Right of medication administration
Medication error defined as “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of health professional, patient or consumer”. Such events may be related to professional practice (the 8 rights; right patient, right medication, right dose, right route, right time, right documentation, right reason and right effect. ), health care products, procedures, and systems, including prescribing, order communication, product labeling, packaging, and nomenclature, compounding, dispensing, distribution, administration, education, monitoring and use.
Some of the factors associated with medication errors include the following: dedications with similar names or similar packaging, forgetting to check for known allergy, misreading medication names that look similar is a common mistake and understand; nurses are left alone to administer medication when two nurse are require to witness and double check it first but nurses are too busy to do this all the time because it’s such a time consumer/waster.
Among many reasons for the prevalence of nurse involvement in medication errors is that nurses may spend as much as 40 percent of their time in medication administration. The purpose of conducting this research is to investigate whether the 8 rights of education administration really are being followed by all nurses in all health care setting or not.
I believe most nurses don’t use or follow the 8 rights of medication administration and that medication error is the result of it. Literature Review on Patient Safety and Quality, Medication Administration Safety One commonly used definition for a medication error is: Medication error defined as “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of health professional, patient or consumer”.
With the growing reliance on medication therapy as the primary intervention for most illnesses, clients receiving medication interventions are exposed to potential harm as well as benefits. Proper uses of medication’s Benefits are effective management of the illness/disease, slowed progression of the disease and improved patient outcomes with few if any errors. Harm from medications can arise from unintended consequences as well as medication error (wrong patient, wrong medication, wrong time, wrong dose, etc. ).
Medication safety is a top priority for long-term care facilities and the reasons are clear: the harm to residents from education errors is great, the cost of such errors to society is high, and accrediting organizations, federal agencies, and third-party payers expect facilities to adopt the numerous strategies currently available to prevent medication errors. Therefore, reducing the frequency and severity of medication errors and adopting strategies to prevent adverse drug events are ongoing goals for facilities by the use of the 8 rights of medication administration and facilities’ policies.
Summary In this study conducted by Rondo G. Hughes and Mary A. Baleen have studied that actors associated with medication errors most of the time are: medications with similar names or similar packaging (Look-alike/sound-alike medication names); medications that are not commonly used or prescribed; commonly used medications to which many patients are allergic (e. G. Antibiotics, opiates, and nonessential anti- inflammatory drugs) and medications that require testing to ensure proper (I. E. Nontoxic) therapeutic levels are maintained (e. G. Thumb, warfare, Diophantine, and dioxin) which of all can be recognizes and easily identify if the 8 rights of medication administration are use or follow. Misreading medication names that look similar is a common mistake. These look-alike medication names may also sound alike and can lead to errors associated with verbal prescriptions and verbal medication administration authorizing/empowering in the case of emergency and those ones are considered the most problematic medication names across settings that can be distinguish by triple check and peer review.
This Journal has found that medications with complex dosing routines and those given in specialty areas such as intensive care units, emergency departments, and agnostic and international areas are these associated with increased risk of adverse drug reaction that are also easily recognizable and preventable with a triple check and peer-review (Pamela & Uteri, 2010 & O’Connell et al 2007) which basically are part of the 8 rights of medication administration.
This study has found that deaths the most severe adverse drug events associated with medication errors involved central nervous system agents, antiseptics, and cardiovascular drugs. Most of the common types of errors resulting in patient death involved the wrong dose (40. Percent), the wrong drug (16 percent), and the wrong route of administration (9. 5 percent) as a result of not following the 8 rights of medication administration. Oral and written miscommunication, name confusion like names that look or sound alike were among these deaths was reasoned at.
Early research on medication administration errors reported an error rate of 60 percent, mainly in the form of wrong time, wrong rate, or wrong dose. In other studies, approximately one out of every three adverse drug events was attributable to nurses administering medications to patients. In a study of deaths caused by education errors reported to the FDA from 1993 to 1998, enunciable drugs were most often the problem; the most common type of error was a drug overdose, and the second most common type of error was administering the wrong drug to a patient (Lobby .
R, Susan . S & Elli . R 2013). Even though this report seems old and we know that the 8 rights of medication administration are not that old you would be so shocked to know these types of errors exist. Conclusion Nurses’ vigilance and adoption of precaution measures about medication errors are key factors for preventing medication errors. The elimination of medication administration errors of course is difficult to be successful, but the reduction of their frequency remains still achievable.
In conclusion, it is clear that the reduction of all types of errors during the delivery of nursing care, promotes a safe environment of hospitalizing. Double-checking medication administration Double-checking is double-person checking and independent double-checking (DC) and it is a strategy that has been used to reduce errors (Pamela & Uteri 2010) in the 5 rights of medication administration which are the (right patient, right drug, right dose, right route and right time).
