Medication Administration Project

Background

The concept of medication errors has caught the attention of many scholars. However, traditionally, practitioners have always used the “five rights” approach to medication to protect patients from the effects of medication errors, which includes drug, dose, time and route – although some practitioners add some rights such as documentation and reason to the five rights (Revikumar & Miglani, 2012). Nonetheless, Cisneros (2012) argues that none of these rights resonate to the complexities involved in medication administration within a hospital setting; neither do they consider factors related to human the human nature and operation systems, which is often a focus in healthcare dissertation help.

Against this background, there is a consensus among Tipnis & Bajaj (2013) and Schneider (2012) that whereas nurses and other health practitioners are expected to be perfect in the way they handle all types of medications and that within an understanding and supportive environment they are able to acknowledge their mistakes and learn from them, the paradox is that it is unrealistic to expect an error-free performance environment.

Hence, it is reasonable that nurses must be able to understand their professional responsibilities towards medical administration, and how they can perform to abate these errors. Having said so, Benner et al (2002) observe that it is the professional responsibility of nurses to report any errors or mistakes they perform during medication administration if at all they intend to learn from their mistakes. It can be argued that when nurses learn to report their mistakes, they are able to ensure a safe environment for patients and improve their practice. On the same note, the Institute for Safe Medication Practices (2012) asserts that it is the nurses’ obligation to identify risks, report them and lend a helping hand in developing safer systems. It is also part of their moral obligation and professional duty to so, and failure to perform this duty is tantamount to violation of their professional standards (Institute for Safe Medication Practices, 2012).

Another professional responsibility that nurses have towards medication administration is the duty to be knowledgeable in pharmacology and integrate this knowledge in their practice as part of the effort to ensure patient safety. According to Kessler (2013), having a complete understanding of onset and duration of medication side effects enables a timely administration of medication to ensure that the patient does not experience an accumulation of adverse drug events. Also, being aware of the implications of the administered medications is a critical aspect of improving positive patient outcomes (Schenider, 2012). For instance, furosemide has been prescribed for a patient, it is the nurse’s professional responsibility to check the patient’s potassium levels because due to the potassium-wasting loop diuretic nature of furosemide.

One major problem related to patient care and safety in the context of medication administration is the systems and environment within which medication administration is conducted. According to Revikumar & Miglani (2012), the process of administering medication involves several decision-making points that increase the vulnerability to medical errors. Hence, in a clinical environment where there is inadequate decision-making support, poor checks and balances and over-reliance on manual documentation system affects the ability of the practitioners’ ability to correctly or accurately interpret the medication orders. This goes against the nursing principles of non-maleficence, which requires all practitioners to always strive not to harm the patient either consciously or non-consciously (Tipnis & Bajaj, 2013).

Why Elderly Patient Wards?

The elderly wards are of specific interest for this project due to the predicted shift in demographics. According to United Nations (2013), there is a trend of aging global population, and it is expected that by 2030, the number of aged people above 65 years old shall have reached 71 million compared to 35 million a decade ago. Similar statistics are quoted by Centres for Disease Control and Prevention (CDC, 2003) who notes further that by 2050, there shall have been an increase in global life expectancy by 10 years compared to the life expectancy level in a decade ago.

In light of this predicted demographic shift, it is expected that there will be an increase in multimorbidity (i.e. the occurrence of two concurrent chronic medical complications within one patient). Current statistics by Salive (2013) indicate that approximately 81.5% of adults aged 85 years or above encounter multimorbidity contrasted with 62% of people aged 65-74 years. But, according to Steinman et al (2006), the fact that multimorbid patients are prescribed more medication at a time exposes them to more risk of inappropriate drug administration, inappropriate prescription (Steinman et al, 2006), drug-disease interaction, drug-drug interaction Goldberg et al (1996) and adverse events. All these adverse side effects are interlinked. Hence, from the above statistics, we can extrapolate that there is likely to be an increase in problems associated with medication administration among the elderly if appropriate measures are not taken to address the issue. This project, therefore, focuses on the elderly wards as part of the solution to address medication errors in their treatment.

LITRATURE REVIEW

Manual methods of administration of records are usually more prone to the errors

The incomplete or inaccurate medical records for the patients usually represent the most common administrative errors (Armstrong et al, 2017). For instance, documenting or filing the information on the incorrect file of the patient and through poor documentation which can easily result to the gaps within the records of the patients. The gaps can highly be prevalent within the systems of health care in which the records that have been handwritten becomes predominately over the electronic records though they still have the issues on administration. According to Revikumar and Miglani, (2012), the lapses found in the confidentiality of patients which are related with the patient’s administration records are described; for instance, the medical or personal details on the history can be provided to the others mistakenly or even overheard with the parties and not the patient.

There could be the fragmentation of the records of the patients while at the individual practice in the clinic. The various members of the care teams can easily record the data from different areas and may not be able to read the notes from each other as indicated by Tipnis and Bajaj, 2013. In case therefore, computerizing the records may assist with the legibility, even though the electronic design system of recording may result to other different problems for example the delay of the accessibility of the crucial information. The information volume that is available within the system may lead to difficulty in reviewing the information through timely and comprehensive manner.

