Analyzing the Issue of Medication Errors
A medication error is a term used to refer to events that result in inappropriate medication being given to the patients. Such events may occur when the medication is under control of a professional in a health care setting or a patient. However, such events can be prevented. The current paper aims at analyzing the issue of medication errors conclusively. In order to achieve the intended task, the paper will provide data addressing the subject by looking at common clinical problems caused by errors in medication.
The most common clinical problems that result from errors in medication is vomiting and diarrhea. Vomiting refers to an involuntary process of forcefully expelling contents from one’s stomach using the mouth and the nose in rare cases. Diarrhea, on the other hand, refers to increase of frequency in movements of one’s bowel, hence resulting in increased looseness of a person’s stool. The two clinical problems may result from errors caused by wrong medication given to the patients. It is the reason why it is important to develop a procedure that requires each nurse to record the progress of a patient during their shift.
Members of Health Quality & Safety Commission New Zealand (2011) argue that, having nurses monitoring patients’ progress positively impacts the patient as he/she is involved in care for his/her own health. Moreover, having this system enables health care providers to realize, and measure any improvements on patient’s health. It is necessitated by the requirement of exchanging information about a patient among the oncoming nurses and the ones on shift in the presence of the patient, as a way of reducing errors in medication, and allowing patient participation. For authorities in charge of monitoring institutions that offer health care services, implementing such system makes it easier to measure a quality of services provided by health providing institutions. According to Fung & Canadian Patient Safety Institute (2012), it also helps analyze how safe the institutions are for patients.
Considering the large number of patients in the country’s hospitals, errors in medication have a great possibility of occurring. Consequently, as Koutkias and IOS Press (2011) state, errors in medication may lead to injuries in patients, which may further result in a disability. Based on the fact that the nurses are the ones who attend to patients and their medication, making regular reports about a patient’s condition may help in preventing the occurrence of such errors. Nurses can communicate to each other, share the history of patient’s health, findings of physical assessment, and the plan to be used for treating the patients.
Importance of the Clinical Problem
Mahoney (2013) noted that a hospital that considers implementation of patients’ progress reporting done by nurses regularly, saves much time, which would otherwise spent on rectifying errors that may have occurred in medication. At the same time, mandating nurses with reporting helps in building stronger relationships between the nurses and other staff members in the hospitals. It means that there is a mutual respect for the staff, and a cohesive environment for working. To measure the effectiveness of involving nurses reporting procedures, the heads of hospitals can perform surveys on patient experience.
Whenever a hospital involves its nurses in monitoring medication administered to patients, transparency is improved among the team members providing healthcare, and the patients. Health Quality & Safety Commission New Zealand (2011) members argue that the patients are able to participate in the process of medicating them used by the providers of health care. Moreover, they receive a chance to ask questions or add more information. It prevents an issue of confusion of treatments to be employed, the diagnosis to be used, and the most appropriate medication for different ailments.
According to Genchi (2012), making nurses involved in the process of medication prescription for the patients has had a great impact on improving the attitudes of care givers, their patients, and the patients’ families. Most patients and their families now believe in services offered at the hospitals. They all see a low possibility of errors occurring in medication. Health care given in health institutions has become centered on patients and their families. Care givers have become more coordinated when they are providing health care services. Team work has become a key factor for providing health care services within health institutions.
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With cultural values in place, reporting of patients’ medical condition by nurses becomes a great boost. Patients receive the chance to interact with their care givers, and ask questions. They also have a chance to give a short history of their health to care givers, and be a part of the decision-making process concerning their treatment. Nurses and other care givers have the chance to socialize and share their experiences. At the same time, nurses are able to communicate and support each other emotionally, mentor one another and reduce chances of errors in medication.
Mahoney (2013) argues that patients become more satisfied with their experience at a health care institution when medication given to them is monitored by nurses. They hold an assumption that such practice helps avoid errors that may occurr in medication. On the other hand, nurses do not overwork anymore, and are able to leave their shifts on time. With a system of medication monitoring by nurses, all care givers become more accountable and accurate in their methods of prescribing medication. Patients also benefit from such activities as they become aware of the procedures involved in medicating different types of ailments. At the same time, the nurses become more empowered, while patients feel safer at a health institution, where they are monitored.
In order to encourage the use of the system of nurses monitoring medication given to patients in most hospitals around the country, it is important to involve the government in providing education to all health workers in the industry through forums and seminars. By the use of CINAHL, the government may work together with the National League for Nursing, as well as the American Nurses Association in developing an indexing database for nurses. Such method would help in issuing journals and publications to educate nurses all over the country, according to Samaranayake & Cheung (2013).
Working together with the Nursing Reference Center would be a great opportunity at reaching out to more hospitals in the country. It can be supported by the fact that this establishment is responsible for observing the conduct and performance of nurses. Another important body that has to be involved in the campaign of nurses’ participation in patient medication is Rehabilitation Reference Center. The given body will make it easy to assess the satisfaction of patients with the services offered to them by hospitals.
