Double Checking the Administration of Medicines, Capstone Project Example

Introduction

Patient safety is of critical importance in the nursing practice environment and requires nurses to demonstrate expert knowledge and efficient use of resources to minimize risk. This process requires a substantial learning curve in regards to the systems that are typically employed within the nursing unit to address patient safety, including but not limited to matters related to medication errors and improving safety in this regard. Nurses must be able to utilize technology-based systems at an expert level and identify areas where improvements might be achieved in order to minimize medication-related risks for patients. Therefore, a shift in strategy and attention to medication risk is required in order to effectively address problems related to errors and an overall ability to achieve best practices at this level. The following discussion will address medication safety and errors in greater detail and will emphasize the importance of strategies for nurses to follow that require astute knowledge and leadership in order to reduce medication risks and improve patient safety throughout all nursing units, using technology and evidence-based practice solutions in this manner.

Body

Patient safety is a critical factor in the success of the nursing practice environment and the level of performance that nurses provide throughout their units. Adherence to recommended guidelines and procedures is only one part of the process, as there must be an additional focus on change as needed in order to improve methods that aim to minimize medication errors and related risks. Since medication errors are a very real component of the practice setting, it is important for nurses to be supportive of activities that will influence positive decision-making that will translate into fewer medication errors and risks to patient safety. There are many parameters associated with this practice that require adherence to quality-based standards in order to support effective outcomes and optimize quality of life for patients. Some of these tools and resources must be examined in greater detail in order to identify the appropriate mechanisms for implementation and to achieve the desired results at the practice level.

Gathering evidence regarding the impact of incidents which compromise patient safety must be examined as part of a larger framework to improve patient safety in the hospital environment (Lawton et.al, 2011). A number of factors are attributed to an increased risk to patient safety; therefore, these factors must be explored in greater detail in order to be successful in addressing the problem on a larger scale (Lawton et.al, 2011). The identification of specific risk factors is instrumental in supporting new strategies for nurses to follow that improve patient safety and support higher quality care and treatment for patients, rather than to focus on patterns that have little to no effectiveness in nursing practice (Lawton et.al, 2011). A greater emphasis on the minimization of errors must be achieved and align with nursing practice objectives and realistic expectations over the long term.

It is known that “Recent systematic reviews of medication administration error (MAE) prevalence in healthcare settings found that they were common, with one reporting an estimated median of 19.1 % of ‘total opportunities for error’ in hospitals…As nurses find themselves as the ‘last link in the drug therapy chain’ where an error can reach the patient, they have traditionally been blamed for errors. However, the reality is that the conditions within which the person responsible for the error works, as well as the strategic decisions of the organisation with whom they are employed, are often the key determinants of error” (Keers, Williams, Cooke, & Ashcroft, 2013, p. 1046). Under these conditions, nursing practice methods and actions may contribute to many common causes of medication errors and nurses’ involvement in these issues; therefore, it is necessary for nurses to adopt and embrace new strategies to improve medication safety and quality of care. This process supports a continuous effort by nurses to be mindful of their actions related to medication administration and to be apprised of changes that may impact their decision-making in this regard.

A successful nursing practice environment will emphasize the importance of medication administration that is designed to minimize errors and promote methods that focus on the patient above all else. However, as noted, the root of the problem often extends beyond what is reported and impacts what is not officially reported to management, thereby creating disconnect between the policies that are enforced and the realities of medication administration in the nursing unit (Dickson & Flynn, 2012). This creates a world of confusion and frustration when policies do not support the actions taking place and a commitment to improving patient safety through policy adherence. It is the responsibility of nurses to be apprised of their roles regarding medication administration and to recognize the importance of reporting errors so that policies fully support the actions that are taking place at the practice level. This will also demonstrate the value of developing new policies or updating existing policies that support medication administration more effectively.

It is important for nurses to recognize when medication administration has become a problem due to existing policies, methods, and technologies or lack thereof across nursing units. This process requires nurses to pay attention and track medication administration events in a manner that is consistent with promoting high quality care and treatment, rather than to focus on procedures that create additional errors or complicate processes to the point that they impact patient safety. By conducting an evaluation of current methods and comparing them to the type and number of medication errors that exist, this may serve as sufficient cause to modify current practices and to reallocate resources in accordance with what will contribute to fewer medication errors in the nursing practice setting. Under these conditions, it is also necessary for nurses to communicate regarding procedural changes and to share new ideas which may contribute to increased efficiency and fewer errors, thereby promoting an environment where patient safety will be optimized as best as possible.