Difficulty with the communication that has been recorded manually which features prominently. The studies have reported that the illegible and the messy or unclear prescriptions contribute to the errors in the manual records by the administration. The errors through transcription have been reported especially by the omission or errors of extra doses that have been caused apparently by other people’s errors in records while they are writing the prescriptions and the medication to be administered by the patients (Latimer et al, 2017).

The higher workload that has been linked to the poor staffing which result to the manual administrative errors, therefore, are in relation to the decisions of the organization regarding the recruitment. Several data made concerning the workload usually comprises the description briefly having the limited evidences that suggests the etiology or whether the combinations with the other different causes for example inexperience results to the errors.

Manual administration records utilizes large amounts of paper

The documentation in nursing is the significant indication of the effective delivery of patients. The documentation in hospitals can be done by different ways for instance the use of paper based method. Despite any method that has been used in the record of information by the nurses, the documentation by the nurses should be conducted at a very high standard so that the delivery to the services of healthcare can remain safe and of high quality (Wise, 2018). The higher quality for documentation by the nurses is required in all areas of healthcare systems. It has been considered most importantly by the nurses to take responsibility for ensuring that there is continuity for the effectively care for the patients and also for improvement of the outcomes by the patients. The nurses who are the larger group within the healthcare systems usually play very important roles in all the areas of work improvements within the organizations of healthcare. The nurse’s roles demand the documentation and management of patient’s information by coordination of the patient’s care and also communication by the rest of interdisciplinary members.

The documentation that is paper based has been believed to have not met the standard requirements for communication and documentation among the providers of healthcare since it consumes a lot of time, inaccurate and repetitive. The problems always arise especially when the nurses are attempting to get the information in the records that are paper based, because it has been considered very intensive in terms of labor. The increase in larger amounts of information to be stored in the data makes it difficult to manage the information, assembling and most importantly, very difficult while providing the required care for the patients. For instance, when collecting the data from the hospitals for the purposes of administration or research. The findings by Salive, (2013) show that the observable time span and the destination discharge date are able to be gathered especially from the discharge or the transfer records in the wards, the handover records for the nurses, inpatient paper based records, observation directly by the personnel’s who are highly experienced and the 24hour key personnel recall within the hospital for example the manager for the nursing unit (Griffiths, 2017). Therefore, it is indicated to be a method that is intensive in terms of time consuming when collecting the data and has proved to be very difficult for funding in recent environment in which funding of the researchers have increasingly becomes very competitive.

The manual administrative records by the nurses utilize the larger amounts of paper and hence, would need the additional employee who can support and handle the paper files and also organizes the documents that are countless. The findings by the United Nation, (2013) reveals that, the nurses use the medical store of medical paper records within larger warehouses which have been filled by the papers. The paper records usually fill up the space, the paper records can also deteriorate after a long period of time. For instance, the physicians that usually keep their records on medicine in the houses would require these records so that they can be scanned, faxed and mailed which is a process that consumes a lot of time.

Sloppily written records result to the legibility issues

In the past centuries, the doctors used to scribble notes so that they could keep their own records of medical history for their patients and could only be seen generally by the doctors themselves. Currently, the doctors have become no one man bands. Considering the dozens provided by the rest of professionals, the doctors have become but one the element to the larger and multidisciplinary team within the healthcare sector (Cisneros, 2012). The consequence for the particular expansion indicates that the scrawls that are illegible, composed hurriedly by the rushing doctors are being presented for the colleagues that are having no or little qualifications of cryptology. The journal written by Learpe and Berwick reveals that, the research audit by surgeons done for the approximately 40 legibility of randomly notes that are operative obtained from the wards of orthopedic within the largest hospital in British. Two of the physiotherapists, two of the nurses and two of the officers from the medical house were requested so that they could rate the doctors’ and nurses’ notes legibility for example; excellent, good and poor. Out of the total number of the doctors’ notes, an estimate of 24% rated as excellent or good and 37% were rated as being poor.

According to the team members within the healthcare systems, the deciphering of the notes may lead to the a nuisance which sometimes require the help of the colleagues, for instance, if the signature used is legible and present, the call can be made to the doctor. Often, names are not usually left in these forms (Kessler, 2013). The frustration and considerable time that would be required to perform the work by using the detectives would be far that outweighs effort required to just cross letter “t” and dot the letter “I”. The doctors or nurses try so that they are able to take short time through quick writing which is a falsely economy.

The handwriting that is illegible within the medical records may result to the adverse implications which are medic legal. It indicated by Stephens that the admissions that are few may appear most damaging than the physicians that admits that they are unable to read what they have written. According to Schneider, 2012), it is indicated that from the perspective of the patients, the handwritings which are illegible may delay the treatment which result to the unnecessarily tests followed by the unrequired doses there by leading to either discomfort or death. Bad handwriting results to the undoubtedly inconvenient truth for example high incidences in Britain through the error in medicine that has been estimated to causing several deaths ranging up to 30000 individuals every year (Abramson, 2015).