Double-checking has also been advocated as an important strategy to prevent drug errors in vulnerable patient populations, such as children. Despite its seemingly beneficial role, the effectiveness of double-checking continues to be doubtful, due to the shortage of studies demonstrating its effectiveness in targeting errors. Especially during night shift- double checking is less likely to happen as everyone is busy.
This saying is supported by Gill et al 2012 (An exploration of pediatric nurses’ compliance with a medication checking and administration protocol). In this article DC is defines as “a procedure in which two individuals, preferably two registered practitioners, separately check each component of the work process” and gives an example of two people independently performing the calculation of a medication dose and matching the results, instead of one simply verifying the other’s calculation.
A literature review that was undertaken to evaluate the available evidence on the utility of double-checking as a strategy to reduce medication administration errors and its impact on the efficiency of the medication administration process conducted in Australia, I-J, US, Sweden, New Zealand and Taiwan showed that policies on bubble-checking are often predisposed to violations by nurses as consequences of its lack of proper definition and misinterpretation.
This study has discovered medications that are high-alert such as (insulin, chemotherapy and IV opiates) which almost always require independent double-checking prior to administration not have been double-checked (e. G. , the drug, dose, calculation) in 45% of hospitals surveyed in the US. This statement is supported by (Lobby . R, Susan . S & Elli . R 2013) Wrong IV administration rate was reported as the second most common cause of error, occurring on 207 occasions due to not a proper check before administering.
This statement also confirms my belief that the 8 rights of medication administration are not followed by all nurses. A study in a I-J children’s hospital reported that double- checking was only carried out on 411141 occasions (16% of patients), despite hospital policy requiring DC for all medication administrations. The effectiveness and safety of single-checking (whereby only one nurse checks that the correct medication is given) as compared to that of double-checking was investigated in five studies.
This investigation that was conducted in 3 wards of an elderly assessment and rehabilitation unit in a INS hospital over two periods of 23 weeks each, approved that the medication error rate with double-checking was significantly lower than that with single-checking (2. 12 vs.. 2. 98 per 1000 medications administered P < 0. 05). Despite these results, a time-and-motion sub-study conducted over a week estimated that single-checking would result in a saving of 17. 1 hours of nursing time per 1000 medications administered and for this reason nurses were largely in favour of single-checking (O’Connell et al 2007 and Pamela &
Uteri 2010), despite the increased level of responsibility. According to this study, a research that was conducted in an Australian regional acute care hospital, nurses estimated that the average amount of time saved by single-checking during routine medication rounds was 20 minutes. And have stated that the result was because of not having to locate, interrupt or be interrupted by another nurse for double-checking, which was of even greater significance for nurses who were on night duty.
The time-saving effect of single-checking was one of the biggest factors that the nurses appreciated as it reduced frustration in trying to find second nurse and enabled them to attend to other patient care needs. Furthermore, the nurses felt that more patients were able to receive their medications on time with single-checking, as opposed to double-checking this statement supports my hypothesis or belief of the 8 rights medication administration not been follow by all nurses and medication administration occurs as a result of this.
Nurses can reduce medication errors by implementing important changes to their individual practice including reporting medication errors, reducing distractions, implementation of safe medication double checks (comprehensive, consistent, and independent) before medication administration, and promoting a safety culture. However this study reveals that not all nurses abide by the 8 rights of medication administration for many reasons mostly to save time. Reference List Davis L, Ware RSI, McCann D, Gogh S, Watson K. Factors influencing pediatric nurses’ responses to medication administration.
Quality & safety in health care Factories Euthanasia’s 2012, prevention of medication errors made by nurses in clinical practice, Volume 6, Health Science Journal, Alexander Technological Educational Institution, Thessalonians Elliott, M. & Lieu, Y. (2010), The nine rights of medication administration: an overview. British Journal of Nursing, 19(5), 300-305. Gill F, Cornish V, Robertson J, Samson J, Simmons B, Stewart D 2012, An exploration of pediatric nurses’ compliance with a medication checking and administration protocol.
Journal for specialists in pediatric nursing : JSP Institute for Safe Medication Practices. Gimps list of confused drug names, 2010 [cited 2014 Swept 1 5], http://www. Isms. Org/tools/counterarguments. PDF Institute of Medicine (MM) 2006, Preventing Medication Errors: Report Brief. Washington, D. C. Institute of Medicine of the National Academies. J. 2005), Innovative approaches to reducing nurses’ distractions during medication administration. The Journal of Continuing Education in Nursing, 36(3), 108-116. Lobby . R, Susan . S & Elli .
