Prevention of medication errors made by nurses in clinical practice

HEALTH SCIENCE JOURNAL® Volume 6, Issue 4 (October – December 2012)

_SPECIAL ARTICLE_

Prevention of practice

medication errors made by nurses in clinical

Efstratios Athanasakis Nursing Student, Alexander Technological Educational Institution, Thessaloniki 1.

ABSTRACT Background: Medication administration to patients is a part of clinical nursing practice with high risk of errors occurrence. The causing factors of medication errors are either individual or systemic. In order to prevent errors before, the establishment of protective measures is pivotal. Purpose: To explore the protective measures taken by nurses to prevent medication errors in clinical practice. Method and material: A search of Medline, Science Direct and Cochrane Library was conducted to retrieve literature published from January 2000 until August 2011. Results: The protective measures against medication errors are related with the preparation and administration of medications, the dosing calculations skills of nurses, the nursing education, the oral medication orders, the interdisciplinary collaboration, the manager nurses and changes in health systems’ issues relevant with medication management. Conclusions:

This review paper

summarizes the preventive measures of medication

errors made by nurses. As it is obvious, there is a plenty of factors that need to be applied

in

health

units

to

succeed

low

medication

error

rate.

Because

of

the

significance of the subject, further research is warranted to prove the effectiveness of every measure in the prevention of medication errors. Key words: Medication errors, prevention, nurses. CORRESPONDING AUTHOR Athanasakis Efstratios, str Imvrou 9, Pilea, Thessaloniki, Greece, Post code: 55535, Tel: +306974992897, E-mail:

[email protected]

INTRODUCTION

S

afety

during

hospitalization

patient

consists

one

of their rights and also the

E-ISSN: 1791-809X

first

priority

of

health

professionals. Errors that occur during

the

application

Health Science Journal © All rights reserved

of

Page | 773 www.hsj.gr

Quarterly scientific, online publication by Department of Nursing A’, Technological Educational Institute of Athens

medical/nursing interventions or

require

patient

to sustain life.3

hospitalization

drawn

health

have

researchers’

necessary

interventions

Studies that examined the types

attention over the last decade.

of

Errors appearing in the hospital

them in categories, according to

settings

concern

the

incidents

like

use

of

wrong

hospitals

a

lot

falls,

omission

equipment,

sores,

error,

management

of and

errors

description

patients

infections,

situations

of

medication

of

route

event:

wrong

drug

patient

improper

wrong

clinical

error,

wrong

wrong

dosage-form

medication

the

error, wrong

divided

error,

error,

wrong

technique

time error,

error

and

errors. Medication error defined

extra dose error.4 Thus, to avoid

as

any

“any

may

preventable

cause

or

event

that

lead

to

type

of

made

medication

by

nurse,

inappropriate medication use or

implementation

patient

measures

harm

while

the

beneficial.

health professional, patient or

account

consumer”.1

medication

It is estimated that medication

firstly

errors deaths

in

USA

annually.

of

undoubtedly

Nurses

all

the

preventive

is

medication is in the control of

error

taking

into

precautions

for

errors, the

reduce

incidence

of

account

7000

medication errors, maintain the

However,

this

culture

of

safe

estimation represents the number

environment

of

medications management by them.

medication

errors

that

resulted in death. Actually, the

A

possibilities

literature

errors 0,1%.2

to

of

result

Mostly

medication to

death

medication

and

hospital

breakdown

is

protective

errors

medication

of

the

showed

relevant that

measures errors

safe

are

for related

with

the patient, or they reach the

administration

patient but do not cause harm,

the dosing calculations skills,

or

the nursing education, the oral

permanent

required

harm

and

prolonged

hospitalization. Moreover, there are

medication

errors

medication

preparation

the

are identified before they reach

cause

the

ensure

of

the

medications,

orders,

interdisciplinary

and

the

collaboration,

that

Page | 774 Prevention of medication errors made by nurses in clinical practice


the administrative nursing staff

calculations.8

and other measures.

calculator, however, requires

Using

a

knowledge of the existing data Medication

preparation

and

management, the way data will

administration Medication

be

safety

aims

at

the

used

and

the

that are required.

conversions 9

Thus, the

reduction of medications errors

use of calculator will serve

rates,

earlier

as

patient

resolving

the

mathematical

functions

their

identification gets

harm

before

and

their

timely

treatment.5 Preventive strategies of medication errors include the standardization

and

simplification procedures Medication

medication

and

others.

preparation

administration medication

are

parts

procedures,



the

ensurance

of

any

for

various and

special

of

nursing

from pharmacy

to

without needed dialysis

preparation staff

pediatrics require

premixed

or

by

the

(especially

medications

precision

in

that dosage

calculation),11

safe 

the mandatory double-checking

preparation by placing labels

of medication by two separate

(“Do

not

discourage

disturb”,

to

nurses (particularly in high

visitors

to

risk

medications,

which

interrupt the nurse that time)

usually

and also to remind nurses the

adverse events or errors),

importance

of

concentration

during

medication

preparation,

6,7



the

responsible

implementation

rights”

(right

the reduction of distractions

time,

and

preparing

the

interruptions

assistive

calculator

during

use

7

E-ISSN: 1791-809X

for

“five

medication,

of

right

patient)

when

medications

(although this factor focuses of

to facilitate the

resolution

of

are

right dose, right route, right

medication administration, 

tool"

of

further

and

environment for the medication



delivery

nursing wards

which

a

the

medications

involve the follow measures: 

"useful

conversions,10

the

of

a

on individual performance and does

not

reflect

the

the




complexity

of

medication

procedure),12 



all

types

of

medication calculations. Emanuel of

and

medications with similarities

the

either in color or in name, by

in clinical practice, as a duty.

