Introduction
Medical errors remain in the list of serious problems that the modern healthcare industry is facing. Notably, the amount of fatal cases that result from not adhering to standards or prescriptions is slightly smaller than 100,000 per year (Saljoughian, 2020, p. 10). Work injuries, vehicle accidents, and AIDS, which many mention among the key causes of human death, statistically are less lethal. In the United Stated, according to Al Mutair et al. (2021), medical errors are the sixth most substantial contributor to mortality rates. The data of this kind determine the need for a thorough investigation on the issue, particularly on its origin and possible solutions.
In fact, the root of mistakes in any industry is the inappropriate organization of the work process. This may involve understaffing that leads to excessive load, insufficient awareness of staff members because of poor communication, ergonomics-related failures, or other. Each of those factors can distract personnel from work and consequently prevent them from fulfilling their duties as appropriate. A reconsideration of the conditions in which employees find themselves actually is sufficient in the vast majority of cases for reducing mistake rates. The purpose of the paper, therefore, lies in identifying and examining the ways in which the organization of workplace can affect the frequency of mistakes that medical practitioners make and offering the necessary improvements.
Capstone Proposal
The project focuses on the incidence and most typical causes of medical errors in the neighboring hospital. The most appropriate title for it “Improving Safety,” which actually corresponds to its main aim. This task is critical because the sense of security is a basement of trustworthy relationships between patients and physicians as well as nurses that, in turn, underlie successful treatment. Meanwhile, American patients report a loss of trust to the national health care system, mostly due to its generally inadequate response to the COVID-19 pandemic (Mensik, 2021). Although this tendency may be temporary, its appearance marks the existence of problems in the sphere.
The primary step to solving the issue is identifying its seriousness, which allows for a more appropriate calculation of the necessary measures. The first project question, therefore, is the degree to which mistakes influence the productivity of the personnel in the given hospital. It is worth noting that the real situation may be difficult or even impossible to estimate since practitioners tend to hide their faulty actions and the consequences of those. Specifically, Paulin et al. (2018) mention that the share of physicians who find it acceptable not to inform their patients on errors reaches a quarter (para. 6). It may be even higher, assuming that not all of the respondents were ready to admit such views.
After assessing the scope of the problem, the question is what solutions are the most relevant and how to implement them. It is possible to split this into several components for convenience, which can serve as a base for the tasks to complete within the project. The first regards the period during which it is necessary to reduce the frequency of errors. The following point is the strategies that would allow for the reduction. Finally, within the strategies, it is essential to identify the necessary measures and assess the ways as well as the expense of their implementation.
Background
The staff of the hospital under review report minor medical errors 10 times a week, on average. The most typical among those are preventable, such as inappropriately long intervals between drug administrations and bruising after injections (Panagioti et al., 2019). Considering the relatively low severity of the problem, it may be possible to decrease the amount twice in half a year, which requires the identification of the causes as the primary step. The analysis has shown that the configuration of the workplace generally is quite proper in terms of comfort, although the personnel complain about insufficiently bright lamps. In addition, there is an apparent scarcity of nurses, and not less than one third of those present are in their first post-graduation year.
As the practitioners are few, each of them has more duties in fact than he or she would do otherwise. Meanwhile, having “many other things to take care of” is the third most frequent cause of mistakes (Bari et al., 2016, p. 525). Even experienced nurses are not necessarily able to bear large masses of information in memory and be maximally careful during procedures, when the intervals between those are excessively short. The stress resistance of most young professionals is lower by definition and, furthermore, decreases with the growth of work intensity. Therefore, they are more probable to forget to administer a medication to a patient or hurry while injecting, which results in bruises.
The problem has several solutions that are possible to realize within 6 months. First, it would be reasonable to hire a certain amount of people with appropriate nursing experience to outbalance the newcomers. This variant, however, presupposes additional investments in waging, hence is acceptable solely if affordable, while the facility actually does not have sufficient finance. Alternatively, its administration could implement mandatory in-house training in a form of experience exchange. Simply stated, those who have done nursing for years could help their younger colleagues acquire and/or boost important non-medical skills, such as concentration.
Objectives
The main goal of the project is to decrease the number of the mistakes that the personnel of the medical facility under review make by two times during 6 months. The steps towards that, which actually form the list of objectives, are as follows. Primarily, to develop a typology of malpractice by its nature as well as consequences and apply it to the case. The next stage is analyzing the causes, which requires a thorough examination of the workplace, the working schedule of the staff, their knowledge, and the intensity of interaction among them.
