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Study of Factors
Medication errors are among the most widespread and potentially adverse safety issues that directly impact nursing practice, hospital revenues and expenditures, and patient satisfaction. According to Cheragi, Manoocheri, Mohammadnejad, and Ehsani (2013), 64.55% of the nurses who took part in their research have experienced medication errors, whereas 39.86% of mistakes were not repeated. The delivery of medications is a high-risk activity that can lead to various adverse consequences, including the increased length of stay, different comorbidities, additional costs spent on treatment, and, in some cases, fatal outcomes.
Nursing leadership can draw attention to this problem by emphasizing the importance of systems thinking. The prevalence of medication errors is directly related to other issues such as understaffing, high workload, the lack of training, unclear safety guidelines, and the unit environment (Frith, Anderson, Tseng, & Fong, 2012). In this case, strategic leadership (objective-oriented leadership) could help nursing professionals understand what aims they have with regard to medication errors (e.g., decrease the number of errors to 50% by 2018), how these aims can be achieved (ensure adequate staffing and training of newcomers), and what other issues need to be considered (reorganize the unit and the environment so that they support the clinical practice). The lack of policies regarding understaffing and time pressure directly relates to the greater number of medical errors; for example, the higher number of total hours per one nursing shift increased the number of medication errors made by nursing professionals (Frith et al., 2012). Therefore, it is obligatory to address understaffing, time pressure, and burnout in nurses at the organizational level to reduce the number of medication errors.
Recommendations
The recommended evidence-based strategy for the issue is a computerized provider order entry (CPOE). The strategy was proven to be effective by Radley et al. (2013) despite its modest adoption in American hospitals and clinics. CPOE can decrease the number of medication errors due to poor handwriting or wrong transcription; it also often includes information about dosage, harmful interactions, and clinical decision support (Radley et al., 2013).
To collect information about the safety concern, it is suggested to conduct monthly surveys among nurses and patients; surveys will contain questions about medication errors, their severity, and perceived cause. All surveys will need to be anonymous to exclude social desirability or any other bias. The surveys will be collected at the end of the month, analyzed by a nursing leader and a manager; its findings will be presented in the unit in written form and e-mailed to all nursing professionals. With the help of these surveys, the manager will be able to assess and find the most important perceived cause of medication errors and address it accordingly.
Implementation Plan
Quality indicators will include nurses’ adherence to the use of CPOE, the number of prescriptions provided via CPOE, and the number of medication errors made during the implementation period (six months; surveys will be conducted at the end of each one). To monitor outcomes, monthly data on the number of medication errors will be compared to the number of prescriptions via CPOE with regard to other factors such as possible understaffing, the length of nursing shifts, and the complexity of the patient’s case. The procedure of medication prescription will be changed; all nursing professionals will be required to use CPOE to provide patients with prescribed medications. Error increases will also be monitored like some of the studies report that the use of CPOE can make the number of medication errors greater in some cases (Radley et al., 2013).
Additional training will be required for the nursing staff as well. All nursing professionals will need to get acquainted with the four-step process of medication prescribing and administering (ordering, transcribing, dispensing, administration). Although CPOE-software is usually user-friendly, it will require five to ten training sessions so that the working process at the rehabilitation center can continue without severe disruptions due to nurses’ inability to work with the system. To provide sufficient training and improve the clinical care with CPOE, nursing professionals will need to visit several short lectures and three to five practical workshops that will focus on CPOE usage. Furthermore, the management also plans to send instructions for CPOE use to nursing professionals directly so that they can study those at any time suitable for them.
There are several limitations in the CPOE-approach. First, it increases the technology dependence of nursing professionals; any disruptions in the program will adversely influence the working process. Second, as was already mentioned, CPOE can increase the number of medical errors in some cases. It is suggested to use a clinical decision support system together with CPOE to avoid additional medication errors (Radley et al., 2013). Third, the implementation of CPOE might at first negatively influence the time of admission and discharge, especially during the first month of implementation, as the working process will adapt to the usage of CPOE on a daily basis. Fourth, there is no clear evidence that the use of CPOE can directly prevent patient harm, although it does decrease the number of medical errors approximately by 12% (Radley et al., 2013). Its effectiveness will be evaluated both by the manager and nursing professionals throughout the implementation process.
References
Cheragi, M. A., Manoocheri, H., Mohammadnejad, E., & Ehsani, S. R. (2013). Types and causes of medication errors from nurse’s viewpoint. Iranian Journal of Nursing and Midwifery Research, 18(3), 228-231.
Frith, K. H., Anderson, E. F., Tseng, F., & Fong, E. A. (2012). Nurse staffing is an important strategy to prevent medication errors in community hospitals. Nursing Economics, 30(5), 288-294.
Radley, D. C., Wasserman, M. R., Olsho, L. E., Shoemaker, S. J., Spranca, M. D., & Bradshaw, B. (2013). Reduction in medication errors in hospitals due to adoption of computerized provider order entry systems. Journal of the American Medical Informatics Association, 20(3), 470-476.
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