A medication error occurs as a result of the failure of a planned action to be completed as intended or the use of the wrong plan to achieve a specific aim. The rate of medication errors that occur as well as the consequences of those situations are frightening. In the hospital setting, where most of the reports have been generated, approximately 47 percent of medical errors are medication related. Approximately 1.4 million medication errors occur in the U.S yearly (Barbara, 2009). In addition, the number of deaths from medication error ranges from approximately 44,000 to 90,000 (Barbara, 2009). Nurses are the ones who predominantly administer medications to patients. For that reason, they are often the last potential barrier between a medication error and serious harm. This paper discusses the nurses’ role in preventing medication errors.
Literature review
Causes of medication error
A number of researches have been written about medication errors and the role of the nurses in their prevention. According to Kiekkas, Karga, Lemonidou, Aretha, and Karanikolas (2011), most errors are linked to nurses’ lack of familiarity with the wide variety of tablet strength, vial sizes, concentrations, and dosage forms stocked in the pharmacy. Kiekkas et al. (2011), however, stress that most of these errors are preventable. On the other hand, Caroline Sue White (2011) asserts that nurses who lack the competency to do dosage calculations in medication preparation and administration are likely to facilitate these errors.
In most hospitals, the highest percentage of medication errors occurs in intensive care units (ICU) (Henneman et al, 2010). Some of these medication errors may consequently lead to adverse events. Henneman et al. (2010) state, “most of these adverse events are likely to result from system failures” (p.501).
Other major causes of medication errors, as described by Suzan Starkey and Pamela Walden (2010), include poor communication, lack of appropriate labeling, environmental factors, and patient misuse because of poor understanding of the directions for use of the medication.
Types of medication error
Medication errors are often classified and studied as per when they occur in the medication use process (Cheragi, Manoocheri, Mohammadnejad, & Ehsani, 2013). According to Suzan Starkey and Pamela Walden (2010), serious medication errors often happen during prescribing process. Poor order transcription and drug administration processes also contribute largely to medication error. Suzan Starkey and Pamela Walden (2010) as well agree that a large percentage of medication error may occur during the dispensing process.
Specific roles and responsibility of nurses in prevention of medication error
Henneman et al. (2010) states that what is necessary is proper due diligence from nurses when it comes to the performance of their duties. Due diligence can be described as the implementation of a certain standard of care based on an individual’s profession. Within the context of nursing practices, this manifests itself in the following medication administration rules that nurse needs to observe:
The right patient
Henneman et al. (2010) argues that nurses should understand their patient’s conditions prior to holding medications. As such, they have to make sure that they are administering the right type of medication to the correct patient.
The right medication
It goes without saying that awareness of proper medication is an essential skill for a nurse since giving a patient the wrong type of medication at a time when they need the right kind of medication the most can result in their death.
The right dose
Due diligence in administering the right dosages is essential in preventing medication errors since overdosing a patient on a particularly strong type of medication can cause their system to go into shock or could even severely damage their internal organs.
The right time
Timing is an important facet of administering medication since a patient’s body needs time to adapt to the previous dosage of medication that was already given. If proper timing is not followed, it is likely that an overdose may occur resulting in possible toxicity in the patient’s bloodstream or organs.
The right route
There are certain types of medication that can be taken either orally, intravenously or even through suppositories. The reasoning behind this is connected to the dosage needed as well as how fast the medication is supposed to act. Nurses need to know how a specific route of medication would best resolve a patient’s current condition otherwise they may induce a negative reaction due to either overdosing or under dosing a patient.
The right reason
There are some medications such as morphine and painkillers that are often abused by patients that are given them. Nurses need to develop proper reasoning in the administration of these types of medication since simply giving them to a patient because they asked for them is unacceptable since you are enabling them to develop a drug dependence.
The right documentation
Starkey and Walden (2010) explain that one of the most common medication errors in a hospital setting comes from overdosing a patient on a specific type of medication due to improper documentary practices. Since medication is often given at a precise set of intervals (as determined by standard practices), improper documentation of the doses already given on a patient’s chart can result in a fatal overdose. Nurses need to ensure that when medication is given, proper documentary procedures have been followed to ensure that the next nurse knows when the last dose was given (Starkey and Walden, 2010).
Implications for Nursing Practice or Health Care
From the literature review, this study reveals that nurses spend more time with patients than other prescribers do. For that reason, nurses have a unique role in preventing medication error. Even with increased standardization of drug ordering, computerized delivery system, and bar coding, nurses must feel comfortable raising concerns and asking for clarifications about orders that do not make sense to them.
Therefore, although members of any discipline can make mistakes in the chain of steps in the medication management system, this study clearly states that nurses, who are at the sharp end of the process, play a unique role in preventing medication error. The literature review above, therefore, will help enable nurses and other related disciplines to get fresh insight into risk management concerns with medication administration and subsequent errors.
Additionally, nurses should be willing and able to educate patients and their families about medication procedures. As a matter of fact, the role of nurses in prevention of medication error is indeed weighty and challenging one and, therefore, should be taken seriously. A thorough understanding of the medication use system and the roles and responsibilities of nurses is critical both to developing a system approach to error prevention as well as to targeting improvement opportunities. The effect of this study, therefore, will be to encourage nurses’ participation in prevention and reduction of medication error in health care.
Conclusion
Conclusively, the role of nurses in prevention of medication errors is vital. In regard to a number of deaths resulting from medication, it is important that nurses should participate in practices that would help prevent errors in medication. Most of these medication errors are preventable. For that reason, nurses must ensure that they are skilled and competent enough to prevent these errors.
References
Cheragi, M., Manoocheri, H., Mohammadnejad, E., & Ehsani, S. (2013). Types and causes of medication errors from nurse’s viewpoint. Iranian Journal of Nursing and Midwifery Research, 18(3), 228-31. Web.
Henneman, E., Gawlinski, A., Blank, S., Henneman, L., Jordan, D., & McKenzie, J. (2010). Strategies used by critical care nurses to identify, interrupt, and correct medication errors. American Journal of Critical Care: an Official Publication, American Association of Critical-Care Nurses, 19(6), 500-509.
Kiekkas, P., Karga, M., Lemonidou, C., Aretha, D., & Karanikolas, M. (2011). Medication errors in critically ill adults: a review of direct observation evidence. American Journal of Critical Care: an Official Publication, American Association of Critical- Care Nurses, 20(1), 36-44.
Starfield, B. (2009). Medical Errors: A Leading Cause of Death. The Journal of the American Medical Association 284(4), 2-5. Web.
Starkey, S., & Walden, P. (2010). How can we prevent medication errors?. Nursing Made Incredibly Easy!, 8 (6) 18-22.
White, C. S. (2011). Advanced Practice Prescribing: Issues and Strategies in Preventing Medication Error. Journal of Nursing Law, 14(3), 120-127.