Understanding Medication Errors in Healthcare

Introduction

As defined by the National Health Service (NHS) medication error is a kind of preventable event that leads to the inappropriate medication use and serious harm to the patient (NHS, 2019). Medication is under the control of the healthcare professionals and senior officials in healthcare authorities. Medication error is serious concern in now-a-days which is associated with the negligence of health professionals, lack of professional practices, poor health care procedures and system (Keers et al. 2015). Report from the World Health Organisation (WHO), a medication error is associated with the inappropriate prescribing, product labelling, nomenclature, dispensing, compounding and distribution (WHO, 2019). This research paper is going to highlight the research question: “What are the causes of medication errors on hospitalised Patients?. With applying relevant literature, this research conducted the overall secondary research in order to analyse the finding regarding the cause of the medication errors on hospitalised patients. This research paper has used PICO Tool in order to frame the research questions and analysing the different elements such as problem, intervention, comparison and outcomes. Moreover, this research paper has also used the PARIHS framework in order to represent overall search strategy based on which the revenant articles have been selected. Through using CASP tool, this research has represented the limitations and strengths of the research articles, which may assist those seeking healthcare dissertation help.

Research questions:

Rationale:

The rationale behind asking this research question is to analyse the appropriate reason behind medication errors in hospitals and its overall impact on hospitalised patients. In today's fast-paced medical world, medication error is one of the greatest global concerns, which not only affect the overall health care system in different countries but also raise doubts on the integrity and proficiency of the medical professionals. The recent report from WHO on medication errors shows that in the UK more than 237 million cases of medication errors occur in the NHS England [WHO, 2019]. Moreover, the report also shows that medication errors lead to be Avoidable drug Reactions (ADR), which is one of the leading causes in several deaths in UK based hospitals. Moreover, a researcher in New York and Manchester have shows that, more than 712 death occurs in each NHS hospitals each year due to the ADRs , which is one of most common outcomes of medication error. Therefore, it is high time to determine the possible cause behind the ever-increasing rates of medication errors in the hospitals. Through framing the research questions, research is not only able to highlights the reason behind the medication errors but able to successfully identified the impacts of these medication errors on the health of the hospitalised patients. Moreover, chasing and framing of this research question assist the researcher to recommend the proper tactics and strategies in order to reduce the medication errors in hospitals.

Lack of evidence:

Although research has selected relevant literature by using the PRISMA Tool, there are some limitations and lack of evidence in the literature. Moreover, although, most of the literature assists the researcher in order to answer the research question in well-organised to met research criteria, there is some literature which has some limitations. In order to combat this type of issues, research has selected only authentic database from the relevant literature in order to meet the research aim and objectives.

Formulation of research questions: (Using PICO Tool):

PICO Tool is an evidence-based model which is used by the researcher in order to frame relevant questions for assessing, analysing and evaluating the database. In PICO Tool there are four important elements such as Population/problem, Intervention, Control and Outcomes. By analysing these four elements, the PICO model researcher is able to answer healthcare related questions. In this researcher has used PICO Tool in order to analyse the above-mentioned four elements of research questions in order to answer it properly. Moreover, through using this tool, here the researcher is able to develop proper literature search strategies. Application of PICIO Tool in this research has assisted the researcher to analyse the actual problem that eh research is going to analyse, the intervention or strategies that are important for dealing with this issues, the outcomes that the research was expected to achieve through completion of this research.

Research aim:

This research aims to determine the actual reason behind the medication errors in hospitals patients. Moreover, this research also aims to highlight the important strategies and tactics that need to be used by hospitals for reducing the rates of medication error.

Research objectives:

To determine the reasons behind medication errors in hospital patients

To analyse the strategies that can be used by the hospital’s in order to reduce the increasing rate of medication errors in the hospitals

Methodology:

Searching of literature (Using PRISMA Tool):

