Nurse’s Perspectives on Medication Safety in Critical Care Units in Saudi Arabian Hospitals: A Pilot Study

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Table of Contents

Introduction
Background
Literature Review
Medication Safety in Saudi Arabia
Medication Safety in the Middle East
Medication Safety in the World
Medication errors
Conclusion
Reference List

Introduction

The concept of medication safety refers to the errors made by medical professionals during various treatments that involve the use of medications of different types. The errors of this kind are known to be some of the most frequent cases of medical malpractice that often lead to the deterioration of a patient’s condition and iatrogenic injuries that sometimes may be irreparable (Al-Jeraisy, Alanazi,&Abolfotouh, 2011). The issues of medication safety and medication errors have a global character and are faced by the hospitals and medical professionals all over the world (Aljadhey,Alhusan, Alburikan, Murray, & Bates, 2013). It is important to notice that regardless of its commonness, this problem is preventable and can be successfully addressed under the circumstances of deep understanding of the factors that contribute to its development. Even though medication errors are present in the hospitals all around the world, the causes of these mistakes are similar from a country to a country.

Background

This research focuses on the medication safety in critical care units from the perspective of nurses in Saudi Arabia. The main contributing factors of the medication errors in this state are several, among them there are the unrestricted access to medicines, lack of innovative technologies and systems helping to modernize health care service delivery and improve its quality, issues of communication between different medical organizations and facilities, and insufficient attention to the problems of medication safety expressed in the lack ofhealthcare programs addressing the errors (Aljadhey et al., 2014).When it comes to nurses, their impact on the rates of medication safetywill depend on such factors as their acceptance and knowledge of the safety practices, their agreement with these practices, and their overall job satisfaction (Smeulers, Onderwater, van Zwieten, &Vermeulen, 2014). The last factor is tightly connected to the workplace organization and climate in the medical facility. In other words, the working conditions of the nursing staff in a hospital are critical for the improvement of the quality of the patient care and the minimization of the number of medication errors (Walston, Al-Omar, Al-Mutari, 2010). The main causes of the medical errors among the medical staff are the inadequate or inequitable allocation of workloads that leads to burnout and depersonalization, insufficient nurse to patient ratio, chaos and confusion at the workplace, tension between the employees due to various factors such as bullying, or misunderstandings and confusion of duties (Al-Homayan,Shamsudin, Subramaniam& Islam, 2013). As the common causes of serious medical errors, medication administration and safety are to be researched and monitored. While in the Western countries the practice of evaluation and researching of the medication administration is frequent, the countries of the Middle East and the Kingdom of Saudi Arabia namely experience a knowledge gap in this sphere due to the lack of research addressing this issue.

If properly researched and analyzed, medication safety problem can be addressed and prevented. This research targets studies focusing on the nurses’ perspectives on the subject of medication errors in Saudi Arabia specifically and in the world in general. For this paper, a search of relevant scholarly articles was accomplished. The main tools assisting the information search process were Google Search and Google Scholar. As the information concerning the nurses’ perspectives on the medication safety practices in the critical units in Saudi Arabia is limited, the studies exploring the same issue in other countries of the Middle East and the world in general were located. A total of fifteen scholarly sources were selected for this paper. The chosen articles focus on the main subject and some of the topics closely related to it. Apart from the primary topic, the selected studies also address such issues as challenges to the medication in Saudi Arabia in the future, factors that create a negative impact on the workplace climate in the medical facilities causing a threat to the medication safety, the nurses’ willingness to report the cases of medication errors, patient safety culture in the hospitals of Riyadh, factors that cause medication errors made by nurses, to name a few. Besides, the research by Alahmadi (2010) demonstrated that many nurses in Saudi Arabia believe the medication errors caused by inadequate workloads is a management problem that occurs when the leaders fail to accomplish their tasks and duties.

Among all the medical workers, nurses are the ones who are the most frequently responsible for the medication administration practices, and this is why their perspectives on this process need to be studied as preventing medication errors will lead to the reduction of the patient morbidity and mortality (Al-Youssif, Mohamed, & Mohamed, 2013; Pirinen et al., 2015). Surprisingly, the points of view of the RNs have not been explored by the researchers regardless of their extremely active role. The investigation of the factors that impact the quality of the medication administration provided by nurses will shed light on some of the most crucial influences and need to be addressed to help the nurses as well as their patients.

