Question

five similar nursing station have very differnt results or medication errors , how will you approach The OFI? Go to the worst and tell them they must improve? Go to the best , and give them a prize ? Go to tge second best , and ask them to copy the best ? Do all these ? something else? what is the right approach and why is it the best.

Answer 1

Greetings of the day!

Answer:

INTRODUCTION

A medication error is 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 the healthcare professional, patient, or consumer,” according to the National Coordinating Council for Medication Error Reporting and Prevention.

Factors associated with health care professionals

• Lack of therapeutic training n Inadequate drug knowledge and experience
• Inadequate knowledge of the patient n Inadequate perception of risk
• Overworked or fatigued health care professionals
• Physical and emotional health issues
• Poor communication between health care professional and with patients

Factors associated with patients

• Patient characteristics (e.g., personality, literacy and language barriers)
• Complexity of clinical case, including multiple health conditions, polypharmacy and high-risk medications

Factors associated with the work environment

• Workload and time pressures
• Distractions and interruptions (by both primary care staff and patients)
• Lack of standardized protocols and procedures n Insufficient resources
• Issues with the physical work environment (e.g., lighting, temperature and ventilation) Factors associated with medicines
• Naming of medicines
• Labelling and packaging Factors associated with tasks
• Repetitive systems for ordering, processing and authorization
• Patient monitoring (dependent on practice, patient, other health care settings, prescriber) Factors associated with computerized information systems
• Difficult processes for generating first prescriptions (e.g. drug pick lists, default dose regimens and missed alerts)
• Difficult processes for generating correct repeat prescriptions
• Lack of accuracy of patient records n Inadequate design that allows for human error Primary-secondary care interface
• Limited quality of communication with secondary care
• Little justification of secondary care recommendations

PREVENTION OF MEDICATION ERRORS:

1. Ensure the five rights of medication administration.

Nurses must ensure that institutional policies related to medication transcription are followed. It isn’t adequate to transcribe the medication as prescribed, but to ensure the correct medication is prescribed for the correct patient, in the correct dosage, via the correct route, and timed correctly (also known as the five rights).

2. Follow proper medication reconciliation procedures.

Institutions must have mechanisms in place for medication reconciliation when transferring a patient from one institution to the next or from one unit to the next in the same institution. Review and verify each medication for the correct patient, correct medication, correct dosage, correct route, and correct time against the transfer orders, or medications listed on the transfer documents. Nurses must compare this to the medication administration record (MAR). Often not all elements of a medication record are available for easy verification, but it is of paramount importance to verify with every possible source—including the discharging or transferring institution/unit, the patient or patient’s family, and physician—to prevent potential errors related to improper reconciliation. There are several forms for medication reconciliation available from various vendors.

3. Double check—or even triple check—procedures.

This is a process whereby another nurse on the same shift or an incoming shift reviews all new orders to ensure each patient’s order is noted and transcribed correctly on the physician’s order and the medication administration record (MAR) or the treatment administration record. Some institutions have a chart flag process in place to highlight charts with new orders that require order verification.

4. Have the physician (or another nurse) read it back.

This is a process whereby a nurse reads back an order to the prescribing physician to ensure the ordered medication is transcribed correctly. This process can also be carried out from one nurse to the next whereby a nurse reads back an order transcribed to the physician’s order form to another nurse as the MAR is reviewed to ensure accuracy.

5. Consider using a name alert.

Some institutions use name alerts to prevent similar sounding patient names from potential medication mix up. Names such as Johnson and Johnston can lead to easy confusion on the part of nursing staff, so it is for this reason that name alerts posted in front of the MAR can prevent medication errors.

6. Place a zero in front of the decimal point.

A dosage of 0.25mg can easily be construed as 25mg without the zero in front of the decimal point, and this can result in an adverse outcome for a patient.

7. Document everything.

This includes proper medication labeling, legible documentation, or proper recording of administered medication. A lack of proper documentation for any medication can result in an error. For example, a nurse forgetting to document an as needed medication can result in another dosage being administered by another nurse since no documentation denoting previous administration exists. Reading the prescription label and expiration date of the medication is also another best practice. A correct medication can have an incorrect label or vice versa, and this can also lead to a med error.