In this search, strategy researcher has used the PRISMA tool. This tool has been used by the researcher in order to select relevant literature for meeting the research objectives. This tool assists the researcher to search relevant literature by searching through using the key terms. Through using this process, the researcher is able to short out the relevant articles based on the inclusion and exclusion criteria out of the total articles (722 words) that are initially selected. (Refers to appendix 1) A search of the following databases was undertaken to retrieve relevant articles for the study that would help to answer the research question: Psycarticles, Psycinfo (that provided professional articles), Medline (supplied bibliographic articles), CINAHL (provided acceptable, extensive, reliable and accurate source of articles related to nursing) and British Education Index. Boolean operators AND or OR were used (Fink 2014) "hospitalised patients" OR patients AND "medication errors" OR "drug errors" AND causes were used to search these databases. Boolean operators were used to narrowing the search (Gough et al., 2012,)(Vincent Icheku pg 48). The search generated a total of 722 articles. The following exclusion and inclusion criteria were used to reduce the number of articles. Articles published between 2009 and 2019 to be included and this reduced the number to 470 articles. Then only full-text articles inclusion was applied resulting in the number of articles reduced to 115. The only academic journals inclusion criteria were applied which helped to reduce the number of articles to 95 and when language was set to English, the number reduced to 91. Out of 91 further 77 articles were discarded after reading through their titles and abstracts. Finally, 14 articles were read through and 7 were selected to be reviewed for the assignment and the other 7 were used as supporting articles

Search terms:

Exclusion and Inclusion Criteria:

Inclusion criteria:

In searching the relevant literature researcher have used the following inclusion criteria:

The articles would be selected based on their appropriateness and relevance to the research topic

The selected articles should contain authentic and relevant information that will assist the researcher to meet the research outcomes. (2014-2019)

Articles that are published in less than five years would be selected for the research

The articles that are going to be selected would be fully accessible

Exclusion criteria:

Non-English articles and journals should not be selected for the research

Articles that are published before 2014 cannot be selected for the research

Articles and journals that have irreverent and vague information that cannot be used for this research cannot be selected by the researcher

Articles and journals that are not fully accessible cannot be selected by the researcher

Result of search strategy:

By using the PRISMA Tool and the search terms, the researcher is able to select 7 relevant articles that assist the research to answer the research questions. Findings of this research process also assist the researcher to meet the research objectives and research aims. [Refers to Appendix 3] Based on the table that is given in Appendix 2, it can be stated that the overall findings of the entire research process show that medication error is one of the greatest concerns. Moreover, by using the revenant literature it is possible for researcher to find out the appropriate cause of medication error in the healthcare system which leads to different health issues and deaths in the hospitals. Moreover, the table also shows the strength and limitations of all the selected literature in order to highlight are issues that are faced by the researcher in order to meet the research outcomes. Patel et al. (2018), has investigated the cases of Medication Errors (ME), in Tertiary Care Hospital. Then finding suggests that there are different categories of medication errors in hospitalised patient of general medicine wards and surgery wards. Moreover, the findings from these articles also suggest that use of Antimicrobials is categorised understand the major class of medication error that leads to severe health issues even death in a hospitalised patient in the general medicine wards. In this aspect, Christensen and Lundh (2016) mentioned in their article that, in order to reduce the medication errors, it is important to find out the proper cause behind these errors. The article also finds out that, there are some common types of medication errors such as inappropriate use of anaesthesia, antibiotics and painkillers. The funding from this article shows that the reason behind the medication errors in hospitalised patient are inappropriate prescribing, packaging, labelling, dispensing and distributing if drugs. On the contrary (Patel et al. (2018), argued in their articles that except the inappropriate prescription and poor manufacturing process of the drug, there is another important reason behind the medication errors in, lack of administration in healthcare and poor professional standard of health professionals.