putting a label on them,13

So,

the

apparent

the

separation

preparation

administration

and

of

the

medication

and

the

check

Prynce-Miller, establishment it

if

medication

had been administrated to the

would

nursing

calculation

skills

and

Another

protective

measure

against

medication

errors

of

be

dosing

the

improvement

calculation

skills

through nursing education. This can

make

prepared duties related

nursing for

their

afterwards. to

the

above,

students clinical Directly are

the

mathematical competencies of the students.16

nursing involving

fractions,

Skills decimals

and percents, are examples that complicate

the

easier

for

to

meet

students

nurses,

and

believe

professional

that

what

they

knew was sufficient to calculate of

medication

administration, medication terms and medication abbreviations was

nursing education

to

be

protocols

students

way

consider

of

doses (tablets, injections), the

proper patient.15 Dosing

considered

correctly dosing calculations.19 Both

the same time,14 

thoroughly

application

of

mathematic operations, as Brown

known

almost

from

both

groups.

Subjects in which knowledge was lessen were pharmacodynamics and pharmacokinetics,20 calculation

of liquid

and dilutions.16 assess

that

events

medication those

events

found

unsafe

errors

associated

courses

calculation

56%

of to

and

20%

of

lack

of

with

of

that

for

related

nursing student skills. Attendance

solutions

In a study, to

unsafe

patients,

dosing

21

educational

improve

dosing

skills

through

mathematical tests seems useful.

mentioned.17 The article entitled:

“Clinical

skills:

a

guide

working

out

written

by

practical drug

to

calculations”

Trim,18

analyzed

Particularly, books and books

with

the

provision

exercises

recommendations to

study

are

of

examples of

some

enhancing



students’

skills

Strengthening

nursing

theoretical background

learning.22

of

students’

pharmacological will

help

them

to

these take

actions, place

is

proposed

before

the

to

doctor

hang up the telephone.27,28 Particularly

valuable

cooperation

they will become future nurses.

and pharmacists for establishing

Alongside

policies, strategies and systems

background

is

practice. the

theoretical

At

role

the

this

of

clinical

point

clinical

enters nurses’

that

will

of

doctors,

the

recognize medication errors, as the

of

is

reduce

the

nurses

incidence errors.12

medication

Interdisciplinary

cooperation

educators to teach all required

needs to obtain a comprehensive

skills

view

to

their

students

to

about

the

issue

of

avoid any type of error in the

medication errors, their causes

future.23-25

and

the

way

professional Oral

medication

orders

and

errors.

every

health

faces

care

medication

29

interdisciplinary collaboration Oral

medication

transmitted

by

orders

phone

doctor

to

a

risks.

The

existence

a

concerning

nursing

administrators

are

hiding

There

of

voices

nursing

or noises in the environment of

central

the speakers, the unfamiliarity

of medication errors.30 The head

with

patients’

bad

nurses have strong influence in

phone

connection

way

clinical nurses’ conduct to keep

of

speaking,

nurse

from

Measures

situation, and

are

rapid

some

factors

is

growing

evidence

administrators role

positive

in

the

attitude

that

possess

management

towards

that make communication through

reporting

phone difficult.26 So as to avoid

errors.30,31

errors

head nurses and nurses aims to

in

these

cases,

it

is

important firstly to write down

the

the

beliefs

order,

patients’

then

name,

confirm

medications’

of

the

The

understood of

medication cooperation of

each

creating

of

group

a

safe

environment of health care.32

name, the precise dosing and the

The

reason

minimize phone calls during drug

of

medication

administrate to

the

E-ISSN: 1791-809X

patient.

this All

head

nurses

administration

time


decision

to

(8:30-10:00 Page | 777 www.hsj.gr


am,

8:30

to

10:00

In

the

necessary.7 nursing also

is

offers

duties

of

information

administrators

the

creation

culture

of

patients,

the

managers

to

vigilant treatment the

a

be

medication

nursing



staff



of

each

of

bar

coding

the

design

of

an

electronic

system

for

each

to

derive

essential

information on medications,35

anonymously.

providing

to



nurses

feel

name,

the

and

possibilities

to



about

medication to

(height,



weight,

the establishment of hospital a

service

procedures

involving

the

use

the

which

of

differentiation package

name,

the

but

of with

different

establishment

of

administration

policies,5,12, 

allergies, laboratory tests),34

intranet,

all

medication concentration,37

prevent

the nurses access to patients’ information

opportunities

medication

medication errors include:

of

concerning

similar

errors is essential.30,31,33 strategies

provision

medication

at the success of this reporting information

and

medication,36

report their error. Also, aiming procedure, nurses’ feedback with

pharmacology

educational

makes

comfortable

with

topics

the

their medication errors without their

the attendance of educational programs

By

opportunity of voluntary report mentioning

the increase of patient-nurse ratio in each shift,14

of a system to report medication



use

have access and the capability

Fundamental is the establishment



the

errors



Other

the

clinical setting, where nurses

Other measures

increases

around

of

the

clinic.

them

gathering

details

medication

29

errors

and

access,

technology,1

promote

enable

rapid

patient,11

of

constantly to

all

safety

motivation

that of

of

include

hospitalized

and

conditions by

pm)

25

and the placement of colored labels

upon

medications

syringes, are

when

preparing

in

the operation room.38 A study that examined patients’ perceptions medication

of

the

safety

in

administration,



patients improve The

consider the

two

ways

medication

first

way

is

to

safety.

about

clear that the reduction of all types

of

errors

the

delivery

communication of patient and the

promotes

nurse

hospitalization.

during

administration.

medication

The

second

the

a

nursing

safe

the care,

environment

of

one

is in the same range, but refers after

of

during

medication

administration.39

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