Capella 4020 Assessment 1 : Enhancing Quality and Safety

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Capella University

Capella 4020 Assessment 1

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Enhancing Quality and Safety

Unsafe medication practices are one of the leading factors for preventable patient harm in healthcare systems and the biggest proportion of these malpractices occurs in the administration phase where nurses are primarily responsible (Wondmieneh et al., 2020). In this paper, a similar incident will be discussed that highlights the safety and quality issues related to medication administration at a renowned hospital in the US. 

Factors leading to the safety problem

Simi is a registered nurse with 15 years of bedside experience who works at Vila Health facility. One day on a busy shift, Simi mistakenly administered the antibiotic Piperacillin/Tazobactam 100 mg dose of another patient to Mrs, Goldsmith who was allergic to this drug. After receiving Pip/Tazo, the patient developed a severe anaphylactic reaction where her symptoms were redness, itching, and high-grade fever. Although her allergic symptoms were immediately treated by anti-histamines, medication administration error by the nurse was a highlighting concern here. According to the research, poor quality of care can result in extreme morbidity and mortality cases for the patients likewise in the scenario mentioned above hence the healthcare system must ensure quality care is provided (Kruk et al., 2018). 

The literature identifies many factors that lead to patient safety risks in terms of medication administration. These factors include:

Poor team collaboration/Poor communication:

One of the factors for medication administration errors is poor collaboration and ineffective communication among healthcare providers. Data presented by the study reveals that ineffective communication practices like unofficial conversations at the bedside, misreading/misinterpretation of drug orders, and incorrect prescriptions are reasons for 18.8%, 32.3%, and 12.9% of medication error cases respectively (Manias et al., 2021). Moreover, a lack of interprofessional collaboration leads to incomplete sharing of information among nurses, doctors, and pharmacists which can harm patients and further negatively impacts costs to the healthcare systems (Rajendran, 2022). 

Inappropriate training:

Escrivá Gracia and colleagues (2019) identified in their research that 42.5% of nurses failed the drug knowledge test which resulted in a mean score of only 47% (Escrivá Gracia et al., 2019). The research recognized that medication errors due to inappropriate training account for 78.7% of cases (Tsegaye et al., 2020). This data reveals that when nurses have minimal knowledge of drugs, they may cause errors in administering the drugs without noticing the adverse events that the patient may survive hence patients’ safety is impaired (Escrivá Gracia et al., 2019). 

Shortage of staffing:

Inadequate nurses increased the workload eventually increasing the risk of omission and other medication errors impacting patients’ safety. The study reveals data that staffing shortages and workload is evident almost 114 times in the medication errors that are reported. Furthermore, employee shortage accounts for 72.8% of various medication errors (Härkänen et al., 2019). Shortage of staff is a concern because it increases the nurse-to-patient ratio, eventually enhancing the workload which makes nurses commit unintentional medication errors. 

Nurses’ burnout:

In connection to the shortage of staff and increased workload, burnout among nurses is a common factor for medication administration errors as it leads to stress and poor attentiveness (Montgomery et al., 2020). It is further evident by the research where authors have identified that burnout results in 43.3% of nurses being distracted during medication preparation hence 90% of nurses reported that this results in incorrect administration of the drug (Boutou et al., 2021).

Constant interruptions:

 Constant distractions like unavoidable conversations, unnecessary workload, and multi-tasking at a time cause nurses to mistakenly administer either the wrong drugs, the wrong dose, or the wrong frequencies. Authors reveal that 75% of medication errors are due to environmental and personal interruptions caused during the medication administration process (Tariq et al., 2022). These interruptions have negative impacts such as increasing the time of administration, reducing nurses’ efficiency, and increasing the risk of errors by nurses (Wang et al., 2021). 