According to Keers et al. (2015), most of the hospitals in the UK face high rates of Intravenous Medication Administration Errors (MAEs). The finding from this articles shows that one of the most important reasons behind the MAEs in most of the NHS hospitals in the poor prescribing format used by the health professionals. In most of the cases, NHS nurses confuse the prescribed medicine with another one due to using obscure handwriting. This causes the high rates of medical errors in the hospitalised patient in the emergency department. In this aspect Lertxundi et al. 2017 has mentioned in their articles that, the patient admitted in emergency wards with Parkinson’s disease faces the health issues due to medication errors made by nurses. Moreover, the research articles also point out that, an important reason behind medication errors is using the inappropriate scientific name or nomenclature of drugs, use the poor handwriting the prescription and lack of proper communication r by Health professionals about the use of the drug with nurses. From the article by Bos et al. (2017), it is found that most of the prescription errors are due to prescription errors. Majority of the cases ion medication errors, healthcare professionals use the name of inappropriate medicines or drugs, which leads to developing of health issues, even death. Moreover, the articles also find out that, one of the most important methods in reducing medication errors is the betterment of education to the prescribers, through educating the prescribers it is possible to minimise as well as eliminate the cases of mastication error in hospitals patient. For this reason, it is importunate for healthcare authority to provide high-quality training and education t the healthcare professionals about how to use the prescription in a well-organised manner to avoid any kind of mistakes/. The Article written by Kaufmann et al. (2015) provides important knowledge about multi-dimensional issues associated with drug errors. Based on the finding collected from this journal, drug errors is one of the most common issues that today's medical world faces due to several causes such as prescription errors, poor skill and professional knowledge of prescriber, poor communication between the nurse and health professional and inappropriate nomenclature, manufacturing and labelling of drugs. In this aspect Saedder et al. 2016) mentioned that, in order to determine the high risk of medication error it is important ti determine the root cause of the issues. Based on the finding of this articles it can be stated that, low skilled nurses, lack of skill of prescribers, poor communication in the healthcare system, negligence of drug manufacturers and packages and lack of sincerity if the health professional and nurses are the root causes behind drug error in hospitalised patient. Moreover, the finding also suggests that, in order to reduce the drug errors, health care authority needs to improve the overall administration process and training as well as education to doctors and nurses in order to use appropriate medications for promoting their integrity.

Quality appraisal: (using the CASP Tool):

Researcher has used Critical Appraisal Skills Programme (CASP) tool, in order to analyse and evaluate the quality of each research paper that is selected for this research. CASP tools assist researchers in this research for critically appraise the selected research evidence accordingly. Through using this tool, the researcher is able to analyse the strengths of each research paper that are highly useful in order to meet the research aims. On the other hand, by using the CASP tool checklist, the researcher is also able to determine the limitations of selected research papers that have created bias or issues for the researcher in order to meet the research outcomes. The entire appraisal of each selected research paper is given in the appendix. [Refers to appendix 3]

Summary and synthesis of the paper:

Through analysing the findings of selected literature, the researcher is able to make some relevant and appropriate themes that have assisted this research to describe the proper answer of the research questions. Through identifying as well as evaluating each theme, the researcher is able to represent the comprehensive discussion on the overall research topic. According to (), thematic analysis is important for conducting secondary research. In this research, the researcher has successfully identified and discussed relevant themes in order to generate appropriate insight into data making the process for presenting enriched and valuable evidence in this study.

Theme 1: Determining medication error in hospitalised patient is associated with identifying its nature, frequency and outcomes:

World Health Organisation has defined medication error is any of preventable situation that is occurred due to use of inappropriate medicines unintentionally which leads to developing of health issues, even death in patients (WHO, 2019). Recent evidence shows that, in order to determine eh actual reason behind the medication error, it is important for the investigators to identify the nature and frequency of the outcomes. Patel et al. (2018) mentioned in their research articles that the nature of outcomes due to the medication errors is different for different types of patient. In some cases, mediation errors lead to mild health issues which can be preventable, on the other hand, in some cases the medication errors lead to chronic health disorders that can lead to death. In this research paper, 427 patients have been selected for detecting medication error and determining the frequency of this situation. From the analysis of the result, it is seen that medication errors have been identified in 196 cases (45.9%). In order to determine the nature and frequency of medication errors in positive cases, the researcher has seen that most of the medication errors occur in the age of 41-60 years (34%). Moreover, this research paper also shows that most of the medication error that happens with 196 cases is prescription errors (70%). This article also represents that, the other medication errors such as administration errors, lack of communication and proper professional standard of prescribers. On the contrary, Christensen and Lundh (2016) argued in their research paper that, in order to detect the actual cause of the medication errors medication review is important, that can reduce the of morbidity and mortality cases. Moreover, the articles also suggest that, through medication review, health professions and medication instigators can easily determine what type of drugs have been used for hospitalised patients. Moreover, through conducting the proper medication review, investigators also can determine the severity of the outcomes of this medication error. Moreover, Christensen and Lundh (2016) also started in the research paper that, through conducting a proper medical review, it is possible to make a systematic assessment if the pharmacotherapy for the individual patient. The medical review process also assists clinical official in evaluating and improving the quality of prescribing and preventing medication errors.

