Enhancing Quality and Safety

Introduction

Human beings are not infallible and therefore they are susceptible to making errors in their lives. There is no exception when it comes to the healthcare setting. Medication errors have been and will continue to be a problem that plagues the healthcare setting even though providers give it their best effort to avoid them. These errors occur before, during, and after administration of the medicines and are the causes of 7000 to 9000 deaths every year. (Tariq et al. 2018) Nurses do have that final check on the line of administration. They can potentially be the ones to prevent the error and therefore are responsible for a lot of the quality improvement measures that occur in their facilities and practices.

Factors Leading to Safety Risks

There can be many causes of medication errors, and it can start at the original point of contact with the prescription itself. There may be illegible orders, quickly scribbled down for lack of time, and then misinterpreted by the pharmacy. It could also be an incomplete order or one that is missing a dosage, route, or time of administration. Another very real problem leading to a potential medication error is the severe nursing shortage that causes the nurse-to-patient ratio to not be conducive to positive patient outcomes across the board. When a nurse is caring for too many patients herself, it can become complicating and disorganized, leading to mistakes in medication administration. (Gatchel, 2018) One can also look to the nurse’s educational background and competence when it comes to calculating and checking dosages, or knowing how quickly a medication can be pushed IV. With so many variables in healthcare, medication errors seem inevitable but must be constantly studied so that fewer and fewer can happen in the future.

Improving Patient Safety with some Solutions

Many studies show that electronic recording is much more efficient and leads to fewer errors in communication from provider to nurse or to pharmacy. (Lin et al. 2020) Computerized records eliminate the variable of navigating illegible handwriting and ultimately cut down on many of the potential errors. Even telephone orders are generally not given unless there is an emergent order, and even then there is a read-back policy to make sure the rights of medication administration are being followed.

When discussing these five or six rights of medication administration it is understood that going through each right can definitely reduce errors by ensuring the right patient, right drug, right route, right time, right dose, and right documentation is occurring with each patient interaction. (Jarvill et al. 2018) Nursing education varies, but most suggest a three-point identification check-twice while pulling and preparing the medicines and once more right at the bedside. Using the electronic record to triple-check the patient and the medication can prevent significant adverse events.

High-risk medications like insulin and heparin, and controlled substances, like opioids, require two registered nurses to check all the rights as well and sign off on giving the medication. When two nurses sign off on the medicine, it helps assign accountability and reduces the chance for mistakes. (Koyama et al. 2020) There should also be continuing education on proper medication administration including calculations and dosage problems so that staff is up to date on proper dosing and there is less error. (Jarvill et al. 2018)

Nurses’ role in Improving Patient Safety

Nurses are the front line to patient care and safety. Much of what is taught in nursing school emphasizes the importance of safety in the healthcare setting. Nurses are trained to check and recheck for any barriers to the desired level of utmost safety to their patients. They are that final line of defense in preventing medication errors and ensuring safety. However, as aforementioned, nurses and providers are humans and humans make mistakes, no matter how many precautions are taken, and it is their duty to immediately notify the healthcare provider when an error was made. Reporting the incident to the proper supervisor should be done without fear of being reprimanded or being judged. It is a teachable moment, and although terribly unfortunate, the admission should be accepted and used to facilitate the teaching of and implementing policy changes or creations. (Dirik et al. 2019) Research shows that oftentimes nurses would rather save face and avoid shame than report the error, but this attitude must be changed for the sake of patient safety going forward. Opening the lines of communication interprofessionally will only increase patient care and decrease mortality rates.

Another main duty to the nurse is patient education. The nurse must teach the patient about the medication he is taking, including what it is, what it’s for, how often to take it, and which side effects are worth mentioning or consulting with the doctor. It’s imperative that in teaching the patient, the nurse use language that is easy to understand and make sure the patient fully comprehended the instructions. (Shitu et al. 2018) When the patient is able to repeat back the medication education he received before discharge, there is less chance of adverse events related to medication administration. Learning about the medicine and how it can help the disease process will fortify the patient with the knowledge that gives autonomy to him to be in control of what is going into his body and when or how.

These medication errors cost the hospitals as much as $40 billion when the mistake causes disabilities, permanent injuries, or long hospital stays. (Tariq et al. 2018) Nurses have the ability to save money for the institution by providing proper and safe medication administration in every single patient encounter. Nurses who follow the six rights of medication administration, triple-check patient identifiers, and even call the doctor when the order seems inappropriate can all potentially save lives.

Stakeholders

Every part of the hospital’s organization is responsible for patient safety. The entire interdisciplinary team can be a part of ensuring patient safety and the highest quality of care. Doctors are responsible for selecting the correct medication for each specific ailment or disease and then they must legibly write out the order or input it correctly and accurately into the electronic record. Pharmacists have to be knowledgeable about drug interactions and possible side effects and must accurately fill the ordered medicine. Nurses are responsible for knowing the medication indications and they are the patient’s advocates when something is amiss. The nurse has the power and right to question the order if it seems incorrect and unsafe. The interdisciplinary communication must be impeccable so that patient safety is not compromised by any breach in that communication.

Conclusion

Mistakes are going to happen in every area of professional and everyday life. Medication errors occur, but must be the consistent target of healthcare education and organizational teaching. It is vital to patient safety to continuously analyze and update information for any or all evidence-based practices that may help to prevent these errors. Medication errors can happen at any part of the communication chain and nurses have to be on alert all the time to help prevent unnecessary misfortune. The healthcare professionals in every discipline must constantly remain on alert to avoid adverse or sentinel events due to errors in the medication administration chain of action.

Resources

Dirik, H.F., Samur, M., Intepeler, S.S., hewison, A. (2019). Nurses’ identification and reporting of medication errors. Journal of clinical nursing 28 (5-6), 931-938.

Gatchel, R.J. (2018). The importance of the profession of nursing in health care: Current and future issues. Journal of Applied Biobehavioral Research 23 (1), e12127.

Jarvill, M., Jenkins, S., Akman, O., Astroth, K.S., Pohl, C., Jacobs, P.J. (2018). Effect of simulation on nursing students’ medication administration competence. Clinical Simulation in Nursing 14, 3-7.

Koyama, A.K., Sheridan Maddox, C.S., Li, L., Bucknall, T., Westbrook, J. I. (2020). Effectiveness of double checking to reduce medication administration errors: A systemic review. BMJ quality & safety 29 (7), 595-603.

Lin, H.L., Wu, D.C., Cheng, S.M., Chen, C.J., Wang, M.C., Cheng, C.A. (2020). Association between electronic medical records and healthcare quality. Medicine 99 (31).

Shitu, Z., Hassan, I., Aung, M.M.T., Kamaruzaman, T.H.T., Musa, R.M. (2018). Avoiding medication errors through effective communication in a healthcare environment. Malaysian Journal of Movement, Health & Exercise 7 (1), 115.

Tariq, R.A., Vashisht, R., Sinha, A., Scherbak, Y. (2018). Medication dispensing errors and prevention. StatPearls Publishing, Treasure Island. PMID: 30085607

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