Improving The Safety Of Using Medications
In Hospital Settings
Background
Improving the safety of using medications was the third Joint Commission safety goal for 2014 (Hospital National Patient Safety Goals, n.d.). Every year medication errors are a significant cause of morbidity and mortality in hospitals. Simply put, medication errors come from incorrect dosing by physicians on prescriptions, administration of the wrong dose of the prescribed medication to the patient, failure of the healthcare provider to administer prescribed medication, or failure of the patient to ingest said prescribed medication (Choo, J., Hutchinson, A., & Bucknall, T., 2010).
Role of the Nurse According to the Journal of Nursing Management, nurses should practice the five rights of administration that they are taught while in school. Those rights are: right medication, right dose, right route, right time, and right patient (Choo, J., Hutchinson, A., & Bucknall, T., 2010). While checking the five rights is useful in the final stages of the administration process, the rights do not reflect the other complex steps to medication administration, such as preparation, labeling, determining interaction, etc. Normally medication errors are never the result of an isolated human error. They may come from workplace stress, distractions, interruptions, insufficient training, and misinformation (Choo, J., Hutchinson, A., & Bucknall, T., 2010). The individual nurse should make sure that he or she is educated on medication dosing and interactions. He or she should also be getting plenty of rest and attempt to keep stress at a minimum. Keeping a positive attitude is also said to decrease the possibility of medication errors.
Recommended System Changes Issues and errors when dealing with medications can occur in a variety of ways. A large number of these errors can be prevented by following protocols and developing systems for quality control of medication prescription and use. Programs developed to supervise and control medications should be multi-disciplinary and include such groups as pharmacy, physicians, nursing, risk management, legal counsel and organization administration. One such topic that needs to be discussed and regulated is the care and control taken when hiring personnel and making sure that there is sufficient personnel to perform tasks. This includes, but is not limited to pharmacists present during each shift, nurses and assistive personnel on each floor, nurse managers, and physicians on call during off-hours. Making sure there is sufficient staff present helps to decrease stress and patient overload, thus decreasing the risk of errors in medication administration (Medication Misadventures, n.d.).
Pharmacy plays an important role in medication errors, and we should not forget their roles and responsibilities in this matter. It is vital that pharmacists have access to patient information and maintain patient profiles. Such action would help to greatly decrease the administration of drugs to which the patient may have an allergy or hypersensitivity, as well as a reaction to one that may be contraindicated with their current prescriptions. The pharmacy is responsible for the distribution, procurement and control of drugs and should be a large authority, in combination with the physician prescription, in the release of such drugs (Medication Misadventures, n.d.).
If at all possible, a patient’s “home” medications should never be used in the hospital or inpatient setting. Drugs that a patient takes at home should be obtained through the pharmacy, and a drug interaction and allergy check should be completed. Such action will ensure no drug-drug interactions and minimize allergic and hypersensitivity reactions (Medication Misadventures, n.d.).
Patient/Family Involvement
Along with healthcare providers and hospital staff, it is imperative that patients and families help take an active role in the prevention of medication errors. Patients and their families know themselves better than anyone else, and thus should be included in a plan of care and medication regimen. Patients should be asked about all medications that they are currently taking, prescribed, and over-the-counter (Britten, N., 2009). Patients should also take an active role and ask the healthcare professionals about any new medicines that they are being prescribed; this includes any side effects of the medication and contraindications that might apply (Britten, N., 2009). Patients also need to be responsible for speaking up and reporting any adverse effects that they may have when taking a new medication or a combination of medications. Patient compliance while in the hospital is vital, and this includes letting the hospital staff administer “home” medications and refraining from taking any over-the-counter medications on their own, or without staff approval (Britten, N., 2009).
Patients should also educate themselves concerning their medications and be able to be their own advocate. This includes carrying a list of medications, including doses and frequency with them at all times, as well as knowing any allergies they may have. This is crucial in emergency situations. If the patient is unable to do this, the family should be willing and able to step in on their behalf.
Healthcare Team Collaboration As stated above, medication administration not only involves nurses, but physicians, pharmacists, and the family of the patient. It is important to note that nurses are just essentially the last link of the hypothetical medication administration chain, not the only link. Therefore, it is important to note that healthcare professionals should have adequate communication (Choo, J., Hutchinson, A., & Bucknall, T., 2010). Nurses should not feel belittled for asking questions and should not be put off when voicing legitimate concerns. They are responsible for advocating for their patient (Advocacy, Agency, and Collaboration, n.d.).
Conclusion
Overall, medication safety is one of the most important issues in hospitals today. First, in addition to checking dosages and interactions, the nurse should have an adequate understanding of medications and how they should be administered to the patient. Second, the patient or their family should speak up with any concerns about the medication regimen they may have. Also, it is important for them to watch for any new side effects of the medication. Lastly, adequate communication between all healthcare providers is crucial in decreasing the amount of medication errors that occur across the board.
References
Advocacy, Agency, and Collaboration. (n.d.). Advocacy, Agency, and Collaboration. Retrieved April 28, 2014, from http://ajcc.aacnjournals.org/content/15/4/428.short
Britten, N. (2009). Medication Errors: The Role Of The Patient. British Journal of Clinical Pharmacology, 67(6), 646-650.
Choo, J., Hutchinson, A., & Bucknall, T. (2010). Nurses' Role In Medication Safety. Journal of Nursing Management, 18(7), 853-861.
Hospital National Patient Safety Goals. (n.d.). Joint Commission. Retrieved April 27, 2014, from http://www.jointcommission.org/assets/1/6/2014_HAP_NPSG_E.pdf
Medication Misadventures. (n.d.). ASHP Guidelines on Preventing Medication Errors in Hospitals. Retrieved April 27, 2014, from http://www.ashp.org/s_ashp/docs/files/MedMis_Gdl_Hosp.pdf