Theme 2: Different factors and causes are associated with medication error:

The recent report by the World Health Organisation (WHO) on drug errors shows that, in most of the NHS hospitals, the patient suffers from medication errors that are associated with prescribing errors and administration errors. According to Patel et al. (2018), the study of medication errors in Tertiary Care Hospital shows that most of the meditation errors (70%) occur due to prescribing errors. Moreover, the administration errors are associated with the cases of medication errors (196 patients) that have been identified in n this article. According to NICE (National Institute of care and Excellence), prescription errors are the unintentional event which occurs due to the inappropriate prescribing decision and poor prescription writing process. On the contrary Keers et al. (2015) argued in their article, not only the prescribing errors but also there are other important factors that lead to Medication Administration Errors (MAEs) in NHS hospitals such as poor support to the NHS nurse, poor skill and efficiency of nurses, severe workload in the emergency wards and shift changes. These factors are associated with frequent negligence in providing proper medication to each hospitalised patient. Moreover, the articles stated that, after prescribing the proper medicines, it is the responsibility of nurses to understand follow the appropriate procedure of providing timely medicines to each patient. However, the above-mentioned factors enhance the chances of negligence, lapses, inappropriate use of medicine by NHS nurses in emergency wards. In this context Bos et al. (2017.) mentioned in their article that, prescribers’ education and the professional standard is one of the important aspects that need to be considered during identifying causes of medication errors. Through conducting research by using 8 relevant articles thus research articles have concluded that poor and low skilled education level of the prescriber is potential reason behind occurring prescription errors and adverse drug events. In order to deal with prescription errors, it is important education and train prescribes in hospitals. Moreover, through conducting a proper assessment process, it is possible to evaluate the efficiency of prescriber which will assist the prescribers to improve their prescribing methods in order to reduce the medication errors.

Theme 3: Medication errors have adverse outcomes that are associated with increased rate of mortality and morbidity in hospitals:

A medication error is one of the greatest concerns in today's medical world. Based on the recent report of the World Health Organisation, it is seen that, in the UK, most NHS hospitals are reported to have cases of several health issues and death due to medication errors. The common impact of medication errors in a hospitalised patient is adverse health condition such as fever, irregular heartbeat, abnormalities in lung function, mental instability and loss of remembering ability. As mentioned by Lertxundi et al. (2017) in their article, medication errors in the treatment of Parkinson's disease (PD), leads to an adverse impact on the overall health condition of the hospitalised patient. In this research article, it has been shown that out of 1628 hospitalised patients suffer from PD, half of the patient have the prevalence towards higher mortality. Use of inappropriate doses off PD medicines, affect directly on the brain function which not only leads to further loss of mental stability but also reduce the functioning ability of different organisation such as lung, heart and pancreas in the body. This article has shown that inappropriate antipsychotic administration is associated with the adverse health condition of the hospitalised patients. In this context Keers et al. (2015) mentioned in their article that, intravenous medication administration errors in the NHS hospitals lead to severe mental and physical disorders in the hospitalised patient. They stated that that poor knowledge and skill of the nurses’ make them unable to use appropriate medicines and therapies for the hospitalised patient which is the main causes behind the increasing rates of Medication Administration Errors (MAEs). In this article, researchers have conducted an interview of 20 NHS nurses in order to record their own opinion regarding the cause and outcomes of increasing rates of MAEs in NHS hospital. By analysing the database that is collected through the interview, it can be stated that MAEs are associated with improper function of heart, lung and respiratory organs, metabolic disorders, abnormal and irregular thinking ability and poor decision-making process. On the contrary Saedder, et al. (2016) argued that, apart from the health issues and mental disorders that are preventable, one of the major outcomes id medication errors unpreventable damages into a body that put the individual into high risk of disease prevalence. This article stated that detection of medication errors in hospitalised patients show that, majority of patients have severe unpreventable health issues that expose them to chronic diseases such as bronchitis, lung infection, pancreas infections and diabetes.

