Medication Safety Report: Factors, Strategies, Practice in Nursing

This report examines medication safety, a critical aspect of nursing practice. It begins with an introduction outlining the significance of medication errors, supported by statistics from the Australian Commission on Safety and Quality in Healthcare and the World Health Organization. The body of the report identifies three key factors contributing to medication errors: prescribing errors, incorrect administration times and routes, and errors in drug preparation, including issues with "look-alike, sound-alike" medications. Each factor is discussed with supporting evidence from various research studies. The conclusion emphasizes how the evidence informs clinical practice, highlighting the importance of strategies such as adhering to the five rights of medication administration, following medication reconciliation protocols, and using strategies like "Tall Man Lettering." The report provides a detailed analysis of medication errors and offers practical strategies for registered nurses to prevent them and improve patient outcomes, with a focus on evidence-based practices and continuous improvement in nursing care.

Written report: Medication Safety
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Introduction
Provide background information on medication errors, significance of the problem.
Australian Commission on Safety and Quality in Healthcare (2017) suggested that
2% to 3% of discrepancies regarding hospital admissions are related to medication errors.
They also revealed that 230,000 of total admissions in Australia are due to consuming
excessive medicine or wrong medicine. World Health Organisation developed the Patient
Safety Challenge to prevent medication related discrepancies. Parri, Barriball and White
(2015) analysed patient difficulties and the factors contributing to medication error of
registered nurses. This assignment will focus on discussing certain factors leading to the
medication discrepancy, potential consequences, significance to nursing practice and role of
nurses.
Body
Identify three factors that cause medication errors and discuss why these factors lead to medication errors and
impact on patient safety.
Factor One
A very common error that happens during administration of medicines is prescribing error.
The wrong dosage of medicine is often prescribed to patients, or, drugs are selected without
considering the allergy profile of the patient. Mira et al. (2015) revealed that dosage errors is
a very common problem of medication worldwide, with instances of wrong dose calculation
in cancer chemotherapy drugs (calculated with previous weight of the patient) that negated
the effect of the drugs, and dose of carboplatin replaced with cisplatin dose resulting in
severe toxicity. Johnson, Haskell and Barach (2015) reported multiple deaths have occurred
in medical history due to not considering patient’s allergy to anaesthetic drugs. Australia has
the leading cause of death in the world due to anaphylaxis, the most of which are due to
medication. There had been 324 deaths due to anaphylaxis between 1997-2013, 52 of
which are due to medication. It is reported that they have the highest documented hospital
anaphylaxis admission in the world.
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Factor Two
According to Bogner (2018) another cause of medication error that can be considered, is the
incorrect time and the wrong route of administration of the drug. It includes using improper
administration technique to deliver a drug or skipping a dose. Skipping a dose can be
explained as administering the drug at an incorrect time or by means of an incorrect and
inappropriate route. Administering drugs via wring route can drastically impact the patient in
a number of ways such as clogging the blood vessels or acting against the desirable impact
of the medication which would subsequently delay the recovery process. In addition to this,
administering the medication at wrong timings can elicit a cascade of complex chemical
reactions that can interfere with the normal functioning of the physiological functions. Also,
skipping dose of certain medications can overall cease the activity of the medication.
Discontinuation of consumption of antibiotics after recovery, and not completing the
prescribed course, can invalidate the effect of others. Martinez-Ramirez et al. (2015)
suggested that missing dopaminergic dosage of drugs in hospitalized patients of Parkinson’s
disease prolonged their duration of stay in the hospital. It should be noted in this regard that
certain dosage of solid oral medication while administering to patients with limited ability to
consume the drug orally are crushed and administered intravenously. It should be noted that
crushing and or dissolving solid oral tablets lead to destruction of protective enteric covering
of the release medications and might reverse the intended therapeutic action. One instance
where wrong route of medication led to death of a patient can be explained as the case of 97
year old, Nymphea Anderson who was administered a mixture of 3 crushed oral tablets that
was intravenously administered to her by a nurse (Bibby 2019).
Factor Three
Paranad et al. (2016) suggested that another factor that contributes to medication error can
be explained as incorrect dose preparation of the drug or committing an error with the
preparation of ‘Look alike sound alike’ medication. Look alike sound alike medication or
LASA medication create confusion among care professionals which lead to fatal health
outcome within a healthcare environment. In this regard, it should be noted that medicines
that are packaged in an identical way constitute the ‘look alike’ medication and the drugs
whose generic name are similar are referred to as the ‘sound alike’ medication. Research
studies reveal that LASA drugs can be used interchangeably and could lead to adverse
patient outcome (Rash-Foanio et al. 2017). Research reports reveal that on an average 15%
of the medication errors occur on account of incorrect medication preparation pertaining to
human error as caused due to the interchangeable use of LASA drugs (World Health
Organization 2017).
Conclusion
Describe how the evidence will inform your practice on clinical placement.
Hayes et el. (2015) suggested that medication administration errors continue to be a potent
patient-safety issue, internationally. His study revealed that a considerable numbers of
medical errors have happened due to interruptions faced during administration or
distractions. A number of research studies have also revealed that insufficient knowledge
about pharmacology also attributes to medication error that concerns incorrect route of
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administration or incorrect dose preparation. So, they suggested that awareness must be
raised regarding this issue to safely delegate medicines in a clinical environment. Australian
Commission on Safety and Quality in Healthcare (2017) revealed that substantial medication
errors have happened in the country due to errors of nurses such as discrepancy while
rewriting charts, omission of dose, workload pressure and inadequate staffing. The Nursing
and Midwifery Board of Australia (2019) suggested that a nurse must participate regularly to
improve quality and standard of practice to reduce errors and to provide comprehensive care
to patients. So, as a nurse it is very important to identify and deal with potent problems
regarding medication issue.