Evidenced-based and best-practice interventions

As the cases of medication errors increase it also enhances the financial burden on patients as well as hospitals. Expenditure of around $20 billion is identified to be on medical errors (Ahsani-Estahbanati et al., 2021). Moreover, medication errors cause patients’ delayed treatment and increased length of stay hence putting a monetary burden on patients and their families. The solutions for improving patients’ safety regarding medication errors are:

EMR and BCMA systems:

Electronic medication record systems are beneficial to prevent human errors. These systems are generated to avoid manual entry of medication and an electronic record provides complete data on all medications that are being administered (Kenawy & Kett, 2019). Furthermore, EMRs linked with computerized physicians’ order entry systems (CPOE) will assist nurses to only administer drugs that are currently active in the system. Authors cited that 50% of the errors are prevented by CPOE systems (Elshayib & Pawola, 2020). Another strategy is the barcode medication administration system which supports nurses in correctly identifying patients and preventing identification issues of medication administration. This system enables healthcare facilities to fulfil one of the goals of JCIA standards of patient safety (Rodziewicz et al., 2022).  

These strategies combat previously discussed the risk of poor collaboration as nurses and doctors work collaboratively on the same system and all the steps of the medication process from prescription to administration are based on the same system to identify discrepancies (Mulac et al., 2021). EMR and BCMA systems will initially require a financial investment however, they will prevent medication errors to be committed eventually reducing the unnecessary costs that are utilized after errors are performed (Larson & Lo, 2019). 

Quality and Safety Education for Nurses competencies:

QSEN competencies include patient-centered care, teamwork and collaboration, evidence-based practices, quality improvement, safety, and the use of informatics. All of these competencies are established so that a healthcare system provides evidence-based care which is based on patients’ needs and preferences performed by effectively communicating and working together to ensure that quality is improved and safety is ensured. These practices are designed by analyzing the evident data acquired from clinical practices (QSEN Competencies, 2020). Incorporating these proficiencies reduces the risk of lack of training and improves the quality and safety education for nurses related to medication administration hence bringing positive change in nursing practices (Watanabe et al., 2021). Although training nurses require a specific amount of budget, these professional education guidelines will assist nurses in safely administering medications hence reducing the costs associated with errors (Mahsoon & Dolansky, 2021). 

Medication reconciliation: 

The medication reconciliation process helps nurses to only administer the drugs which are actively accurately prescribed by doctors to ensure drugs are administered correctly (Ciapponi et al., 2021). This process helps nurses, doctors, and pharmacists to effectively work together hence reducing the risk of poor interprofessional collaboration. Research-based on medication reconciliation and cost-effectiveness identified that around $210.33 of amount can be avoided by using the program of hospital-wide medication reconciliation (Uhlenhopp et al., 2020). 

Teamwork and communication:

Improved handover communication related to medication like pending orders and prescription issues has been an important factor in reducing the risks associated with medication errors. Moreover, ineffective communication practices like constant interruptions should be avoided (Rodziewicz et al., 2022). Some of the methods for improving communication include the establishment of a standardized hands-over form that includes the component of medication details and anti-interruption boards/alarms for nurses to indicate that nurses are occupied and must not be distracted. Both leadership and frontline staff play a vital role in this regard. Leaders should educate their employees and staff should have an insight that interruptions can lead to medication errors which are harmful to their patients as well as hospital assets (Mortaro et al., 2019). Along with good communication, teamwork should be promoted as well. Teamwork helps in reducing the risk of ineffective collaboration, decreasing workload, and eventually reducing burnout among nurses (Tariq et al., 2022). 