Nurses must utilize existing evidence regarding medication administration efforts in order to be successful in optimizing patient safety and in minimizing errors, and this reflects a need to better understand the dynamics of this practice and how it impacts attention to patient care. For example, prior evidence regarding double checking medications, which involves two nurses reviewing medication orders prior to administration, has been evaluated with mixed reviews (Alsulami, Conroy, & Choonara, 2012). Therefore, the process of double checking is not necessarily useful on the typical nursing unit, but is common in the pharmacy setting to confirm that medication orders have been properly filled (Alsulami et.al, 2012).  With this perspective in mind, it is also likely that performing double checking on a regular basis may lead to inconsistencies with the process and how nurses conduct the practice, thereby raising questions regarding its overall effectiveness (Alsulami et.al, 2012). Dosing solutions such as Computerized Physician Order Entry and Unit Dose Dispensing Systems are practical alternatives that have been adopted in many hospitals that are likely to have a greater level of effectiveness than the double checking method (Alsulami et.al, 2012). Therefore, these issues must be considered as part of the discussion regarding the most feasible alternatives in the promotion of an environment where medication safety is of critical importance (Alsulami et.al, 2012). The utilization of technology-based solutions, therefore, must be considered in the development of strategies to support medication safety and administration across all nursing units.

There must be considerable efforts made to identify prior forms of evidence upon which medication administration has been successful is a challenging task, and it introduces new questions regarding the efficacy of some methods within the context of a given organization. It is known that “the degree of success in eradicating preventable harm has not matched the investment in effort and financial resources…Practicing clinicians increasingly see patient safety as something that they do rather than something that is done to them” (Wachter, Pronovost, & Shekelle, 2013). This reflects the importance of examining prior evidence in order to determine which methods have been successful versus those which have not, thereby creating an environment whereby patient safety in medication administration is of critical importance in shaping patient wellbeing. These factors must be considered when developing a framework for patients that will not compromise their safety in any way and which will support an environment where patient needs are taken seriously and with the utmost caution at all times. As a result, an examination of prior evidence is necessary in order to be successful in addressing the needs of patients with respect to medication safety, including an evaluation of existing methods that may be useful for application in other settings. The purpose of evidence-based practice is to recognize where there are weaknesses in existing practices and to support a dynamic where patient care is improved when evidence is applied to healthcare settings. This will ensure that the organization is fully supportive of activities that promote patient safety and provide an umbrella for addressing issues effectively and consistently.

One of the critical areas that may contribute to larger than anticipated problems associated with medication safety is disruptions, which are a natural occurrence in the course of a given day in the nursing unit (Freeman, McKee, Lee-Lehner, & Pesenecker, 2013). This also reflects the importance of identifying the nature and cause of these disruptions and to recognize the importance of developing priorities so that all duties and responsibilities are properly managed and disruptions are tolerated (Freeman et.al, 2013). This process also reflects the importance of understanding how disruptions could impact medication administration and subsequently reduce the number of errors that are observed (Freeman et.al, 2013). This process is ongoing and requires nurses to recognize how disruptions impact their focus, concentration, and daily activities, including medication administration (Freeman et.al, 2013). These practices support the need for further guidance in developing methods to improve medication administration at the highest possible level and to achieve a level of focus and communication on this process that will have lasting benefits (Freeman et.al, 2013).

Medication administration impacts healthcare practices in many different types of organizations, including those providing primary care services and mental health support. For the latter, it is necessary to consider the significance of medication administration, errors, and safety improvements to ensure that this population is protected from unnecessary risk or harm as much as possible (Soerensen, Lisby, Nielsen, Poulsen, & Mainz, 2013). Within a psychiatric facility, there is limited data available regarding this process; therefore, an examination of the impact of medication errors in this setting must be further explored (Soerensen et.al, 2013). In a descriptive, cross-sectional study involving medication administration and subsequent errors, it was determined that these issues appear to be less significant within the psychiatric setting; however, nurses may play a role in shaping a culture that is not amenable to optimizing patient safety in different ways (Soerensen et.al, 2013). Nonetheless, it is known that “nurses are the professionals spending most time with the patients and, therefore, function as gatekeepers, where they can prevent errors and harm from reaching the patient. Nurses are coordinating several aspects of care to patients, including the care delivered by other health care professionals, and this is a major contribution to patient safety” (Soerensen et.al, 2013).