The outcomes will reveal the existing drawbacks and, consequently, set the direction or directions for improvements. Their function lies in building the “culture of patient safety” in the facility (American Society of Health-System Pharmacists, 2018, p. 1493). This is critical not exclusively in the given hospital, but for the entire healthcare industry since the incidence of mistakes in medical practice has not reduced throughout the ages. Even in developed countries, not less than 1 in 10 patients becomes a victim (Kapaki & Souliotis, 2018, para. 2). The successful implementation of the above culture, meanwhile, is the key to reducing malpractice.
Literature Review
It is worth noting that the understanding of medical errors and the attitude to them has differed throughout the history of medical science. Thus, in the middle of the 20th century, when patient safety actually came into discourse, they were seen as “inevitable diseases of medical progress” (Moser, 1956, p. 606). Simply stated, practitioners considered mistakes unavoidable by definition and, furthermore, regarded them as the payment for new methods of diagnostics and treatment (Barr, 1955). Today, however, the principles of humanism lay the emphasis on minimizing faulty actions. This determines the growing need for exploring their nature and identifying their most common causes, which enables developing reasonable solutions.
Methods of Searching
A literature review was conducted using both electronic and manual resources. The initial step involved collecting information on medication mistakes from peer-reviewed articles whose authors had investigated the topic between 2016 and 2021. The tool for conducting the research was Google Search that enabled scanning multiple writings in a short time frame, hence simplified picking the most relevant of those. The data underwent both quantitative and qualitative analysis, which allowed for identifying the seriousness of the problem and its most probable sources, respectively. The final stage presupposed suggesting solutions, the implementation of which would reduce the risk for unwanted consequences of drug treatment.
Project Proposal Topic
The project proposal targets at finding the solutions that would enable reducing the frequency of medical errors. The initial step lies in classifying those, which task may be challenging due to the dramatically limited room for measurement (Rodziewicz et al., 2021). Notably, there are several possible criteria for describing and categorizing improper actions of healthcare professionals, each of which is qualitative rather than quantitative. Then, it is essential to identify the most common reasons why medical practitioners may perform inadequately, relying on the outcomes of the relevant surveys. Finally, it is necessary to search for the most effective ways to minimize the influence of the factors that cause errors, hence the amount of the latter.
Review of the Literature
The literature review examined the types of medical errors by their nature and origin. This is critical, as improper results of medication admission derive from various mistakes that nurses make in process. Thus, Rodziewicz et al. (2021) describe two major categories of errors: those of omission and of the commission. Omission means not taking necessary actions, for instance, not replacing the used needle prior to an injection. The commission happens when the actions are wrong, which includes, for instance, administering a certain substance to the patient who is known to be allergic to it.
In terms of severity, medication mistakes are possible to classify by such criteria as actual harm and potential harm. While the former is observable in real time and, consequently, assessable, the latter is based on assumptions and probabilities, hence not necessarily precise. Considering this, the existence itself of potential harm is the key determinant of how serious the error is. Simply stated, any mistake that bears a threat to the patient, notwithstanding its type and degree, is “major”, “problematic”, “high risk”, or “clinically significant” (Gates et al., 2019, p. 933). These interchangeable terms mark the higher of two severity levels, while a mistake that bears little to no potential harm is “minor” or “insignificant” (Gates et al., 2019, p. 933). Although such a classification may seem to be dramatically general, it is sufficient to determine further actions in each particular case.
Incorrect steps are inevitable in any activities, including healthcare, simply because none of human beings is able to perform perfectly on a constant basis. Furthermore, Bari et al. (2016) insist that medical errors are, in fact, more common than the population may believe them to be due to frequent underreporting. According to the experts, insufficient recognition of improper actions of personnel complicates the identification of their causes. This is the reason why punishing practitioners for mistakes is not only senseless, but also harmful. Being afraid of sanctions, people tend to hide errors, which in some cases has fatal consequences.
One of the most effective research methods in the given context apparently is an anonymous survey. It requires neither specifying the name and location of the facility nor any personal data of the respondents, due to which those have less fear. Having conducted such, the investigators found that the majority of medical errors derived from the lack of experience or knowledge; 52% and 40%, respectively (Bari et al., 2016, p. 525). Another frequent reason is overworking-related exhaustion that is responsible for 66% (Bari et al., 2016, p. 525). Simply stated, many practitioners make mistakes because they are not sufficiently competent or attentive to realize what they are doing.
Meanwhile, it is critical for a health professional to be aware and concentrated, as the occasions that can have unwanted consequences are numerous but often seemingly minor, hence easy to miss. Among those are, for instance, handwritten orders that a nurse, especially a newcomer, is not necessarily able to decipher correctly (Saljoughian, 2020). Another common mistake in both making and interpreting prescriptions is the incorrect use of zeroes and decimal points in dosages, which can lead to a 10-fold error in drug administration. Such factors as poor lighting and similar-sounding or similar-looking medications contribute to the probability of incorrect steps as well.