Theme 4: Important measures and strategies need to be applied in order to reduce the impact of medication errors:

According to Christensen and Lundh (2016), medication review is one of the most important strategies in reducing the rates of medication errors in hospitalised patients. Based on this article it can be stated that, through conducting proper medication review it possible for the medical investigators to identify the actual causes and outcomes of drug errors through medication review, investigators can check what type of medicines are used for patients and whether medication that is provided to are given according to their health situation. On the contrary Bos et al. (2017) argued that in order to reduce the medication errors in the hospitalised patent it is important to educate prescribers in a proper manner. Based in this articles, most of causes of medication errors occurred due to inappropriate prescribing process used by the prescribers, moreover, prescriber’s poor skill and professional level also affect the prescribing technique and prescription writing styles, therefore, in order to reduce the cases of mortality and morbidity due to medication errors, health authority needs to conduct proper training and education for prescribers in hospitals. Proper education and training will assist prescriber to get proper knowledge about how to write the prescription inappropriate manner which can be understood by all professional and health staffs. Another important process in reducing medication error is improving the skill, efficiency and education for nurses. Keers et al. (2015) mentioned in their articles that most of the education administration errors occur due to negligence and poor skill of nurses. Nurses in NHS hospitals have to face lack of training education, support and proper working environment which make them highly irresponsible and inattentive towards the work. Therefore, in order to reduce the medication errors along with education to prescribers and health professions skilled development of nurses in also requires.

Issues in Implementation:

PARIHS (Promoting Action on Research Implementation in Health and services) framework assist the researcher to implement the overall research into practice. In this research, researcher has used the PARIHS framework, in order to evaluate three different factors such as evidence (E), facilitation (F) and Context (C). This framework assists the researcher to implement the overall research evidence into practices in order to meet research objectives. Through using this framework, the researcher is also able to analyse whether the evidence is relevant for implementing into practice proper manner. Here researcher has used on the table in order to depict the entire implementation process by using his framework. [Refers to appendix 4]

Recommendation:

In order to reduce the medication errors following strategies should be taken by the healthcare authority:

Improving eh overall administration of the medication system and prescribing methods in hospitals

Conducting regular medication review process, which assists the health investigators to identify any risk factors associated with used and delivery of medication

Educating prescribers and nurses in order to improve the overall drug delivery process

Conducting proper support, positive environment and regular training program for nurses

Improving the overall communication process between nurses and health professional to improve the information sharing process regarding medicine delivery system

Conclusion:

From the above mentioned discussed it can be concluded that medication errors are a preventable event which occurs due to inappropriate medication use for the patient which leads to the development of several health issues, even death inpatient. In order to determine the actual cause behind the medication errors, it is important to analyse the nature and frequency of the medication errors in the hospitalised patient. There are several factors that are associated with medication errors such as the poor skill of a nurse, lack of education and training to prescribers, inappropriate writing styles and prescribing methods used by prescribers and lack of administration. Increasing rates of medication administration errors (MAEs) in NHS hospitals is due to lack of support, training and professional skill of the nurses. Medication errors, although considered as preventable, sometimes leads to the development of chronic diseases in patients such as lung infections, brain malfunction, respiratory disturbances and metabolic disturbances. In order to reduce the medication errors, it is important to make effective strategies such as education to prescribers, support the NHS nurses, improvement of medication administration in hospitals and improving the communication among the nurse, health professions and patents.

Reference list:

Bos, J.M., Bemt, P.M., Smet, P.A. and Kramers, C., 2017. The effect of prescriber education on medication‐related patient harm in the hospital: a systematic review. British journal of clinical pharmacology, 83(5), pp.953-961.

Christensen, M. and Lundh, A., 2016. Medication review in hospitalised patients to reduce morbidity and mortality. Cochrane Database of Systematic Reviews, (2).

Kaufmann, C.P., Stämpfli, D., Hersberger, K.E. and Lampert, M.L., 2015. Determination of risk factors for drug-related problems: a multidisciplinary triangulation process. BMJ open, 5(3), p.e006376.

Keers, R.N., Williams, S.D., Cooke, J. and Ashcroft, D.M., 2015. Understanding the causes of intravenous medication administration errors in hospitals: a qualitative critical incident study. BMJ open, 5(3), p.e005948.

Lertxundi, U., Isla, A., Solinís, M.Á., Domingo-Echaburu, S., Hernandez, R., Peral-Aguirregoitia, J., Medrano, J. and García-Moncó, J.C., 2017. Medication errors in Parkinson's disease inpatients in the Basque Country. Parkinsonism & related disorders, 36, pp.57-62.

Patel, S., Patel, A., Patel, V. and Solanki, N., 2018. Study of Medication Error in Hospitalised Patients in Tertiary Care Hospital. Indian Journal of Pharmacy Practice, 11(1), p.33.