8. Ensure proper storage of medications for proper efficacy.

Medications that should be refrigerated must be kept refrigerated to maintain efficacy, and similarly, medications that should be kept at room temperature should be stored accordingly. Most biologicals require refrigeration, and if a multidose vial is used, it must be labeled to ensure it is not used beyond its expiration date from the date it was opened.

9. Learn your institution’s medication administration policies, regulations, and guidelines.

In order for nurses to follow an institution’s medication policy, they must become familiar with the content of the policy. This is where education comes into play whereby the institution’s educator or education department educates nurses on the content of their medication policy. These policies often contain vital information regarding the institution’s practices on medication ordering, transcription, administration, and documentation. Nurses can also familiarize themselves with guidelines such as the Beers’ list, black box warning labels, and look alike/sound alike medication lists.

10. Consider having a drug guide available at all times.

Whether it’s print or electronic is a matter of personal (or institutional) preference, but both are equally valuable in providing important information on most categories of medication, including: trade and generic names, therapeutic class, drug-to-drug interactions, dosing, nursing considerations, side effects/adverse reactions, and drug cautionaries such as “do not crush, or give with meals.”

Utilizing any or all of the above strategies can help to prevent or reduce medication errors. Nurses must never cease to remember that a medication error can lead to a fatal outcome and it is for this reason that med safety matters.

MEDICATION ERROR REPORTING MUST BE CARRIED OUT BY THE NURSES WHO HAD COMMITTED THE MEDICATION ERROR:

Nurses are responsible for filling out and completing a medication error notification when a medication error is discovered, and for completing a medication error sheet when a medication error has been made.

PROCEDURE:

A. The Nurse who discovers the medication error will complete the medication error notification form.

1. The medication notification error form is then forwarded to the QI Department.

2. The QI Department will send the medication error notification form with the medication error sheet attached to the nurse responsible for the error. The QI Department will send a corresponding email to the nurse responsible for the error.

3. The nurse responsible for the medication error will complete the medication error sheet as instructed in part B; number 1 through 6.

B. The Nurse who makes a medication error will complete the medication error sheet.

1. The following information will be included on the medication error sheet.

• a. Person responsible for the error.
• b. Name of the patient, the patient’s hospital number, the date/time of the incident, and the date the incident was discovered, and who the error affected or involved.
• c. The “Type” and the “Reason” of the error.
• d. The Description of the incident.
• e. The order as written.
• f. If and in what way the patient was affected by the error, and what interventions were initiated.
• g. Physician/Supervisor notified and by whom.
• h. Signature/date/time of the person preparing the report.

2. When the medication error sheet is completed it will be forwarded to the QI Department.

3. The QI Department will record and file the completed medication error and a copy will be forwarded to the Nurse Manager on the unit where the error occurred.

4. The Nurse Manager will follow up on the medication error and will complete the follow up section of the medication error sheet.

5. The Nurse Manager will return the medication error follow up to the QI Department.

6. The QI Department will track, file, follow up, and ensure completion of the medication error sheet.

Reporting medication errors is problematic due to fears of reprisal, intimidation, or disciplinary actions.3 Oshikoya et al. surveyed pediatric nurses working in a public hospital to examine their experience with medication administration errors.3 Structured questionnaires were distributed to 75 nurses, and 50 nurses completed them. The major factors contributing to errors were found to be increased workload (26.2%) and failure to check the drug dosing (12.24%). Barriers to reporting medication errors included fear of punishment for committing the error (11.22%), lack of a standard reporting system (13.26%), and fear of punishment for reporting the errors (27%). As a result, 34% of medication errors weren't reported by nurses.

• THEREFORE, THERE SHOULD NOT BE ANY PUNISHMENT FOR A MEDICATION ERROR, TO AVOID FEAR OF REPORTING THE ERROR. APPRECIATE EARLY REPORTING OF THE MEDICATION ERROR .
• PREVENTION OF MEDICATION ERRORS SHOULD BE ENCOURAGED BY RE-EDUCATING THEM TIME TO TIME.
• REWARDS SHOULD BE AVOIDED TO AVOID ANY UNDER REPORTING OF THE MEDICATION ERRORS BUT WE CAN APPRECIATE AND ENCOURAGE THEM.