with feedback knowledge translation intervention to promote medication error
reporting in health care: a protocol. Implementation Science, 10(1), 70.
ISMP (2015). Medication error and patient safety approach. Retrieved from:
https://www.ismpcanada.org/download/presentations/SystemsApproach_ISMPCanad
a_18Nov2015.pdf
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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Louie, K., Wilmer, A., Wong, H., Grubisic, M., Ayas, N., & Dodek, P. (2010). Medication
error reporting systems: a survey of Canadian intensive care units. The Canadian
journal of hospital pharmacy, 63(1), 20.
Miller, K., Haddad, L., & Phillips, K. D. (2016). Educational strategies for reducing
medication errors committed by student nurses: a literature review. International
Journal of Health Sciences Education, 3(1), 2.
Mira, J. J., Lorenzo, S., Guilabert, M., Navarro, I., & Perez-Jover, V. (2015). A systematic
review of patient medication error on self-administering medication at home. Expert
opinion on drug safety, 14(6), 815-838.
Nanji, K. C., Patel, A., Shaikh, S., Seger, D. L., & Bates, D. W. (2016). Evaluation of
perioperative medication errors and adverse drug events. The Journal of the American
Society of Anesthesiologists, 124(1), 25-34.
Niemann, D., Bertsche, A., Meyrath, D., Koepf, E. D., Traiser, C., Seebald, K., ... &
Bertsche, T. (2015). A prospective three‐step intervention study to prevent medication
errors in drug handling in paediatric care. Journal of clinical nursing, 24(1-2), 101-
114.
Olaniyan, J. O., Ghaleb, M., Dhillon, S., & Robinson, P. (2015). Safety of medication use in
primary care. International Journal of Pharmacy Practice, 23(1), 3-20.

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Parry, A. M., Barriball, K. L., & While, A. E. (2015). Factors contributing to Registered
Nurse medication administration error: A narrative review. International journal of
nursing studies, 52(1), 403-420.
Poorolajal, J., Rezaie, S., & Aghighi, N. (2015). Barriers to medical error
reporting. International journal of preventive medicine, 6.
Soydemir, D., Seren Intepeler, S., & Mert, H. (2017). Barriers to medical error reporting for
physicians and nurses. Western journal of nursing research, 39(10), 1348-1363.
Sutherland, A., Canobbio, M., Clarke, J., Randall, M., Skelland, T., & Weston, E. (2020).
Incidence and prevalence of intravenous medication errors in the UK: a systematic
review. European Journal of Hospital Pharmacy, 27(1), 3-8.
Tariq, R. A., & Scherbak, Y. (2019). Medication errors. In StatPearls [Internet]. StatPearls
Publishing.
Vrbnjak, D., Denieffe, S., O’Gorman, C., & Pajnkihar, M. (2016). Barriers to reporting
medication errors and near misses among nurses: A systematic review. International
journal of nursing studies, 63, 162-178.
World Health Organization. (2016). Medication errors. Retrieved from:
https://apps.who.int/iris/bitstream/handle/10665/252274/9789241511643-eng.pdf

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Yung, H. P., Yu, S., Chu, C., Hou, I. C., & Tang, F. I. (2016). Nurses’ attitudes and perceived
barriers to the reporting of medication administration errors. Journal of nursing
management, 24(5), 580-588.