The Medication Errors Generated By Nurses Nursing Essay

The Medication Errors Generated By Nurses Nursing EssayIn umpteen cases, medicine errors ca employment adverse events, and sometimes, the con epochs ar fatal. Many of these mistakes be avoidable if policies of the infirmary governing medicament validations be adhered to. In the U.S. today, almost people engagement ethical drug musics, over the counter do drugss, or dietary supplements. Errors when prescribing or fetching these medicinal drugs has been a problem for patient of roles, insurance companies and the health headache industry. The focus on medicament errors has stimulated rapid adoption of medical specialty court technologies such(prenominal)(prenominal) as the barricade-code medical specialty administration (BCMA) arranging. Medication administration is an important treat task. Work overload, combined with increased totals of prescribed medical specialtys, puts nurses at luck of making dear errors. Medication errors are costly in basis of increa sed infirmary stays, resources consumed, patients harmed and lives lost. Mistakes similarly have the potential for serious effectuate on the nurse involved, ranging from feelings of guilt and fear, to loss of clinical confidence, and disciplinary performance as well up as job loss. Medication errors happen in the hospital much more than are reported and their reasons are versatile including errors clinicians make in prescribing medical specialtys. A physician writes an rig that sometimes contains instruction manual that if stick toed, will result in patients getting musics that are harmful to them. They whitethorn have had adverse reactions to such practice of medicines in the past or the drug may be contraindicated for the purpose for which they were devoteed. This question paper will hear that the BCMA system is a reliable technology in trim back medication errors. On the other(a) hand, critical steps omitted by health care providers and nurses often contribute to more than half of the medication errors generated when victimization the BCMA system. Thus, health care providers and nurses emergency to be educated on patient and medication guard as well as the accurate use of the BCMA system. A clinical policy on the use of the BCMA system will in addition be developed.For the purpose of research, the medication errors to be discussed will be dependant to the use of the BCMA system by nursing personnel. There are many regulatory guidelines for the administration of medications, but these policies are often turn offd by nurses and other healthcare workers, and cigaret result in errors. In the hospitals where we aid our clinical rotations, such as Kaiser and San Francisco General Hospital, medications such as chemotherapy, insulin, narcotics, heparin and magnesium sulfate have been identified as high seek medications. The nurse assigning these drugs must have some other licensed nurse swing out regard the order including the patients name and assignment number (ID), route, dosage and administration time for accuracy. The second nurse often appends his or her signature to the order without doing or completing the cross-check. Medication error is the inappropriate use of medication that can make water harm to patients. (See accessory A)Literature round research and Critique of literatureFranklin, OGrady, Donyai, Jacklin Barber (2007) are a multitude of pharmacists from the take of Pharmacy London and the Department of Pharmacy Surrey, UK, who conducted a originally and by and by psychoanalyse of the BCMA system. They concluded that the closed-loop electronic and prescribing bar-code system witherd medication errors. Strengths of the arena are that data were collected with a comprehensive framework and the identification of prescribing error was renowned employ a validated method. One endureing is that the system was piloted on one ward. A mixed method field of battle by Koppel, Wetterneck, Telles Karsh (2008) from the Center for Clinical Epidemiology and Bio-statistics and the Department of medicine identified xv types of BCMA workarounds. Workarounds such as omission of cultivate steps, steps performed out of sequence and unauthorized process steps. Some limitations in this study were that the nurses knew they were being watched apply the BCMA and all possible workarounds were not included. However, the study suggests that the BCMA is beneficial in reducing medication error. Sakowski, Newman and Dozier (2008) found that medication errors identified by the BCMA system are benign and pose no harm to patients. A limitation of this study is that only errors detected by the BCMA were reviewed and errors did not contain the patients diagnosis. Cina, Fanikos, Mitton, McCrea Churchill (2006) are a group of pharmacists that include a medication safety officer and a director of pharmacy services at Brigham and Womens hospital (BWH) in Boston. The group studied errors generated i n the medication repackaging center of BWH, in order to send and implement improvements to keep down medication dispensing errors. Unfortunately, the study examined only one rank and relied on human observers who may have failed to detect errors. See accessory BAccording to the book To err is human building a safer health system medication errors frequently occur during the prescribing, dispensing and administration stages, and preventable adverse drug errors are a minceing cause of destruction in the U.S (Kohn, Corrigan Donaldson, 2000, p.26). The American Hospital Association found that over 33.6 million admissions in U.S. hospitals in 1997 alone, at least 44,000 to 98,000 died of medical error and another 7,000 deaths were due to medication errors (as cited in Kohn et al., 2000, p.26). In addition, Philips et al. noted that a review of some U.S. death certificates, revealed about 7391 deaths ca apply by medication errors in 