Best Practices for Reporting and Improving Environmental Safety Issues

Hammoudi, Ismaile, S., & Abu Yahya, O. (2018). Factors associated with medication administration errors and why nurses fail to report them. Scandinavian Journal of Caring Sciences., 32(3), 1038–1046. https://doi.org/10.1111/scs.12546

In this article, Medication Administration Errors (MAEs) are reported by 2–14% of hospitalized patients and are estimated to kill 7000 patients and injure at least 1.5 million patients per year. Safe medication administration is vital for patient safety, and medication administration errors (MAEs) are directly associated with mortality and morbidity rates worldwide. According to the author, it is the nurse's role to provide the best possible quality of care and patient safety. This includes administration of the correct medication to patients and rapid detection of MAEs. Therefore, nursing staff are the first line in MAE prevention. Their study had shown that more than 70% of errors resulting in adverse effects are related to negligence and failure to report the error. Another study reported that more than 90% of such errors were preventable. As a result, the highest‐scoring factors contributing to MAEs were medication packaging, followed by physician communication, and pharmacy processes. Interestingly, the least‐mentioned contributory factors for MAEs were transcription‐related causes followed by nurse staffing.

Lesar, T. S.,Pharm D. (2002). Prescribing errors involving medication dosage forms. Journal of General Internal Medicine, 17(8), 579-87. doi:https://doi.org/10.1046/j.1525-1497.2002.11056.x

This article explains how hospitalized patients are at risk for adverse outcomes due to prescribing errors related to inappropriate use of medication dosage forms. They discuss some Factors related to prescribing errors include inadequate drug therapy, inadequate consideration of patient characteristics, dose calculations, nomenclatures, and dosage formulation. A general understanding of these contributing factors is useful in designing and implementing improvements in the medication use system. They conduct a study to Improve the medication safety processes within health care and, those specifically related to dose formulation issues to reduce risk for adverse drug events. For example, prescribing errors involving dosage formulations are common, and without appropriate safety processes such as pharmacist order review in place it can present significant risk to patients. Finally, the authors point out the improvements in health care provider knowledge, dosage form safety design, improved classification, and improvements in medication usage are necessary for safeguarding patients from errors involving medication dosage formulation.

JEN. (2020). The effect of implementing bar-code medication administration in an emergency department on medication administration errors and nursing satisfaction: Journal of Emergency Nursing, 46(6), 884-891. doi:https://doi.org/10.1016/j.jen.2020.07.004

This article talks about how bar-code medication administration has been shown to reduce medication errors in inpatient settings with limited studies on its use in emergency departments. The author used direct observation to compare medication error rates before and three months after implementing bar-code medication administration. Medication Administration System and nurses’ assessment of satisfaction survey was used by the author to assess the impact on nursing satisfaction before and one month after bar-code medication administration implementation. According to the article, “after bar-code medication administration implementation, the medication administration error rate fell to 0.76%, a relative reduction of 74.2%. and “Nurses Assessment of Satisfaction score pre-implementation was 2.60 (0.75) and improved to 2.29 (0.66) one month post implementation.” This means the results of this study suggest a benefit of bar-code medication administration in reducing medication administration errors and improved nursing satisfaction in the emergency department. The author emphasizes the errors related to the medication administration process contribute to the overall clinical mistakes that could lead to patient harm. Whereas errors related to medications can arise from the ordering or preparation process, he thinks at least one third of the errors occur during the administration process. This refers to the previous example, because when you prepare an unfamiliar medication, it is important to ask the pharmacist about the process to prepare and administer it. Otherwise, you can ask your teammate to measure you do it the right way. The author points out how medication administration in the emergency department differs from that in the inpatient setting. For example, the way the emergency department receives patients with unknown health care issues who undergo medical evaluation for their condition. Because medical information evolves with further assessments, the medical record has limited information on medication allergies, weight, and height. Most treatment with medications is one-time-only or a loading dose for medications that continue after admission. Other challenges faced in the emergency department are an increased number of verbal orders. These elements that the author mentioned are crucial because as an inpatient nurse we encounter patients coming from ED with overdue medication more than hours. We always called to check if the medication was given or not in ED because they can give medication without charting them in the eMAR. finally, this article offers support about patient medication safety by implementing electronic medication administration record (eMAR) and bar-code medication administration (BCMA) technology in emergency departments despite the difference in practice from inpatient nursing units. The authors conclude that implementing eMAR and BCMA can reduce medication administration errors and may improve overall nursing satisfaction.