Nurses’ Awareness of Medication Administration Errors

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Introduction

The provision of quality care and adequate patient safety, especially regarding medication administration, is the primary and nationwide initiative that assumes implementing evidence-based strategies and practices. In this regard, staff training is an integral component of maintaining, improving, and upgrading nurses’ competency in all areas of their activity and increasing their commitment to the best medication administration principles. Therefore, this paper aims at enhancing nurses’ awareness of medication administration errors (MAEs), providing an improvement plan, and describing their role in realizing it. The session will also deliver resources or activities promoting necessary skill development and process understanding and methods of fostering the audience’s feedback and integrating it for future improvements.

Problem Overview

Despite the recent significant technology implementation in the healthcare sector, adverse drug events (ADEs) still remain one of the most prevalent medical safety issues. According to the Agency for Healthcare Research and Quality (AHRQ), ADEs amount to about 700,000 visits to the emergency department and 100,000 hospitalizations every year (“Medication errors,” 2019). Moreover, 7,000 to 9,000 patients die because of MAEs, and the total cost of medication-associated errors is over $40 billion every year (Tariq et al., 2021). Herewith, it is worth noting that thousands of patients and even medical providers do not report complications and different adverse reactions induced by medications.

Issues of Concern

Generally, MAEs can result from various sources connected with prescription, clinicians, nurses, medical organizations, and patients as well. The causes of medication errors include incorrect dose, expired drugs, improper medication preparation, a mix of several drugs with contradictions, disregarded allergies, pharmacists’ or nurses’ wrong actions, frequent distractions, and distortions. In particular, distractions are guilty of nearly 75 percent of all MAEs and are mainly related to nurses’ and physicians’ overload and multitasking (Tariq et al., 2021). Additionally, Hammoudi et al. (2017) indicate inadequate communication between nurses, doctors, and patients. Wondmieneh et al. (2020) also state nurses who had low work experience and training and do not follow guidelines for medication administration and are more inclined to MAEs. Finally, patient age and related diseases are among the widespread factors.

Safety Improvement Plan

A safety improvement plan (SIP) pursues five objectives: enhancing patients’ and nurses’ education and collaboration, improving environmental conditions, cultural strategies, clinical interventions, and technological interventions. Specifically, the first goal includes close face-to-face discussions between various professionals, strict adherence to medication administration guidelines, ongoing training, and visual tools. Communication can be strengthened by conferences, active listening, proper writing, and specific technologies such as clinical decision support systems. The second goal assumes streamlining nurses’ workflow and alleviating workload. Cultural strategies imply highlighting a multidisciplinary responsibility for error prevention, whereas clinical interventions mean minimizing opioid and sedative medications. Finally, technological interventions involve using barcode scanning of medication (BSM) or smart infusion pumps.

Staff’s Role

The staff plays an essential role in realizing the SIP’s goals since their main responsibility is to promote care quality and safety. In particular, nurse executives arrange measures and ensure the resources’ availability for the SIP, while nurse managers supervise and encourage nurses’ commitment to the structure of the plan’s implementation. Quality assurance coordinators gather relevant data on the progress of the plan’s implementation and collect regular forums to accord productive quality improvement work. Nurse practitioners (NPs) and registered nurses (RNs) deliver appropriate day-to-day care, diagnosing and treating patients and conducting minor medical procedures. Besides, these persons are directly responsible for identifying problematic areas in medication administration in their organizations.

Staff’s Importance

The personnel motivation, attitudes, commitment to the structure and core objectives of the improvement plan will reflect on the ultimate outcomes. Nurses are accountable for delivering robust communication, necessary emotional or physical support for patients, and the continuity of care and involving patients in their self-management and education. Furthermore, since nurses are at the forefront of care delivery, the relevancy and quality of provided information for developing and adopting the SIP considerably depend on them. The study by Rahimi et al. (2020) exhibits that due to understaffing, nurses’ error reporting is relatively low. This unfavorably impacts data collection, which eventually results in the ignorance of critical issues linked to medication administration.

Benefit for Staff

First of all, the successful realization of the plan will contribute to the formation of a thriving corporate culture with a healthy working atmosphere and sound communication. In turn, this will improve nurses’ motivation and devotion to their obligations, which should boost safety culture. Moreover, participants can receive valuable experience during the implementation process and acquire or develop useful skills and knowledge needed for daily tasks and procedures. Finally, the SIP can streamline personnel’s workaday workflow, which alleviates nurses’ workload and reduce the number of distractions, the predominant cause of MAEs.

Skills and Processes

First, the training session will aim at enhancing the staff’s communication skills such as active listening, emotional control, speech clarity, body language, empathy, and respect. Communication also assumes knowing both verbal and non-verbal means of conveying information. Besides, participants will be familiar with multitasking skills which implies concentration on medication administration as the primary task while tracking others. Furthermore, personnel will gain profound knowledge about federal and WHO guidelines, nursing textbooks, and other relevant literature related to medication administration. Finally, nurses will be acquainted with advanced technologies, including health information systems (HISs), BSM, and smart infusion pumps.