1993 (as cited in Kohn et al., 2000, p.32). Rese archers Kaushal, Bates, Franz, Soukup, and Rothschild (2007) conducted a statistical analysis and noted that about 49.1% of medication errors were serious and 15% were life threatening. They overly found that the cost of medication errors at the 735-bed Brigham and Womens Hospital is about $1.5 million per year and $1.48 million for a 20-bed third care academy hospital (Kaushal et al., 2007). Fatal or serious medication errors result in additional lengths of stay in the hospital, thus adding to interference costs. In order to get over frequent errors, the BCMA was introduced to the health care system by the Agency for Healthcare Research and Quality and the Institute of medicinal drug (OMalley, 2008).Sakowski et al. (2008) have found that approximately 3.1% of drug errors are made during hospital stays in the U.S. This queue uping is astonishing in the sense that the hospital is where people turn to for medical help and not medical psychic trauma that can result in death. Howe ver, the adoption of the BCMA by most hospitals today, has helped reduce medication errors to begin with they reach patients (Cochran, Jones, Brockman, Skinner Hicks, 2007). With the use of the BCMA, 37% of medication errors were detected by nurses during the dispensing phase and 27%, during the administration phase (Cochran et al., 2007). Furthermore, they noted that the implementation of the BCMA in a 240-bed regional hospital study prevented 1,300 medication errors for a period of eight months (Cochran et al., 2007). Some of these errors were break up by the BCMA when medications were leaving to be disposed prior to their specified time, or about to be given without a physicians order, or to be given to the improper patient (Cochran et al., 2007). Due to heavy workloads, busy vexs, error warnings and the bulky nature of the BCMA, nurses find ways to bypass the BCMA system in order to get done busy schedules. These shortcuts often lead to errors in medication administratio n on with errors generated by the prescribing physician, as well as by the dispensing pharmacy. Medication administration is a complex system that requires coordination among physicians who order the medications, pharmacists who verify and dispense the drugs, and nurses who administer the medications to the patients.SummarySteps in medication administration are initiated when a drug is prescribed by a health care provider. The prescriber writes the patients name, date, medication name, dosage, route (e.g. by mouth), number of tablets/capsules to be dispensed, the prescribers signature, his/her medical license number and Drug Enforcement Administration number (DEA) ( numbers pool assigned to health care providers used for prescribing pain medications). Medication errors occur at this stage and include reasons such as a lack of attention to detail, lack of communication, duplicate medication with the same name but different doses or an illegible prescription order (Benjamin, 2003). B enjamin (2003) also noted that 71% of medication errors are due to poor communication, which can lead to prescribing contraindicated medication for a patient He goes on to give the example of an 80-year old man who was given the pain medication Demerol despite a reported allergy to Demerol. After administration, the patient became unresponsive, had respiratory arrest and suffered hypoxic encephalopathy (lack of oxygen to the whiz causing brain damage) (Benjamin, 2003). This incident goes further to show how important it is for physicians to announce and listen to patients and nurses concerns when prescribing medications. Below is a copy of a poorly create verbally prescription by a healthcare provider. In this example thither are 3 different types of medications prescribed for one patient. Although the handwriting is legible, indistinct writing can lead to misinterpretation and further lead to medication error (Benjamin, 2003). See Appendix C.Steps taken to en accepted safety s tandards include affixing a calculating machine generated bar code on medication containers. Pharmacists are supposed to be the first line of defense in reducing errors however, pharmacies can contribute to medication errors as shown in the research by (Cina et al., 2006). The pharmacist or pharmacy technician prints and affixes bar codes on medications that are ready for administration. During this process, medication errors occur either due to the placement of treat bar codes, medications missing bar codes, misspelled medications or medications with two different bar codes (Cina et al., 2006). Furthermore, 59.7% of medication errors occur during the final stages of pharmacy repackaging system, a system of replace commercial packaging for generic ones, due to incorrect lot numbers and NDCs (Cina et al., 2006). Another research by Cochran et al. 2007 found that medication errors frequently entailed illegal medications, medications without bar codes and medications with bar code s that would not scan. Therefore, pharmacists occupy to be more hawk-eyed in checking for bar codes, lot numbers, correct NDCs, correct medication spellings and also verify illegible prescriptions in order to reduce chances of medication errors. condescension the adoption of the BCMA as a medication safety technology, research has shown that nurses as yet contribute to a majority of medication errors. Koppel et al. (2008) have found that 32% to 60 % (adult pediatric patients) of medication errors occur during the medication administration stage, most of which are caused by nurses because they failed to use the BCMA system. Because medication errors are so universal at the administration stage, nurses are mandated to use the BCMA system and are also required to abide by the medication administration guidelines step-by-step, through the final documentation stage. If a step of the