The handwriting that are illegible can result to wrong administration route, dosage and dispensing of wrong drugs. Also, it can lead to the undue treatment delay as result of the sloppy handwritings by doctors. There have also been instances in which some nurses of staff find it very difficult for reading the orders provided by the doctors and therefore, they administer wrong doses and routes that are incorrect which can result to the death of the patients (Puaar and Franklin, 2018). According to the report by the National Academies of Science’s Institute of Medicine (IOM), the controllable mistakes in medication usually harm about 1.5 millions of Americans yearly. Most of these errors are caused by the abbreviations that are not clear and the illegible writings obtained from the prescription of about 3.2 billion being written from hospitals in US yearly.

The drug inadvertent substitution usually takes place within the doctor’s institutions because of the combination between the handwriting by the physicians which are illegible on the prescriptions. Also, it can result from the misinterpretation by other staff within the healthcare system. According to Steinman, (2006), those having the illegible and poor handwriting are supposed to be aware that other colleague doctors have not expertise to the cryptology therefore, the other members within the healthcare must undergo serious frustrations and also waste the better part of their time as they try to decode the scratches in prescriptions. Similarly, reports have shown that the pharmacists usually make errors which results from the sloppy writing records leading to the legibility in prescription. Therefore, communication occurring between the pharmacists and physicians is very important for controlling the errors from dispensation as a result of poor legible prescription.

References

• Abramson, E. L. (2015). Causes and consequences of e-prescribing errors in community pharmacies. Integrated Pharmacy Research & Practice, 5, 31-38. Do: 10.2147/IPRP.S64927
• Armstrong, G. E., Dietrich, M., Norman, L., Barnsteiner, J. & Mion, L. (2017). Nurses' perceived skills and attitudes about updated safety concepts: Impact on medication administration errors and practices. Journal of Nursing Care Quality, 32(3), 226-233. doi: 10.1097/NCQ.0000000000000226
• Benner P, Sheets V, Uris P, Malloch K, Schwed K, Jamison D. Individual, practice, and system causes of errors in nursing: a taxonomy. J Nurs Adm. 2002;32(10):509–523.
• Centers for Disease Control and Prevention (CDC) Trends in aging – United States and worldwide. MMWR Moro Mortal Wkly Rep. 2003;52(6):101–104. 106
• Cisneros R (2012) Medication Errors. Leon Shargel, etal., Comprehensive Pharmacy Review, 7thedn, Lippincott Williams and Wilkins, 499-506.
• Goldberg RM, Mabee J, Chan L, Wong S. Drug-drug and drug-disease interactions in the ED: analysis of a high-risk population. Am J Emerg Med. 1996;14(5):447–450.
• Griffiths, M. (2017). Standards help to keep nurses and patients safe: The NMC is consulting on plans to withdraw its standards for medicines management. Nursing Standard, 31(47), 30-30. doi: 10.7748/ns.31.47.30.s26
• Institute for Safe Medication Practices. Just culture and its critical link to patient safety (Part I). ISMP Medication Safety Alert! 2012.
https://www.ismp.org/Newsletters/acutecare/showarticle.aspx?id=22
• Revikumar KG,Miglani BD (2012) A Text Book of Pharmacy Practice. Career Publications, 191-232.
• Kessler JZ (2013) Medication Errors. Linda Y. Fred, Manual for Pharmacy Technicians, 3rd edition, American Society of Health-System Pharmacists 325-355.
• Latimer, S., Hewitt, J., Stanbrough, R. & McAndrew, R. (2017). Reducing medication errors: Teaching strategies that increase nursing students' awareness of medication errors and their prevention. Nurse Education Today, 52, 7-9. doi: 10.1016/j.nedt.2017.02.004
• Salive ME. Multimorbidity in older adults. Epidemiol Rev. 2013;35(1):75–83.
• Steinman MA, Landefeld CS, Rosenthal GE, Berthenthal D, Sen S, Kaboli PJ. Polypharmacy and prescribing quality in older people. J Am Geriatr Soc. 2006;54(10):1516–1523.
• Schneider P (2012) Medication Errors.Edited by Parthasarathi G, Nyfort-Hansen K,Nahata MC. A Text Book of Clinical Pharmacy Practice, Essential Concepts and Skills, 424-441.
• Tipnis HP, Bajaj A (2013) Hospital Pharmacy.Chapter 13, Safe Use of Drugs, Career Publications, 229-241.
• United Nations . World Population Ageing 2013. New York: UN; 2013.
• Puaar, S. J. & Franklin, B. D. (2018). Impact of an inpatient electronic prescribing system on prescribing error causation: A qualitative evaluation in an english hospital. BMJ Quality & Safety, 27(7), 529-538. doi: 10.1136/bmjqs-2017-006631
• Wise, J. (2018). Government takes steps to reduce annual burden of medication errors in england. BMJ (Clinical Research Ed.), 360, k903. doi: 10.1136/bmj.k903 Xu, C., Li, G., Ye, N. & Lu, Y. (2014). An intervention to improve inpatient medication management: A before and after study. Journal of Nursing Management, 22(3), 286-294. doi: 10.1111/jonm.12231