Analyze a Current Health Care Problem 

One of nurses’ many tasks includes medicating their patients around the clock. However, as seen in Assessment 2, patient safety can be severely compromised when medication errors occur. The rights of medication are in place for a reason, and when they are not followed, it directly impacts the patient. Medication errors occur for various reasons including knowledge-based mistakes, and personal factors such as burnout and fatigue. Nurses take an oath to cause no harm and are responsible for patients in their most vulnerable moments, therefore even the most experienced and most knowledgeable nurses, should take their time, and refer to the right of medication administration before every medication pass. This topic is of great importance to me as I am a new graduate nurse and though I am aware mistakes happen, I want to train myself to do everything in my power to prevent them. One of the first lessons taught in nursing school is the importance of patient safety, and medication errors compromise that core principle in health care. 

Elements of the Problem

Research demonstrates that medication errors continue stemming from factors such as the lack of knowledge about drugs being administered, as well as personal factors. Beginning with knowledge-based errors, nurses are required to demonstrate a certain level of competency within their specific unit and specialty. A medication should never be administered by a nurse without knowing what it does, the side effects it could cause, and should be aware of any contraindications.  Author Escrivá Garcia (2019) found that nurses that are responsible for critically ill patients with heavy workloads are not fully educated on the medications that they are ordered to administer. According to Escrivá Garcia (2019), a study done on a specific intensive care unit, was designed to ask nurses a multiple-choice style questionnaire based on medications that would pertain to their unit and everyday practice. The results demonstrated that more than half of the nurses that participated in the study, were unable to answer more than half of the questions. This alarming number compromises the patient’s safety and speaks against the values that nurses have took an oath to abide by. 

Furthermore, research suggests medication errors occur while nurses deal with burnout and fatigue. Healthcare institutions are constantly dealing with nursing shortages, especially after a global pandemic, which is requiring nurses to work mandatory overtime shifts. Part of the problem lies within these healthcare institutions dismissing unhealthy working conditions. Shortages lead to unsafe patient ratios, which may lead nurses to feel overwhelmed and a sense of impending doom. There are reasons why healthcare workers are often referred to as a “team” because everyone should be responsible for pulling their weight. This includes managers to ensure proper staffing for what it is most important in our field of work, patient safety. Researchers discovered that nearly 20% of registered nurses working in hospitals, experience overload, find themselves working extra hours, with unsatisfactory staffing. (Alrabadi et al., 2021). Creating dangerous work environments for both patients and staff is something that should be evaluated if the goal remains to have successful patient outcomes.

Analysis

As a new graduate nurse working in Labor and Delivery, I am required to administer routine medications to laboring mothers. Because this is a specialized unit, and I am a new nurse, my hospital requires I have at least fourteen weeks of orientation to the unit, and classes every month to further educate me in the specialty and being a nurse in general. There have been classes where “near-misses” with medications have been discussed and debriefed. The reason I am bringing up this information is because I am sure my hospital is not the only facility who participates in these practices. That being said, medication errors do happen. It is essential to partake in safe practices all of the time no matter how much experience one may have. Triple checking my medications before passing them has become a staple in my routine, and though it may take me a few minutes longer to complete the medication pass, I am ensuring safety with my patients and protecting my license as a nurse. 

Context for Patient Safety Issues

As mentioned in the previous assignment, nursing has been America’s most trusted profession for twenty years straight. With that, comes a huge responsibility to take care of our patients and keep them safe. With very real and current problems in our healthcare system such as short staffing of nurses, and knowledge-based medication errors, safety is being compromised to new extremes. The writing is on the wall and is supported by evidence in research. As medicine in our country advances, the way medications are administered are also changing, and perhaps are leading to patient safety issues. In a recent quantitative study, Author Justinia (2021) discovered the number of “overrides” for medications totaled to 1087 overrides. 738 were done so inappropriately. From there, 283 inappropriate overrides, and 92 appropriate overrides were sampled, and the medication errors resulted to be 7 to 0 respectively. (Justinia et al., 2021). Most devices used to pull medications have been set up to pull medications in a safe and systematic way however a feature such as the “override” immediately unlocks a recipe for potential disaster as there probably is a reason why the machine did not allow the individual to pull the medication in the first place. Our healthcare institutions should inclusively use evidence-based research in applying safety measures with medication administration, as some factors that create error are simply inexcusable. 

Populations affected by Medication Errors

Patients in critical care situations often suffer from medication errors more than patients on other units. Their acute state of being can often result in high-risk situations, requiring nurses to administer medications they may not be familiar with. Working in stressful, fast-paced situations can lead healthcare workers to rush, placing patients at an increased risk for errors. Areas such as the intensive care unit see many medication errors, as many of the causation factors become compiled, again compromising patient safety. 