Literature Review

Search Strategy

The strategy applied to search the relevant literature is PICOT. This strategy helps the researcher to divide the question they are trying to address into a number of categories and make the search of the needed materials easier. The five categories the abbreviation PICOT refers to are population, intervention, comparison, outcome, and time frame. These spheres are the main focuses used to analyze the subject and determine the keywords. In the case of the nurses’ perspectives on the medication safety in critical care units in Saudi Arabian hospitals, the categories are the following: nurses (RN’s, registered nurses) as population, medication safety (medication errors, medication administration) as intervention, unsafe medication (treatment or patient care of low quality) as comparison, and positive and negative patient outcomes. The category of time frame is inapplicable to this subject, so it could be replaced with the category of the location which is critical care units and Saudi Arabian hospitals. The following literature review will present the studies selected for the research in three main groups – the overview of the addressed issue in Saudi Arabia, the same problem in the Middle Eastern countries, and in the global context. In other words, the literature will be grouped geographically.

Medication Safety in Saudi Arabia

The study of Aljadhey et al. (2014) is a qualitative research featuring medical practitioners of various specialties (nurses included) employed in Saudi Arabian hospitals and their discussion of the medication safety perspectives. The outlined challenges of medication safety included communication, innovation, and knowledge gaps among the medical workers of Saudi Arabia (Aljadhey et al., 2014). The solutions proposed focused on the improvement of education for the medical professionalsand policy-making addressing the assessment of medication safety knowledge among the medical staff. The work by Alahmadi (2010) is in agreement with the point of view concerning the assessment of patient safety in Saudi Arabia. In addition to all of these challenges and solutions, Almutary and Lewis (2012) emphasize that medication administration culture is another crucial aspect to address as there is a common tendency of failed reporting of medication errors by the nurses. This action has to be encouraged in order to prevent the undocumented mistakes, and the assessment is to be more careful and frequent to prevent misunderstandings of the duties and responsibilities by the staff.

The study by El-Jardali, Sheikh, Garcia, Jamal and Abdo (2014) as well as those of Al-Ahmadi (2008) and Al-Homayan, Shamsudin, Subramaniam and Islam (2013) target the region of Riyadh and its hospitals researching the factors that impact the nurses’ performance quality and patient safety culture. While Al-Ahmadi (2008) studies the nurses’ job satisfaction as the factor contributing to the patient care quality and the rates of medication errors, El-Jardali, Sheikh, Garcia, Jamal and Abdo (2014) investigate the issue in a more detailed way focusing on staffing opportunities of the Riyadh hospitals. The authors of both studies conclude that the positive nurse to patient ratio is the key to preventing multiple medication errors. As for the work by Al-Homayan, Shamsudin, Subramaniam and Islam (2013), the authors point out that the nurses’ contextual performance influences their task performance and overall productivity quite a lot as any nurses work additional time just to fulfill the specific requests and needs of their patients, provide individual approach. This tendency adds to the overloading of the nurses and contributes to fast burnout rates within this career field.

The work by Alsweed, Alshaikh, Ahmed, Yunus, and Househ (2014) discusses the role of innovation in the issue of medication safety in Saudi Arabia from the perspective of the nurses. The authors find that the employment of the computerized provider order entry system made a significant positive impact on the professional performance of the nurses because it helped them to manage the workflow easier and avoid confusion and chaos. This research demonstrates that the engagement of the computer technologies and the newest systems is crucial for the hospitals and the staff to function efficiently and properly. Computerized operations management systems are getting more and more popular among the hospitals all over the world due to the fact that they prove to be extremely useful for time and resource management, workloads distribution and optimization, and the process organization.

Medication Safety in the Middle East

The study by Alsulami, Conroy,andChoonara (2013) is a systematic literature review covering the medication error tendencies and causes in all of the Middle Eastern countries. The authors find that even though there is a number of factors that contribute to the medication prescription and administration errors, the main causes are the lack of prescribing skills, pharmacological knowledge leading to failed medication administration (Alsulami, Conroy,Choonara, 2013) which is in agreement with the findings of the survey by Aljadheyet al. (2013). The works by Bahadori et al. (2013) andFathi et al. (2014) focus on the issue of reporting of the medication errors by the nurses and the reasons why the reports are often not delivered. Just like the study investigating the same problem in Saudi Arabian hospitals, Bahadori et al. (2013) finds that refusal to report medication errors by the nurses is a managerial mistake and can be addressed by means of shifting the culture within the workplace and employing a more compliance-encouraging way of addressing errors (Almutary& Lewis, 2012). Fathi et al. (2014) explore the frequency of errors and their types discovering that the prescription and administration of unauthorized drugs is the most common error. In other words, the knowledge of medications and nursing education are the keys to preventing further misadministration. A similar study targeting the hospitals of Jordan revealed that the main factors contributing to medication errors there are heavy and inequitable workloads and inexperienced staff causing confusion at the workplace (Al-Shara, 2011). That way, the issue of insufficient education is accompanied by staffing problems as Jordan hospitals are struggling to find the required amount of human resources. Finally, the study by Alkorashi (2013) targets the nurses’ point of view on the main factors impacting patient safety in all the countries of the Middle East. The author confirms all the findings of the other researchers and emphasizes that the management of nursing workforce in the Middle Eastern countries requires a lot of changes and improvements. Besides, the culture of blame that exists in the region makes the nurses reluctant to report errors, and also contributes to the unwillingness of young people to choose medical careers which consequently leads to the nursing shortage and heavy workloads (Alkorashi, 2013). The list of problems faced by the Middle Eastern hospitals seems like a cursed circle where the problems aggravate one another. Therefore, the solutions are hard to find and apply.