medication administration process is missed, the likeliness for medication errors increases. A resea rch by Franklin et al. (2007) confirmed that nurses fail to check patients IDs 80% of the time forward giving medications and 16% of medications were given before scanning the patents ID band (Carayon et al.,2007). For example, wrong medications can be intercepted by a nurse if he/she compares the printed medication bar code to the information displayed on the BCMA system. In order to reinforce proper usage, monthly in-service (refresher course) may be required to educate nurses on medication administration as well as the importance of abiding by the hospital policy of medication administration.The panic sound on the BCMA system also allows nurses to detect medication errors before they get to the patient. But research has shown that nurses often disable and ignore the alarm sound because they claim, the sound is annoying and weird (Carayon et al, 2007). Koppel et al. (2008) found that nurses overrode BCMA alerts for 4.2% of patients charted and for 10.3% of medications charted. E rrors were generated because the BCMA alarm was disabled and nurses did not follow administration steps, thus giving medications without validation by the BCMA system. The BCMA needs to be equipped with a mechanism that would entrap nurses from bypassing any administration step and this would help to reduce medication error. Also, the BCMA alarms should be configured such that the correct administration steps must be taken before advancing to the next step.For the BCMA to work properly, its advised that it should be sendd or plugged in when not in use since it is a mobile machine that is in constant use. Often times, nurses fail to charge the BCMA as advised and when the BCMA loses charge, it shuts down without warning which can lead to data loss (Parker Baldwin, 2008). Data loss causes frustration for nurses so they decide to skip the BCMA system during drug administration (Parker et al, 2008). When batteries fail, nurses had no immediate performer to replace them with charge d battery. Use of the BCMA was suspended until the units were recharged (Parker et al., 2008). Since the BCMA system is used everlastingly for multiple patients, battery life can be preserved by getting a BCMA that uses removable batteries. A removable battery can last for twenty-four hours as well as making sure that there are extra replacement batteries for the BCMA.The BCMA system requires lots of verificatory steps and a personal access process by nurses before a medication is confirmed accurate for administration. Parker et al. (2008) found that nurses were dissatisfied with the log-in process because it requires much time to complete a single log-in. A single log-in process could take up to 2 minutes, overwhelming up to 48 minutes of nursing time waiting for computer access(Parker et al., 2008). Therefore, nurses cut corners in using the BCMA they decide to give the medication without using the BCMA and document the action at a later time. This can cause a nurse to administ er the wrong medication and to the wrong patient. The BCMA process requires that nurses scan both, the medication and patients ID band in the patients way of life before administration. In many clinical facilities, the policy is for nurses to dispense the medications, one patient at a time. In fact, the notice is that the nurse, check the medication record of a patient against the patients profile in the pyxis (medication storage). If they match, the nurse will accordingly pull out the medications for the particular patient and walk directly to the patients room with the medications and the BCMA system. In the patients room, the nurse scans and checks the medication and name against the patients ID band if they match, the medication is accordingly administered and documented after administration. Nurses however, do not follow this simple rule in medication administration. The result of circumventing the rule is that nurses walk into a wrong patients room and administer the wrong medication. According to a research by Carayon et al. (2007), the correct sequence for medication administration is as follows See Appendix D. These steps are critical in verifying that the right medication is given to the right patient. However, they found that nurses often do not follow the steps. For example, nurses were documenting medications before it was actually given to the patient. They check and obtain medication before scanning patients ID band (Carayon et al., 2007). To reduce the problem of workarounds, nurses who are caught with multiple medications and wristbands, need to be disciplined. And bar codes can be printed in bold so nurses can acknowledge them.The use of the BCMA requires complete attention in order to avoid mistakes. Patterson, Cook, and Render (2002) have found that nurses are often interrupted for one problem or another during medication administration. Below is a flow chart that shows the various instances when nurses are interrupted during medication administration process. See Appendix C. Medication administration is very critical and to reduce frequent interruptions, the nurse manager should make sure that a charge nurse (a nurse who supervises other nurses without having a patient) is assigned during every shift to help nurses with minor needs such as moving or walking a patient. Nurses should be given more training probability to better understand the use of the BCMA as well as its functions. endingThe BCMA is still a challenge to health care workers on the other hand, it has helped to reduce medication errors since its adoption. Health care providers need to help reduce medication errors by putting patients safety first. Nursing staff need to be more cooperative and strictly follow the prescribed guidelines when using the BCMA system during medication administration.