Considering Options

With knowing what is at stake, a patient’s life, and reading the research, medication administration errors must be remedied. Strategies that have been evidenced to work include a method that requires units to have a designated supervising nurse overseeing and witnessing the administration of high-risk drugs. These high-risk drugs such as chloride potassium, would have a red label, and be separated from all other medications. (Salar et al., 2020). Nurses are human and humans inevitably make mistakes, therefore having a resource such as a supervising nurse can be that second set of eyes before the drug comes in proximity with the patient.

Next, a study by author Escrivá Garcia (2019) mentioned above, researched a specific ICU unit and the ability of its nurses to answer pharmacology-based questions pertaining to critical care. To further prevent any medication-based errors, nurses should be required to demonstrate competency on drugs they would typically administer daily in their practice. New graduate nurses like myself, should be able to participate in education courses to orient them into the practice of safely passing medications per the facility’s protocol. Education in medicine is essential in caring for our patients and protecting our licenses. 

Additionally, there has been evidence that simply reporting errors, has reduced medication errors in the field. (Mutair et al., 2021). Often nurses are afraid of reporting errors and near misses, as they are afraid of the consequences. Failing to document errors can trigger domino effects, and other nurses may continue to make the same mistakes, constantly compromising patient safety. Creating a culture at work where reporting such instances is encouraged, can help alleviate the fear of perhaps losing your job, but rather saving a life. Institutions can take such errors as learning opportunities and debrief on them using the root cause analysis style to further prevent any potential harm.  

Solution

Being a heavy believer in education, and based on the research presented above, creating a learning environment within the healthcare system can directly and positively impact patient outcomes. This solution can also go hand in hand with creating a culture where reporting errors is encouraged. Instead of reprimanding nurses, educating them on the drugs and debriefing the situation as a team allows for a healthy work environment. 

Implementation and Ethical Implications

Healthcare institutions are often placing changes into the workplace and with that comes backlash from workers who are not willing to change their ways. Sometimes this may cause them to shy away from implementing the changes. However, there should never be any question or debate when it comes to patient safety. Having support from managers, coworkers, and higher ups is extremely important in being successful with change. 

The principles of nonmaleficence and beneficence are embedded around this topic of medication errors as our one of core values remains to not cause any harm to a patient however if medication is not administered properly, this principle would be compromised. It would greatly benefit institutions, nurses and especially patients if they would take this evidence-based practice into reforming the ways medications are administered. Next, autonomy and veracity, which protect our patient’s self-determination, parallel the virtue of being honest. To respect our patients, the standard should be to tell our patients the truth when medication errors occur. As nurses are being educated on pharmacology knowledge as presented in the solution above, they should also be reminded of such principles to utilize in their practice.  Most importantly, abiding by the rights of medication administration will ensure the ethical principles of autonomy, beneficence, nonmaleficence and veracity are being practiced. 

Conclusion

Medication administration is part of the healing process in taking care of a patient. To help a patient, heal safely, proper techniques should be utilized to prevent harm. Errors can occur for various reasons such as not knowing what they do, or unsafe working conditions causing fatigue and burnout. Have designated, assigned supervising nurses on units to witness high-risk medication passes, can be a resource nurses can use to ensure safety. Furthermore, educating nurses and assessing their competencies regarding drug knowledge has previously been found beneficial in decreasing error rates. Finally, creating a culture at work where nurses feel comfortable to report medication errors, can benefit both other nurses, and patients. Actively using evidence-based practice can improve clinical and patient outcomes.

References

Alrabadi, N., Shawagfeh, S., Haddad, R., Mukattash, T., Abuhammad, S., Al-rabadi, D., Abu Farha, R., AlRabadi, S., & Al-Faouri, I. (2021). Medication errors: A focus on nursing practice. Journal of Pharmaceutical Health Services Research, 12(1), 78–86. https://doi.org/10.1093/jphsr/rmaa025 

Escrivá Gracia, J., Brage Serrano, R., & Fernández Garrido, J. (2019). Medication errors and drug knowledge gaps among critical-care nurses: A mixed multi-method study. BMC Health Services Research, 19(1). https://doi.org/10.1186/s12913-019-4481-7 

Justinia, T., Qattan, W., Almenhali, A., Khatwa, A., Alharbi, O., & Alharbi, T. (2021). Medication errors and patient safety: Evaluation of physicians’ responses to medication-related alert overrides in clinical decision support systems. Acta Informatica Medica, 29(4), 248. https://doi.org/10.5455/aim.2021.29.248-252 

Mutair, A. A., Alhumaid, S., Shamsan, A., Zaidi, A. R., Mohaini, M. A., Al Mutairi, A., Rabaan, A. A., Awad, M., & Al-Omari, A. (2021). The effective strategies to avoid medication errors and improving reporting systems. Medicines, 8(9), 46. https://doi.org/10.3390/medicines8090046 

Salar, A., Kiani, F., & Rezaee, N. (2020). Preventing the medication errors in hospitals: A qualitative study. International Journal of Africa Nursing Sciences, 13, 100235. https://doi.org/10.1016/j.ijans.2020.100235