Medication Safety in the World

The research by Welters, Gibson, Mogk and Wenstone (2011) targets the report of incidents in critical care units in England and establishes the importance of error reports for the investigation and prevention of the causes of incidents. This conclusion confirms the recommendation of the introduction of non-blame hospital culture in the Middle East so that the appropriate policies could be made and implemented to improve the performance of nurses and patient care quality. The study by Reader, Flin, and Cuthbertson (2008) explore miscommunication in critical units as a factor contributing to the rates of medication errors and emphasizes the importance of teamwork and collaboration. Two different solutions are applicable here – the creation of friendly and cooperative workplace atmosphere and the employment of new technologies to optimize the working process and optimize or even eliminate some of the processes. Anthony, Wiencek, Bauer, Daly, and Anthony (2010) explore the impact of interruptions of medical staff during work as a source of errors. This factor is unexplored, but the researchers find that creating calmer surroundings for the nurses adds to their productivity and precision. This factor correlates with workplace chaos that occurs due to failed systemization of workforce. Finally, the works by Mayo and Duncan (2004), Armutlu, Foley, Surette, Belzile and McCusker (2008), and Bohomol and Ramos (2008) target the sources of medication errors as perceived by nurses in the USA, Canada, and Latin America accordingly.All of the authors named the following causes as the most common: distraction, exhaustion, and staff miscommunication. The rates of unreported errors in the countries North and South America are much lower than those of the Middle East which indicates different attitudes and culture within the medical facilities. At the same time, the hectic environments, confusion, and heavy workloads are as widespread as they are in the Middle Eastern hospitals. Besides, the issue of the nursing shortage that majorly contributes to the inequitable workloads and long shifts is a global problem that affects the medical organizations all over the world regardless of the region.

Medication errors

It should also be said that another important aim of medication safety is the attempt to avoid medication errors which happen in the course of treatment. The study of Manias, Kinney, Cranswick, Williams and Borrott (2014) states the fact that during the last decade the number of medication errors has significantly increased. It means that despite all attempts to improve the level of services provided by the healthcare system, there are still some problems in the sphere of medication safety. The authors of the work underline fact that these errors result in significant deterioration of the image of the whole sector and, that is why, great attention should be devoted to this question. One of the possible solutions to the existing problem is the systematical examination of the main ways of usage of medication and evaluation of specialists, who work in the given sphere. However, the problem is complicated by the fact that there is no clear definition of a medication error and it is difficult to prove the fault of a specialist. Lisby, Nielsen, Brock, & Mainz (2012) in their work suggest a certain procedure which could help to define the medication error and determine whether it is the fault of a specialist of not. The authors underline the fact that introduction of the outlined test is very important for modern health care sector as it could help to increase the level of medication safety and create a powerful remedy to monitor the state of the whole sphere. With this in mind, it is possible to conclude that the problem of a medication error is rather topical now and needs further investigation in order to guarantee safety for patients and improve the image of the healthcare sector.

Conclusion

The literature review conducted for this paper focused on the nurses’ perspective on medication safety in critical care units in Saudi Arabian hospitals. The studies targeting this particular issue are multiple and various. The review grouped the selected literature into three categories based on their geography (Saudi Arabia, the Middle East, the world) and demonstrated that most of the problems and factors contributing the medication errors and patient safety are the same for the hospitals of any regions.

Reference List

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Aljadhey, H., Alhusan, A., Alburikan, K., Murray, M., & Bates, D. (2013). Medication safety practices in hospitals: A national survey in Saudi Arabia. Saudi Pharmaceutical Journal, 21(2), 159-164.

Aljadhey, H., Mahmoud, M., Hassali, M., Alrasheedy, A., Alahmad, A., & Saleem, F. et al. (2014). Challenges to and the future of medication safety in Saudi Arabia: A qualitative study. Saudi Pharmaceutical Journal, 22(4), 326-332.

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Bahadori, M., Ravangard, R., Aghili, A., Sadeghifar, J., Gharsi Manshadi, M.,& Smaeilnejad, J. (2013). The Factors Affecting the Refusal of Reporting on Medication Errors from the Nurses’ Viewpoints: A Case Study in a Hospital in Iran. ISRN Nursing, 2013, 1-5.

Bohomol, E., & Ramos, L. (2006). Perceptions about medication errors: analysis of answers by the nursing team. Revista Latino-Americana De Enfermagem, 14(6), 887-892.

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