R 2013, Literature Review: Medication Safety in Australia, sited 21 swept 2014, http://www. Substantially. Gob. AU/WAP-content/uploads/2014/02/ Literature-Review-Medication-Safety-in-Australia-2013. PDF MacDonald, M. (2010). Patient safety: Examining the adequacy of the 5 rights of medication administration. Clinical Nurse Specialist, 24(4), 196-201. O’Connell B, Crawford S, Tulle A, Gaskin q. Nurses’ attitudes to single checking medications: before and after its use. International Journal of nursing practice Pamela . A & Uteri .
T 2010, Medication errors: Don’t let them happen to you, Mistakes can occur in any setting, at any step of the drug administration continuum. Ape, T. M. , Grater, M. N. , Muzzy, M. , Bryant,J. B. , Ingram, M. , Screener, B. , Alcoa, A. , Sharp, J. , Bishop, D. , Careen, E. , & Walker, Ramsey . S, Babysat . MET, Lehmann . CE, Westbrook. Jell 2013, Double-checking medication administration, Centre for Health Systems and Safety Research, sited 21 pet 2014, HTTPS://IHA. Nuns. Dude. AU/sites/default/files/IHA/resources/Double- checking_final. PDF Robin Clifton .
K 2008, Newborn and Infant Nursing Reviews, What Nurses Can Do Right Now to Reduce Medication Errors in the Neonatal Intensive Care Unit, Volume 8, Issue 2 , pages 72-82, Rondo G. Hughes and Mary A. Baleen 2008, Patient safety and quality: An evidence- base handbook nurses, medication administration safety, Volume 2, [cited 2014 Swept 16], http://www. Incubi. Ml. NIH. Gob/books/UNBAKED/ National Coordinating Council for Medication Error Reporting and Prevention. Retrieved March 29, 2009 from http://www. Comer. Org John, L. , Corcoran, J. , & Donaldson, M. (2000). (Editors).
To err is human: Building a safer health system. Washington DC: National Academy Press. Dowel, E. , (2004). Pediatric medical errors part 1: A pediatric drug overdose case. Pediatric Nursing, 30(4), 328-330. Research Design for the investigation study of medication administration error: Do Nurses follow the 8 rights of medication administration to reduce medication error? The research is an experimental study to determine whether nurses follow the eight (8) the rights of medication administration error or not. The investigation descriptive research study is a quantifiable method.
The questionnaire survey method is used as a tool for data collection. The research will find out or investigated how well the 8 rights of medication administrations are being applied by nurses to reduce error and the harm caused as a consequence of the error, currently in these selective health care settings. The questionnaire will be analyses by the researcher and the type of questions will require close and open ended responses. Research setting This research study will involve six health care settings namely: Day Night Surgery,
London Medical Clinic, Master, Kowloon, Salisbury and Pitman nursing home. 120 questionnaires will be distributed to the executive or supervisor, Register Nurse, Enrolled Nurses and career currently working in these health care settings. A letter accompanied by the ethics approval (see Appendix II) will be sent to the executive of the nursing homes (see appendix l) to acquire permission to distribute the questionnaires to the staff who would be interested to participate in this research study. When permission is attained the sample will be approached from each individual nursing home.
An information letter will be presented to each sample (see Appendix iii letter to respondent). After obtaining an agreement of the sample, the questionnaire survey with its instruction will be given and data collected will be analyses. Research Sample The sample for this investigation descriptive research study will include executive or supervisor, Register Nurse, Enrolled Nurses and career as they are closely related to the topic “Do Nurses follow the 8 rights of medication administration to reduce medication error? ” Boras et al (2008, p. 06) have stated that a sample is a subset of population selected to participants in a research study. I have provided 20 questionnaires to each of the six health care setting that I have selected for this purpose. A voluntary interested group of samples between the ages of 18 to 100 currently in these health care settings are targeted for this research study. Limitations of the study The study will be limited to the 120 respondents to participate in answering the questionnaires. This may be insufficient as it may not give a generalized result of the effectiveness of the desired outcomes.
Appendix I Researcher: Fryer Thing 3 October 2014 Director of Day-Night Surgery 238 south Road Mile End, AS 5031 Dear Sir/Madam Re: Nursing Research: Do nurses follow the 8 rights of medication administration to reduce medication administration error? I am an Enrolled Nursing student from Port Adelaide. I am doing a research project regarding medication administration error as part of my course. I sincerely wish to conduct my research in related to “medication administration error” in your organization. I am writing this letter to you to ask for your permission to do a survey on my research topic in your facility.
I would like to induct my survey on Monday and Tuesday, 3rd and 4th of April 2014. If you have any inquiry regarding the survey, please contact me either on my mob: 0454264873 or [email protected] Com. AU. Thank your for your cooperation. Yours sincerely, Fryer Thing Appendix II Letter to the Ethics Committee To whom it may concern, I am Fryer Thing, a nursing student at Port Adelaide. I am doing a research project regarding medication administration error as part of my course. Re: Nursing Research: Do nurses follow the 8 rights of medication administration to reduce medication administration error?