Identify three strategies that as a registered nurse you can use to prevent medication errors.
First strategy
According to Lewis et al. (2016), the nurse can ensure that the five rights of medication
administration is followed while providing the medicine to the patient. The five rights include
the right patient, correct dosage, correct drug, the right route and the prescribed time. A
nurse can emphasize while checking each patient that the above five rights are followed
appropriately. So, the authors were of the opinion that the nurse must accept them as
medication administration goals while providing patient-care, and all the above, must be
followed without fail. Therefore, it is absolutely significant to ensure that all the Institutional
policies and above five rights are followed during medication transcription.
Second strategy
The nurse must consult with a fellow RN and ensure that the proper medication
reconciliation protocol is followed at each stage of the hospital admission. Various
organisations follow different procedures for medication reconciliation, and the nurse must
fortify that the protocol is followed efficiently during various stages such as, transferring a
patient between hospitals, transferring between different units, during preoperative and post-
operative durations of surgical patients, and during follow up after hospital release. Charting
the medications listed properly each time can reduce medication related errors (Durham et
al. 2016). Further, appropriate revision and updating of the medication administration record
during the time of shift can help to ensure that medication safety as maintained. It is integral
to ensure further that the new orders are properly updated and changes within the protocol
are clearly highlighted for avoiding possible medication error (Cloete 2015).
Third strategy
Strategies such as Tall Man Lettering that involves the highlighting of the dissimilar letters
can help nurses to distinguish between two drugs such as HumaLOG and HumuLIN or
oxyCODONE and OxyCONTIN (Rash-Foanio et al. 2017). In addition to this conducting
refreshment courses to enhance the pharmacological knowledge of the nurses can help to
improve medication safety and contribute to improved patient safety and help in acquiring
positive patient outcome (Rash-Foanio et al. 2017).
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References
At least 6 quality evidence-based references including two (2) from textbooks, three (3) from nursing journals and
one (1) from an Australian government/health website are used in this assessment item.
Australian Commission on Safety and Quality in Healthcare. (2017). Australia Joins
international push to halve medication errors. Access Date: 6th August, 2019. [Online].
Retrieved from: https://www.safetyandquality.gov.au/media_releases/australia-joins-
international-push-to-halve-medication-errors
Bibby, P. (2019). Sydney grandmother who died after nurse's error was already 'at death's
door', court hears. [online] The Sydney Morning Herald. Available at:
https://www.smh.com.au/national/sydney-grandmother-who-died-after-nurses-error-was-
already-at-deaths-door-court-hears-20150222-13lim1.html [Accessed 21 Aug. 2019].
Bogner, M.S., 2018. Human error in medicine. CRC Press.
Cloete, L., 2015. Reducing medication errors in nursing practice. Cancer Nursing
Practice, 14(1).
Durham, M.L., Suhayda, R., Normand, P., Jankiewicz, A. and 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),
pp.75-81.
Hayes, C., Jackson, D., Davidson, P.M. and 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), pp.3063-3076.
Johnson, J., Haskell, H. and Barach, P., 2015. The big picture: a terminally ill patient in a
fragmented system. Case Studies in Patient Safety, p.177.
Lewis, S.L., Bucher, L., Heitkemper, M.M., Harding, M.M., Kwong, J. and Roberts, D.,
2016. Medical-Surgical Nursing-E-Book: Assessment and Management of Clinical
Problems, Single Volume. Elsevier Health Sciences.
Litman, R.S., Smith, V.I. and Mainland, P., 2018. New solutions to reduce wrong route
medication errors. Pediatric Anesthesia, 28(1), pp.8-12.
Martinez-Ramirez, D., Giugni, J.C., Little, C.S., Chapman, J.P., Ahmed, B., Monari, E.,
Shukla, A.W., Hess, C.W. and Okun, M.S., 2015. Missing dosages and neuroleptic usage
may prolong length of stay in hospitalized Parkinson's disease patients. PloS one, 10(4),
p.e0124356.
Mira, J.J., Lorenzo, S., Guilabert, M., Navarro, I. and Perez-Jover, V., 2015. A systematic
review of patient medication error on self-administering medication at home. Expert opinion
on drug safety, 14(6), pp.815-838.
Nursing and Midwifery Board of Australia. (2019). National Competency Standards for the
Registered Nurse. Access Date: 6th August, 2019. [Online]. Retrieved from: file:///D:/PPT
%20Materials/australia%20nurse.pdf
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Parand, A., Garfield, S., Vincent, C. and Franklin, B.D., 2016. Carers' medication
administration errors in the domiciliary setting: A systematic review. PloS one, 11(12),
p.e0167204.
Parry, A.M., Barriball, K.L. and While, A.E., 2015. Factors contributing to Registered Nurse
medication administration error: A narrative review. International journal of nursing
studies, 52(1), pp.403-420.
Rash-Foanio, C., Galanter, W., Bryson, M., Falck, S., Liu, K.L., Schiff, G.D., Vaida, A. and
Lambert, B.L., 2017. Automated detection of look-alike/sound-alike medication
errors. American Journal of Health-System Pharmacy, 74(7), pp.521-527.
World Health Organization, 2017. Patient safety: making health care safer (No.
WHO/HIS/SDS/2017.11). World Health Organization.
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