Medication Errors in the Elderly Treatment

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Table of Contents

Introduction
Annotated Bibliography
Literature Evaluation
Conclusion
References

Introduction

Thousands of patients suffer or even die because of dangerous or substandard treatment their doctors prescribe. The patients’ safety is a key to the quality health care system that prioritizes and guarantees medication safety. It is one of the crucial aspects of a patient’s safety during his stay in the hospital. The main objective of every medication is to reduce patients’ suffering, but not to increase it. That is why it is necessary for medical personnel to provide high-quality services and to state the patient’s comfort as their primary concern (Keers, Plácido, Bennett, Clayton, Brown, Ashcroft, 2018). However, as some research shows, medical errors occur occasionally, especially when treating the elderly. The essential factor to adequately treating the elderly without any mistreatment occurring is careful consideration of the medication doses prescribed to a patient because metabolism slows with age. Hence, it takes time for older people’s bodies to take the medication properly. If the medicine is not absorbed in the right way, older people may face side effects, which in combination with poor health conditions may result in the patient’s death.

As practice shows, the cause of most inaccuracies is the human factor which can be either wrongly prescribed medicine or improperly educated nurse (Keers, Plácido, Bennett, Clayton, Brown, Ashcroft, 2018). However, the reason for interruptions may also be the doctor’s confidence in him being right and prescribing the proper treatment. Medication administration errors are often connected to medical personnel’s negligence, inaccuracies, or lack of knowledge. Anyway, similar to all patients, older people require considerate treatment and more attention to their medication prescription. Everybody has the right to quality medical treatment, which is effective, safe, and oriented on people’s needs. It is also essential to provide patients with high-quality treatment because both proper and improper treatment affect the reputation of a particular health care institution. Hence, the medical personnel should be appropriately educated and attentive to the patients and to the treatment he prescribes.

All the articles chosen relate to the problem of medication errors that occur while treating the elderly. They address different aspects of the problem, which allows looking at it from different perspectives. They also contain some statistical data that help to assess the scale of the situation in numbers.

Annotated Bibliography

Article 1

Raban, M. Z., & Westbrook, J. I. (2013). Are interventions to reduce interruptions and errors during medication administration effective?: A systematic review. BMJ Quality & Safety, 23(5), 414–421. Web.

The authors present the results of their qualitative research on the connection between interventions and medication administration interruptions and their impact on medication administration errors. The study’s main aim was to find out if interventions to reduce interruptions during medication administration may be considered an effective way to decrease interruptions and medication administration errors. The main methods the authors used during the research were data collecting and analysis. The authors analyzed ten studies from different sources, including MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Effective Practice, Organization of Care Groups, Google, and Google Scholar. The information collected by the authors of the research reports quantitative data based on direct observations of interruptions or medication administration errors. Overall, the authors found 626 citations from the searches. Only 10 of the articles met the requirements of the study and were included in the review – eight from North America and two from Europe. However, the present ten sources provided weak confirmation of the authors’ hypothesis mainly due to the small number of statistical data or lack of inter-rater reliability assessments.

The study’s strength concerns the fact that apart from the lack of statistics, the researchers found out that interventions might be an effective way to reduce the ratio of interruptions and errors during medication administration. However, the study’s strength is inseparable from its limitations due to insufficient information on the topic. The majority of sources did not contain any statistical data on the observed sample size and did not assess the reliability of the data. They also used staff from the same medical institutions as observers, which may become the reason for bias.

The generalization of the study findings is complicated because the research was conducted in the United States only, usually in one hospital, in the same wards, and considered the same medical personnel. That is why the present research seems to require further data gathering and analysis in order to provide more factual findings on the topic. However, the current results may be considered quite promising.

Article 2

Metsälä, E., Viherkoski, U. (2013). Medication errors in elderly acute care – a systematic review. Scandinavian Journal of Caring Sciences, 28(1), 12–28. Web.

The authors define the main aim of the present research as improving the prerequisites of the old age patients’ medication safety by reviewing statistical data of medication errors in elderly treatment. The methods of the research are data gathering and statistical analysis. The sources of the up-to-date information related to the study’s main objective are Cinahl, Medline, Cochrane, JBI Connect+ databases, and Finnish health care databases Medic and Ohtanen. The overall number of studies the authors selected for the research was 20 – eight from the USA, seven from Europe, three from Taiwan, and one each from Canada and Australia. The results of the study prove that the most medication errors mentioned in the research concerned nursing competence, prescription- and patient-related factors, medication work organization and nursing process, and safety culture.