Learning Activities

First, in-service sessions will include diverse classroom activities such as lectures and webinars that will contain PowerPoint papers and videotapes to stimulate group discussion and essential knowledge acquisition. Safaeifard et al. (2020) recommend using diagrams, self-learning, and papers with enjoyable materials in lectures. Besides, sessions can have case studies that examine the most prevalent and adverse incidents and issues connected with MAEs. Job rotation is another practical learning method, which will require participants’ engagement in different interdisciplinary activities, including an NP, RN, pharmacist, coordinator, or nurse manager. It is also relevant to conduct on-the-job training for trainers, assuming reading the manuals and combining explanation, observation, and practice.

Learning Activities (cont.)

Moreover, the fourth learning activity is coaching which means individual mentoring under experienced professionals. In this case, learners can always ask various questions and receive comprehensive answers. Finally, the innovative method of teaching is technology-based learning that comprises e-learning training programs, simulators, and interactive videos with interesting and useful information. During training programs, nurses can receive fundamental knowledge and care skills by simulating interactions with patients. Additionally, coordinators can record and track the progress of participants and address challenging points.

Possible questions

During sessions, students can have numerous questions concerning medication errors and prevention procedures and strategies. For example:

What are the most prevalent causes of MAEs:

Distractions, incorrect dose, and wrong prescription;

Contributing factors:

Poor communication, staff’s negligence and ignorance, and patients’ age and diseases.

How to prevent MAEs:

Double-check the dosing and medications, write legibly and without abbreviations, check drugs’ contradictions and patients’ age, weight, allergies, existing comorbidities, and conditions of the kidneys and liver, be aware of high-risk medications, and monitor patients’ states.

Feedback Encouragement

Feedback from the audience helps determine both enjoyable and struggling activities and assesses the outcomes of the sessions. In this respect, to encourage feedback, the educator can ask questions during the sessions, which are related to the course’s material and learners’ interests. Furthermore, the educator can perform a post-training evaluation survey that contains various questions regarding the course’s goals, structure, activities, and content, the quality of delivery, a trainer, and technical issues. It is also helpful to utilize one-to-one feedback with participants of different occupations, including a pharmacist, RN, or nurse manager. Finally, the coordinator can use other channels such as emails, social media platforms, or telephones. It is also worth noting that it is vital to be open and demonstrate the desire to feedback and encourage honest answers.

Future Improvements

The obtained feedback can be employed while designing future training sessions and selecting respective activities. In particular, it can help tailor the structure and duration of the course to learners’ needs and preferences, and improve the content and ways of its delivery. In addition, feedback aid in averting the most frequent technical issues, including bugs, dead links, problems with video and material loading, and the course’s overall functionality. Due to feedback, educators have an excellent opportunity to explore drawbacks in their communication and areas needing immediate consideration. Finally, educators can make relevant adjustments to the learning environment to make it more conducive for learning.

Conclusion

In summary, the paper has provided an overview of MAEs and the SIP and examined the staff’s role in implementing the plan. In particular, MAEs still remain one of the most prevalent medical safety issues, comprising thousands of hospitalizations and deaths each year. The SIP primarily targets improving patients’ and nurses’ education and environmental conditions and providing technological interventions. The staff encompasses many roles while implementing the SIP, including coordinating, delivering quality data, and diagnosing and treating patients. The direct benefit for personnel is an improved working atmosphere, sound communication, and motivation, and the acquisition of new skills and knowledge. Learning activities can consist of lectures and webinars, case studies, job rotation, on-the-job training, coaching, and e-learning training programs. The feedback can be derived through a post-training evaluation survey and digital channels and be applied to refine the course’s structure, design, and content.

References

Hammoudi, B. M., Ismaile, S., & Abu Yahya, O. (2018). Factors associated with medication administration errors and why nurses fail to report them. Scandinavian Journal of Caring Sciences, 32(3), 1038-1046. Web.

Medication errors and adverse drug events. (2019). Patient Safety Network. Web.

Rahimi, E., Alizadeh, S. H., Safaeian, A. R., & Abbasgholizadeh, N. (2020). An investigation of patient safety culture: The beginning for quality and safety improvement plans inpatient care services. Journal of Health, 11(2), 235-247. Web.

Safaeifard, N., Roshangar, F., Ebrahim, H., Moonaghi, H. K., & Janani, R. (2019). Preferred learning styles of nurses in in-service training courses at Tabriz University of Medical Sciences. Acta Facultatis Medicae Naissensis, 36(1), 69-78. Web.

Tariq, R. A., Vashisht, R., Sinha, A., & Scherbak, Y. (2021). Medication dispensing errors and prevention. StatPearls Publishing.

Wondmieneh, A., Alemu, W., Tadele, N., & Demis, A. (2020). Medication administration errors and contributing factors among nurses: A cross-sectional study in tertiary hospitals, Addis Ababa, Ethiopia. BMC Nursing, 19(1), 1-9. Web.

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