The last body to be involved is DynaMed. According to Onuwa, & Church, (2013), working with Dynamed would help in creating a database for nurses, which will show effective methods for performance and their implementation. Such database is known as Medline. Such move will result in the increased satisfaction levels among all the patients. It would also motivate most of the care givers, including nurses, to improve the services they provide to patients, since there will be a body responsible for monitoring their work.
According to Nurse bedside shift report (2014), the aim of involving nurses in monitoring medication of patients in hospitals can be divided into two groups. First are the short term goals. Helping patients recover quickly by involving them in the process of their medication is one of such goals. The other short term goal involves ensuring that patients receive the right type of medication for their ailment. The third short term goal is to have the patients’ families involved in the process of the patients’ treatment, in order to learn a patient’s medical history.
As outlined by the Nurse bedside shift report (2014), the second group of goals for implementing bedside shift reporting is the long term goals. One of the main long term goals is the improving of relationship between health care providers. When care givers are able to communicate in a comfortable way to each other, providing information about patients becomes a smooth process. The other goal is creating a channel, which will make patients transitioning from care in hospital to care at home an easy procedure. It is achieved by having family members and patients involved in the recovery process of a patient, including using the appropriate medication.
The other long term goal is to change the way in which hospitals provide their services. In order to measure how effective the long term and short term goals implementation have been, it will be important to perform a survey. In the survey, it will be necessary to collect appropriate information by recording short videos, monitoring work of nurses, and provide control over the medication being given to the patients. In addition, the progress of the patients will be documented every day. It will prove both the effect of the process in terms of how care givers conduct their services, and how the patients are involved in the process of their medication.
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According to Onuwa, & Church, (2013), before introducing such strategy, it would be important to prepare the entire body of care givers in hospitals. First, the communication can be boosted through the use of emails, and internal memos. The message should be to provide the information regarding the introduction of monitoring by nurses on medication methods used for different patients, and sharing results collected from literature reviews. A forum should then be created, where care givers are encouraged to raise any concerns they have, and ask questions. It would also be important to clearly explain to all care givers that the strategy is aimed at improving safety of patients, their satisfaction, and the accountability of staff members.
Another important method would be to develop materials for educating patients, and their families on the new method of providing services. It will help involve the patients and their families in monitoring the success of the new method in regard to service delivery at the hospital. The leading nurses in the hospital should be mandated with the right to analyze the experience of the patients, as a way of reexamining nursing reports. Nurses should also be involved in identifying new approaches, which can be more effective in transferring information. Considering the information from Nurse bedside shift report (2014), such methods will help in preparing nurses for their shifts, with the aim of bringing delight to every patient.
When implementing the system of monitoring by nurses, a number of barriers may occur. The first barrier may be a resistance from nurses as most of them firmly support the old practices. They consider a central room to be the place where the nurses should report when they come on their shift, or when going home from their shift. Nurses may argue that with a nurse reporting room, patients benefit by having privacy. Information about the patient is not shared in the presence of family members or other parties.
The second barrier of nurses monitoring medication given to patients is that some situations they experience can prevent them from revealing important information. It is a situation when the patients are not aware of what they have been diagnosed with. It may also occur in a situation where the patient is constantly sleeping. Some patients may have many questions to ask their care givers, which results in prolonging the monitoring process. In other cases, patients may be uncooperative with the process.
The third barrier is that the initial cost of implementation of monitoring by nurses may be very high. It is caused by the cost of training care givers have to undergo. It deals with methods on how to perform monitoring on medication given to patients. This may be done through small forums, and seminars, or individual personnel training. The other cost to incur is employment of staff members, who will be responsible for educating patients, and their family members regarding what the structure of patient medication monitoring by nurses requires of them.
According to Health Quality & Safety Commission New Zealand (2011), the implementation of monitoring by nurses has many benefits. First, the process allows patients to be good aware of all parties, which will be involved in caring for them, as well as to know who will to attend to them at specific times, when they are at the hospital. Secondly, the process clarifies to caregivers the important measures that have to be taken with the patient, hence creating an alignment for the whole care team. Thirdly, the process is effective in ensuring that all patients together with their families feel that they are more informed.
Forth, patients have an opportunity to interact with their care givers by asking questions. Fifth, patients comply more with the treatments they are given, since they are involved in their medication prescription process, which reduces anxiety. Mahoney (2013) noted that for the care givers, the system of frequent monitoring of the medication process, done by the nurses, brings them a number of benefits, as well. First, care givers feel that they are an important part of the care giving process hence, they become more accountable in attending to different patients.
Secondly, care givers receive an opportunity to communicate among themselves, and consult with each other. At the same time, they have a chance to share information with patients and their family members as a way of ensuring that all parties connected to the patient are at per. Thirdly, such structure creates opportunities for nurses who are coming for their shifts to become familiar with the equipment being used, dosages given to different patients for medication, as well as how to handle special orders.
Forth, the structure helps save time. Care givers are able to meet their patients when they are beginning their shifts, which allows them to have time for updating their whiteboards and incorporating new information. Fifth, care givers receive an opportunity to conduct an assessment on the environment where the patient is staying. Mahoney (2013) noted that in order to complete monitoring by nurses on medication given to the patients, it is required a minimum of three and a maximum of five minutes. It depends on complexity of visits made by the patient, and the work of care givers.