The strengths of the research concern the fact that the paper provides concrete data on the topic of medication safety of the elderly and the most widespread medication errors occurring during their treatment. The study also offers several practical implications of the results for improving the medication safety of older people. The limitations of the research regard the fact that its timeline is limited to the years 2001-2011. The authors chose the 10-years limit because the treatment of the elderly and the medication administration process evolve fast, and new criteria and data for the analysis emerge. That is why it is almost impossible to regard the results of any study on the field in the long-term perspective. Another limitation of the research concerns the language of the sources because the authors considered those published only in English or Finnish. This approach did not enable them to study medical data published in other languages. It may be regarded as a significant shortcoming, as the analysis of more sources published by scientists from different countries might have resulted in other conclusions and statistical data.

Overall, the present research may be considered a relevant and up-to-date piece of scientific work. Its results may be implemented to reduce the number of medication administration errors in older people’s treatment. However, the research may need further consideration and fact-checking in 5-10 years due to the fast changes that happen in the field of treating the elderly.

Article 3

Tariq, A., Georgiou, A., & Westbrook, J. (2013). Medication errors in residential aged care facilities: A distributed cognition analysis of the information exchange process. International Journal of Medical Informatics, 82(5), 299–312. Web.

The present article is qualitative research on the topic of medication safety and medication errors. The aim of the study was to explain the cognitive distribution that defines residential aged care facilities (RACFs) medication ordering and delivery to figure out gaps in the theoretical data that lead to medication errors. The data were collected by conducting ethnographic analysis from May 2011 to September 2011. The qualitative methods of the analysis included minimally instructive direct observations, semi-structured interviews, and artefact analysis. Observations were conducted mainly during day shifts of medical personnel, which is from 7 a.m. to 3 p.m., as, statistically, medication activities are the most intense during that period.

It was established during the research that the majority of medication-related errors in RACF medication ordering and delivery do not attribute to individual care providers. The researchers found out three significant factors medication errors contribute to. First, the design of medication charts complicates the ordering procedure. Then, slow coordination between the participants of medication order and delivery process causes the lack of coherence between GPs, hospitals, and community pharmacies. Finally, using mainly fax and telephone as a prevailing means of communication complicates the process of information exchange between hospitals and pharmacies, as the data updates quickly, and pharmacies need to constantly double-check it.

The strengths of the present research concern the fact that it reveals and enumerates the reasons for medication-related errors and explains the reasons for their appearance. Besides, it provides an accurate assessment of the elements composing the medication ordering and delivery process. However, the researchers single out several limitations of the study, which concern only one organizational setting with established organizational practices. The authors stress that they had no intentions of generalizing the data collected to the population of RACFs. Overall, the present research is important for understanding the process of occurring medication errors, though it may need further consideration.

Article 4

Westbrook, J. I., Li, L., Lehnbom, E. C., Baysari, M. T., Braithwaite, J., Burke, R., Conn, C., & Day, R. O. (2015). What are incident reports telling us? A comparative study at two Australian hospitals of medication errors identified at audit, detected by staff and reported to an incident system. International Journal for Quality in Health Care, 27(1), 1–9. Web.

The article in question reveals the quantitative research conducted among the patients of two major academic hospitals in Australia. The study had three main objectives concerning the ratio of medication errors. The first was to compare medication errors identified during audit and observation with medication incident reports. Then, the study needed to determine the difference between the two hospitals regarding the medication error rates and incident report frequency. The third aim was to identify the ratio of prescribing error detections by the staff. The researchers’ methods during the study regarded the comparative analysis of the data on the electronically reported accidents on medication errors that occurred in the two hospitals involved in the research.

The research identified 12 567 medication errors on the whole. However, only 1,3 percent of them were reported. The medical personnel detected 21, 9per percent of all clinically important prescribing errors, but only 6 percent of them were reported. Overall, only 1 of 1000 medication-prescribing errors identified during the research was reported to the incident system. However, only 10 percent of the reported errors had evidence of being reported by the medical personnel. The researchers found no relation between the number of reported medication errors and the actual rate of prescribing errors. However, they established that the first hospital detected errors and reported them to the incident system more often than the second one.

The main strength of the present research is the availability of relevant and reliable data from the studies of the previous years, which enabled the researchers to make quite a precise and concrete conclusion. The study’s limitations concern the fact that the authors relied mainly on documented evidence concerning error detection, which may establish an underestimated ratio of medication errors. As mentioned in the study results, only around 2 percent of them were reported to the incident system. Hence, it is necessary not to rely only on the officially documented data when studying the ratio of the errors related to the medication prescription. Overall, the present study still proves that medical personnel’s lack of reporting medication errors is a significant problem for health care. The insufficient data prevents the therapists from assessing the possible health damage that a particular way of treatment may cause to the patients.