Findings
The literature has shown that three most common causes of medical errors are overworking, lack of competence, and poor communication. Resulting from those, practitioners may skip necessary actions by accident or do them in wrong ways (Rodziewicz et al., 2021). It is critical, therefore, to organize the work properly, which means comfortable conditions and adequate load. For instance, inappropriate schedules result predominantly from little to no communication between personnel and administrations of medical facilities (Bari et al., 2016). Besides, staff members have to communicate on a constant basis to avoid misunderstanding, which also is essential for patient safety.
Training is of great importance as well since it refreshes and enhances the knowledge of personnel, hence maintains it up-to-date. For instance, practitioners need regular informing on the appearance of new medications, of whose specificities they are not aware (Salar et al., 2020). For newcomers, in-house education is especially important since their knowledge frequently is theoretical rather than practical and subsequently insufficient for working at a particular facility. An essential nuance is that medication errors occur inevitably simply due to the imperfection of human beings, but their amount is to be minimal. Considering all of the above, it is possible to state that improving the effectiveness of educating staff members and interaction among them is critical for minimizing malpractice.
Strategies
As apparent from the above, the cornerstone of patient safety is the comfort of the personnel, which, consequently, has to be a priority for hospital administrations. Simply stated, hiring more nurses doubtlessly is a more appropriate solution than waging the existing for extra work, as the latter leads to incomparably more substantial losses. The hospital under review, however, cannot afford more practitioners. In such a case, it is reasonable to improve the conditions in which the present personnel find themselves. It is unacceptable, in particular, to save on lamps since the outcomes may be tragic.
Incompetence of staff is another source of medical errors that, in turn, derives from improper training or its complete absence. Thus, 40% and 52%, respectively, of medical practitioners report the lack of knowledge and experience as the main cause of the mistakes that they have made (Bari et al., 2016, p. 525). Less common but similar reasons are the complexity of the case and an inadequate presentation that embarrass semi-skilled personnel. The given hospital, as said above, is employing a considerable amount of nurses who lack experience, hence need training. An essential part of it should be devoted to the importance of reporting mistakes as the key to avoiding tragic consequences.
Finally, medical errors are a common consequence of faulty communication, especially between the professionals at different levels. That, in particular, includes not asking for advice “from senior” as well as “inadequate supervision” (Bari et al., 2016, p. 525). The scarcity of interaction, in turn, may result from that of time; in other words, staff frequently are too busy to consult their junior fellows or newcomers. Besides, some professionals tend to disregard less experienced colleagues because of their belief in their own superiority. Promoting mutual respect in the team, therefore, is worth mentioning among the important factors of improving patient safety.
Budget
The solutions need to be maximally affordable because the hospital’s budget is quite tight. Regarding charity organizations or volunteers, it is not reasonable and not ethical to count on them on a constant basis. The change, meanwhile, should be long-term since, as said above, patient safety is a cultural phenomenon rather than a one-time action, which subsequently needs gradual building (American Society of Health-System Pharmacists, 2018). Therefore, the hospital most probably will be the main investor in the project. Regarding the responsibility for implementing the solutions, it belongs to the hospital staff and the authors of the project.
The first issue to solve is inappropriate lightning; in fact, it does not seem to be problematic to a third person, but the personnel find it insufficient. The light bulbs in work areas, therefore, need replacing with brighter equivalents. It is cheaper to buy them in packages than individually; a package most typically includes 4, and the price of such is around $8. Hence, the budget of this section of the project equals the necessary amount of bulbs divided into 4 and multiplied by 8, or simply multiplied by 2. Both purchasing and replacing are the responsibilities of the electrician who is maintaining the hospital building.
Regarding ignorance as another source of errors, it would be relevant to begin with improving reporting and interaction among the staff members, which two actually are closely intertwined. Such a measure may reduce the amount of mistakes through better understanding even without additional professional trainings and doubtlessly should be combinable with those. Specifically, both experienced nurses and the newcomers have to listen to a lecture that lasts around 1 hour and explains the consequences of hiding a faulty action. The physicians and the administration, meanwhile, have to realize the irrelevance of punishing junior staff for errors; notably, this results in hiding them and compromises patient safety. The budget of the lecture equals the price of a felt-tip pen for notes, which is around $1,5.
Evaluation
The outcomes of the project cannot be immediate because change in rates become apparent with the time. Neither do the above solutions allow for a complete elimination of errors. First, as said above, they result from the imperfection of humans, and their prevalence is diversely proportional to the level of medicine (Kapaki & Souliotis, 2018). Second, the limited budget apparently does not allow for fundamental shifts. However, the amount of bruises and non-timely drug administrations can decrease, which actually is the main assessment criterion.