When implementing the strategy of monitoring by nurses, a number of measures are involved. First, a multidisciplinary group needs to be formed. The group’s mandate is to identify those areas, which require improvements. According to Health Quality & Safety Commission New Zealand (2011), to achieve this the group is expected to engage with the patients in the hospital, their families, and staff members. The group should also assess the policies of the hospital concerning visitations. It would be important to collect different views about changes in nurses’ shifts, and to identify the challenge of changing the behavior of staff members.
The second step involves deciding on the method to use to implement monitoring of medication given to patients by nurses. At first, the team should discuss the aims of implementation of monitoring by nurses. The group is then expected to offer ideas on the relevance of monitoring of medication administered to patients in the hospitals. After that, the group should suggest methods to be used, and tools to be adapted for implementation of monitoring by nurses approach.
The third step, which is also the last one, involves implementation and evaluation of monitoring approaches used by nurses. The process involves making all staff members aware of the changes that intend to be implemented in service delivery to patients. The next stage is to perform a training exercise to all staff members involved in the process of giving care to patients. After all members know what is expected of them, a monitoring approach by nurses can be introduced in regard to service delivery by the hospital.
Mahoney (2013) noted that it is important to assess the performance and effectiveness of the approach using the initial two weeks of introduction, and once more after a duration agreed upon by the management. In order to perform assessment, it would be helpful to collect feedbacks from the hospital’s nurses, their patients, and family members of the patients.
Participants and Interdisciplinary Approach
A number of parties are involved in the implementation of the process of monitoring done by nurses on medication methods used on patients. First of all, nurses have the mandate to attend to the patients and document their progress. Nurses have to be constantly involved in communication among colleagues for consultation, passing information about the patients between shifts, and engage patients in the process of their medication. The second party involved in the given approach are the patients themselves. According to Onuwa, & Church (2013), patients are expected to show cooperation by giving their medication history, and asking relevant questions.
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The third group of interest, in this type of approach, is family members of patients. Family members are expected to constantly check the patients, share information with the care givers about the history of their medication, as well as be informed about the plan to be used to take care of them. Such move is aimed at creating a smooth process of transitioning care from the care givers in the hospital to family members of the patient. According to Nurse bedside shift report (2014), it should be done when the patient is released from hospital.
The forth group is the management of the hospital. This group is expected to create a platform for training its care givers and patients in questions regarding monitoring by nurses. After that, the group is expected to implement the approach. Thereafter, the same group should perform an analysis of the effectiveness and efficiency of the approach. The sixth group is the government. The government is responsible for ensuring that hospitals do not violate any constitutional human rights by exercising the approach. The government is also responsible for providing funding to hospitals, to enable the smooth implementation of the approach.
According to Onuwa, & Church (2013), after performing a survey on satisfaction of patients, some health care providing institutions, such as Catholic Healthcare West, have decided to change their approach of service delivery to nurses monitoring medication given to the patients. It occurred after Catholic Healthcare West was able to gather feedbacks on the services offered at the hospital. Patients complained of little time spent with them by nurses, and of little information given to them regarding their conditions. The new approach now includes checking the patients on an hourly basis, giving individual care, reporting from the bedside, as well as making of discharge calls.
Members of Health Quality & Safety Commission New Zealand (2011) argue that a major boost to this approach was done by “The Joint Commission’s 2009 National Patient Safety Goals”. The goals provided in it dictate that in the process of shifts changing, the nurses should always share recent information on the method to be used to care of a patient, the treatment to be administered to the patient, the current condition of the patient, as well as the expected changes with the condition of the patient. Monitoring by nurse is the thirteenth goal of the commission, which calls for involvement of patients in their care.
Implementation of the approach of monitoring by nurses on medication given to patients has been seen as efficient in regard to prioritizing work mandated to nurses. The time taken by nurses to perform their task has also reduced. A study made and documented by National League for Nursing revealed that monitoring by nurses has impacted service delivery by reducing shift time for nurses to 100 hours. According to Koutkias, and IOS Press (2011), another documentation made by the American Nurses Association revealed a reduction on two first periods of payment for a single unit of performing general surgery and holding 32 beds.
The other solution was on the unit that performs progressive care and holds 34 beds. Regarding overtime periods, Mahoney (2013) noted that data review performed and documented by Medline showed a reduction of $8,000. It was directly associated with the periods of performing service delivery due to the implementation of regular monitoring by nurses of medication given to patients.
The current research paper has conclusively studied the issue of medication errors, by addressing the approach of implementing regular monitoring by nurses of medication given to patients. It has become evidently that there is a need for nurses to exercise monitoring, since it positively impacts care givers and the patients themselves. In turn, patients receive a chance to be involved in the process of their medication, while care givers have a chance to be more accurate when administering medication.
Consequently, care givers receive an opportunity to consult and share information about patients freely. Such method is important in creating collaboration and building relations between care givers to enable them to work in a team. On the other hand, family members of the patients receive an opportunity to learn how to take care of them when they return home after the release from the hospital.
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