Nurses coordinate to increase patients’ safety

Nurses being the primary source of medication administration errors have this responsibility to ensure that safe medication practices are performed to avoid these errors and that patients’ safety is provided. Some of the ways nurses coordinate care are:

1. Continue professional education whereby nurses are constantly educated with current trends and safety policies related to medication administration. It is recommended to develop a curriculum for nurses so that their knowledge is timely updated (Hawthorne-Kanife, 2018). In the scenario presented earlier, because Simi had 15 years of clinical experience it is possible that she had a knowledge gap related to current practices and that is why she was unable to check medication appropriateness (allergy is one component). Training nurses requires educators to be hired but this prevents medication errors to be committed hence reducing the costs associated. 
2. Nurse and patient collaboration is another important way that nurses coordinate care along with their patients where they inform their consumers about every medicine that is administered to them so that patients can stop any incorrect administration (Jeong & Park, 2022). In the case of the Vila health facility, if the nurse had informed her patient about the Pip/Tazo, the patient would have stopped her before administering it so that severe complications were prevented. Collaboration among nurses and patients will reduce medication errors eventually reducing the avoidable use of hospitals’ financial resources utilized for the correction of errors and improving patients’ health.
3. Following medication safety standards like the six rights of medication (right drug, dose, frequency, route, time, and documentation), QSEN competencies and medication appropriateness helps in safely administering the drugs by checking the medicates which are suitable for the patients and administered in the correct form (Hanlon & Schmader, 2022). These practices are essential to avoid medication errors and costs that patients or hospitals meh bear due to severe complications. 

Nurses’ coordination with other stakeholders

The foremost stakeholder involved in these safety concerns after nurses is patients hence it is the nurses’ primary job to involve their patients and inform them about all intentional and unintentional events. This is important to build a respectful and trustworthy relationship with the patients. Moreover, nurses must work in collaboration with other healthcare providers to ensure that patient safety is a priority for them. Nurses should coordinate with nurse leaders, and policymakers so that the issue can be resolved at the organizational level through the effective implementation of the strategies presented above (Kim et al., 2022). 

Conclusion

In conclusion, medication administration is one of the patient safety concerns and requires immediate interventions to avoid patient harm. It is the primary duty of nurses to adhere to the standards established by the Institute of Medicine (IOM), improve communication practices and coordinate with other stakeholders to ensure patient safety and quality improvement (QI).

References

Ahsani-Estahbanati, E., Doshmangir, L., Najafi, B., Akbari Sari, A., & Sergeevich Gordeev, V. (2021). Incidence rate and financial burden of medical errors and policy interventions to address them: A multi-method study protocol. Health Services and Outcomes Research Methodology, 22(2), 244–252. https://doi.org/10.1007/s10742-021-00261-9 

Boutou, A. et al. (2021). Nursing errors in ICU and their association with burnout, anxiety, insomnia and working environment: A cross-sectional study. Acute Critical Care [Preprint]. https://doi.org/10.1183/13993003.congress-2021.pa2423

Ciapponi, A., Fernandez Nievas, S. E., Seijo, M., Rodríguez, M. B., Vietto, V., García-Perdomo, H. A., Virgilio, S., Fajreldines, A. V., Tost, J., Rose, C. J., & Garcia-Elorrio, E. (2021). Reducing medication errors for adults in hospital settings. The Cochrane Database of Systematic Reviews, 11(11), CD009985. https://doi.org/10.1002/14651858.CD009985.pub2

Elshayib, M., & Pawola, L. (2020). Computerized provider order entry–related medication errors among hospitalized patients: An integrative review. Health Informatics Journal, 26(4), 2834–2859. https://doi.org/10.1177/1460458220941750 

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  

Hanlon, J. T., & Schmader, K. E. (2022). The medication appropriateness index: A clinimetric measure. Psychotherapy and Psychosomatics, 91(2), 78-83. https://doi.org/10.1159/000521699 

Härkänen, M., Vehviläinen‐Julkunen, K., Murrells, T., Paananen, J., Franklin, B. D., & Rafferty, A. M. (2019). The contribution of staffing to medication administration errors: A text mining analysis of Incident report data. Journal of Nursing Scholarship, 52(1), 113–123. https://doi.org/10.1111/jnu.12531  

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Capella 4020 Assessment 1

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Capella 4020 Assessment 1