The former presumably result from poor lightning that deprives the nurses from observing their own as well as each other’s actions as appropriate. Brighter light bulbs, therefore, are able to solve the problem, at least partly, by improving visibility. More confidence in reporting will be beneficial as well since the newcomers will acquire a chance for tips from experienced colleagues on how to inject without bruising. There is, however, no guarantee that the reduction will be as considerable as planned. Health care actually is too spontaneous to favor single-valued predictions.
Regarding inappropriately long pauses between administrations, they also are derivable from the lack of both light and awareness. Notably, one of their causes is incorrect interpretations of prescriptions; improving visibility can reduce those. In addition, delays frequently happen between shifts, when one nurse has no possibility to instruct the other. The lecture, therefore, should include possible solutions to this issue, such as rescheduling. In case of a successful implementation of the measures, the results will be able in several months.
Conclusion
Notwithstanding the progress in medical science, the mistakes that practitioners make continue to be a serious problem. Statistically, their lethality exceeds that of such considerable factors as AIDS and vehicle accidents (Saljoughian, 2020, p. 10). Even in developed countries, malpractice puts 1 in 10 patients at risk; in their developing equivalents, the probability is 20 times higher (Kapaki & Souliotis, 2018, para. 2). Although such rates most probably would have been regarded as a payment for progress half a century ago, the modern medical society has a different view. Notably, mistakes are inevitable, and everybody makes them, but they need to be as rare as possible.
The most frequent causes of mistakes are exhaustion, insufficient interaction among staff members, and inappropriate competence of those. The hospital on which the project focuses is experiencing similar problems. Notably, it has a shortage of nurses but cannot afford hiring more; in addition, at least a third of present practitioners lack experience. This results in overload that, in turn, affects concentration and increases the probability of malpractice. An additional source of the latter may be the lightning that the practitioners consider insufficient.
Considering the tightness of the budget, the most reasonable solution lies in improving the comfort of the present nurses and the effectiveness of their communication. The first point requires replacing light bulbs and is quite easy to realize. Regarding the second, it can have a form of a lecture on two critical topics. First, the junior staff should realize the importance of informing colleagues and/or patients on mistakes and the possible consequences of hiding them. Second, the administration needs to recognize the irrelevance of punishments that discourage practitioners from reporting malpractice and consequently aggravate the problem.
References
Al Mutair, A., Alhumaid, S., Shamsan, A., Zia Zaidi, A. R., Al Mohaini, M., 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), 46-58. Web.
American Society of Health-System Pharmacists. (2018). ASHP guidelines on preventing medication errors in hospitals. American Journal of Health-System Pharmacy, 75, 1493–1517.
Bari, A., Khan, R. A., & Rathore, A. W. (2016). Medical errors; causes, consequences, emotional response and resulting behavioral change. Pakistan Journal of Medical Sciences, 32(3), 523-528. Web.
Barr, D. P. (1955). Hazards of modern diagnosis and therapy: the price we pay. Journal of the American Medical Association, 159(15), 1452-1456.
Gates, P. J., Baysari, M. T., Mumford, V., Raban, M. Z., & Westbrook, J. I. (2019). Standardising the classification of harm associated with medication errors: The harm associated with medication error classification (HAMEC). Drug Safety, 42, 931-939. Web.
Kapaki, V., & Souliotis, K. (2018). Defining adverse events and determinants of medical errors in healthcare. ITechOpen. Web.
Mensik, H. (2021). Physicians, patients lost trust in US healthcare system amid pandemic, survey finds. Healthcare Dive. Web.
Moser, R. H. Diseases of medical progress. The New England Journal of Medicine, 255(13), 606-614.
Panagioti, M., Khan, K., Keers, R. N., Abuzour, A., Phipps, D., Kontopantelis, E., Bower, P., Campbell, S., Haneef, R., Avery, A. J., & Ashcroft, D. M. (2019). Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis. BMJ, 366. Web.
Paulin, I.M., Marash, C., & Ortega, R. (2018). Health care professionals make mistakes, and that’s okay. Scientific American. Web.
Rodziewicz, T. L., Houseman, B., & Hipskind, J. E. (2021). Medical error reduction and prevention. In StatPearls. Web.
Salar, A., Kiani, F., & Rezaee, N. (2020). Preventing the medication errors in hospitals: A qualitative study. International Journal of Africa Nursing Sciences, 13, 100235. Web.
Saljoughian, M. (2020). Avoiding medication errors. US Pharmacist, 45(6), 10-11. Web.