Literature Evaluation

The four present articles address the issue of medication-related errors when treating the patient, the elderly, in particular, and provide scientific data on the topic. Each report deals with different aspects of the issue. Thus, the first study (Raban & Westbrook, 2013) is devoted to the impact of interventions on interruptions and errors during medication administration. However, the research results present weak confirmation of the authors’ hypothesis, mainly due to the limitations, which include the same medication institution for each of the ten studies the authors analyzed. However, even with those limitations, the authors managed to prove that interventions may reduce interruptions which lead to medication administration errors.

The second study (Metsälä & Vaherkoski, 2013) proves that the human factor involving nurse competence as well as work organization and the nursing process are among the key reasons for medication prescription and administration errors. Hence, it is possible to establish the relationship between the competence level of the medical personnel, the work environment, and the medication-related errors. Thus, the more quiet and undisturbed the nurses’ workplace is, and the more skilled nurses are, the fewer medication errors occur. However, this hypothesis may require further consideration and scientific confirmation.

Medication-related work organization presumes not only the process of medication prescription and preparation but the process of medication ordering and delivery as well. The third article (Tariq, Georgiou & Westbrook, 2013) aims to identify gaps in medication-related information exchange between medical institutions in order to figure out the possible limitations that relate to the errors. The results of the authors’ research prove that the main reasons for the work organization-related errors concerning ordering and delivery of medication lie in the lack of information exchange between hospitals, GPs, and pharmacies. The analysis provided by the authors of the research highlights how poor information exchange may result in severe damage to patients’ health conditions. Thus, establishing the proper communication channel between medical institutions will help prevent medication order and delivery errors and

When continuing the description of the medication errors caused by the human factor, the first (Raban & Westbrook, 2013) and the second (Metsälä & Vaherkoski, 2013) studies mention, there is one more aspect to describe. It relates closely not only to the competence of the medical personnel but to the people’s general decency. This aspect is the medication incidents reports made by the doctors and nurses. It is the subject of the fourth study (Westbrook, Li, Lehnbom, Baysari, Braithwaite, Burke, Conn & Day, 2015), which compares the number of medication errors identified during the audit with the number of the reported incidents. The study results reveal the unpleasant truth – the majority of medication error cases remain unreported, which harmfully influences the statistics of the risks a particular treatment carries for patients.

Overall, the results of these four studies supplement each other. They help the people see that the majority of the medication-related errors worldwide are caused either by a human factor or by the unacceptable working conditions of the medication institutions. Hence, it is necessary to educate medical personnel and modify the working environment in order to provide proper health care conditions for the patients. The studies help improve people’s understanding of the nature of medication-related errors by providing numbers, figures, and scientifically confirmed data. The three studies provide a substantial confirmation of their hypothesis that medication errors are caused either by the human factor or the lack of communication between medical institutions and often remain unreported. However, one study (Raban & Westbrook, 2013) on the effectiveness of interventions in reducing interruptions during the medication administration process provides insufficient data and may require further consideration and confirmation.

Conclusion

To summarize, the analyzed studies reveal the problem of improper organization of the healthcare system that causes most medication errors when treating patients. The results of the present studies concern people of all age groups, but it is vital to consider them when treating the elderly. Safe use of medication is essential for people of old age because age alone brings many challenges and health issues that may deteriorate with the improper use of medication. The insufficient data on the influence of improper treatment on older people’s organisms prevent scientists from making proper conclusions concerning possible health outcomes for the patients (Keers, Plácido, Bennett, Clayton, Brown, Ashcroft, 2018). Hence, it is necessary to consider the results of four present studies while treating the elderly in order to avoid possible errors.

The results of the research are also applicable to the work process of nurses, as quite a number of mistakes reported by the four studies regarded the nurse competence and medical proficiency. The present studies may help decrease the number of human factor-related errors and improve the nursing process because they show the importance of attentive medication prescription and preparation and double-checking medication administration. The last one is a standard practice implemented in hospitals, particularly for high-risked drugs (Koyama, Maddox, Li, Bucknall, Westbrook, 2020). The results of the studies may be used to educate and properly train nurses in order to decrease the number of medication administration mistakes.

References

Keers, R. N., Plácido, M., Bennett, K., Clayton, K., Brown, P., Ashcroft, D. M. (2018). What causes medication administration errors in a mental health hospital? A qualitative study with nursing staff. PLoS One, 13(10).

Koyama, A. K., Maddox, C-S. S., Li, L., Bucknall, T., Westbrook, J., I. (2020). Effectiveness of double-checking to reduce medication administration errors: A systematic review. BMJ Quality & Safety, 29(7), 595-603.

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