From this perspective, it may be argued that nurses may serve as both the cause and the solution to medication errors, depending on a variety of environmental factors and the nursing culture within a given organization (Soerensen et.al, 2013). Based upon this logic, it is likely that nurses should have a greater contribution to the discussion of medication administration and should provide increased input regarding technologies and other systems that may be useful in minimizing medication errors through the activities that are conducted on a given nursing unit. Nurses must openly communicate regarding their own efforts related to medication administration in order to determine where improvements are required and to recommend changes that could improve this process.

Technologies that have been created to improve medication safety are varied and diverse; therefore, some of these tools are effective in some nursing environments and less successful in others. Tools such as barcode-assisted medication administration (BCMA) has emerged as a popular choice for many hospitals, as it supports an overall reduction in medication errors and promotes greater accuracy within this process (Bonkowski et.al, 2013). In the typical emergency department, however, this process is not typically utilized at a high level and may have a significant impact on reducing the number of medication errors that are identified over time (Bonkowski et.al, 2013). These practices represent a means of understanding how BCMA as a technology-based tool may influence decision-making within the ED and how it might influence outcomes over the long term with respect to patient safety (Bonkowski et.al, 2013). One study demonstrated that medication errors were reduced by as much as 80.7 percent in one ED, thereby indicating that this process may have significant value to an organization in order to be successful in addressing medication errors and in improving patient safety at a higher level (Bonkowski et.al, 2013).

Barcode verification as a tool to improve medication administration provides an important opportunity to examine the factors that impact this process and the extent to which barcodes may reduce medication errors (Hennemen et.al, 2012). It is believed that nurses are highly valuable in recognizing medication errors and in preventing them in many situations; therefore, barcodes are an important tool in ensuring that they are able to identify these errors and to make the required changes to promote greater patient safety in the nursing environment (Hennemen et.al, 2012). Nurses must be able to verify that the medication is for the correct patient by matching the medication order to the patient and also matching the recommended dose to the actual order to ensure that each of these areas are fully aligned and promote optimal safety for patients (Hennemen et.al, 2012). This process is known as VPtID and represents an opportunity to achieve greater accuracy and fewer errors in medication administration for patients, noted as follows: “The VPtID process is among the most common safety process performed by healthcare workers. It should be completed prior to performing most patientspecific tasks. The 1st Joint Commission’s National Patient Safety Goal calls for identifying patients with at least 2 patient identifiers when providing care, treatment, and services” (Hennemen et.al, 2012, p. 562). With these objectives in mind, it is possible for nurses to achieve the intended results through their actions related to medication administration and to demonstrate their knowledge of these practices in a timely and efficient manner to meet all required standards in this area.

The adoption of barcode technologies in the hospital environment provides many benefits for healthcare organizations in its efforts to reduce medication errors and to streamline medication administration to achieve greater accuracy and buy-in from nurses (Leung et.al, 2015). In conjunction with an electronic medical records system, it is likely that “barcode systems are associated with complete elimination of transcription errors. Furthermore, barcode-assisted dispensing systems are associated with 93% to 96% reductions in dispensing errors, and 85% reductions in potential adverse drug events in dispensing” (Leung et.al, 2015). These considerations support the demand for the integration of barcode medication administration systems in many healthcare organizations where these options are not currently available and to be mindful of the long-term benefits of this practice that will positively impact patient safety over the long term (Leung et.al, 2015). It is important, therefore, to recognize the advantages of a barcode medication administration system and to establish specific standards for this process that will benefit patients over the long term (Leung et.al, 2015).

Mediation administration requires total accuracy and practical knowledge in order to be successful in supporting patient safety on a continuous basis. This process reflects a greater need to understand the dynamics of patient care and trends in medication administration that may have lasting benefits for patients. With the use of barcode technologies, it is possible for nurses to achieve the intended results and to be positively affected by standards related to medication administration that involve this process. There must be a significant emphasis placed upon the demands of the practice setting and to balance competing interests with respect to medication administration in order to be effective in meeting the desired objectives of this practice.

Achieving success with medication administration also requires the utilization of different tools and resources that will improve processes, promote efficiency, and minimize errors as much as possible. A study known as Medication Administration Processes and Systems (MAPS) used observational fieldwork to evaluate nurses’ patterns and system processes regarding medication administration in three separate units, and it was determined that factors such as behavioral differences, system-based protocols, and interactions with patients played a role in determining the overall effectiveness of medication administration activities (McLeod et.al, 2015). These practices will support greater engagement by nurses in medication administration and the ability of patients to gain a greater sense of empowerment that will impact their wellbeing and safety in the nursing unit (McLeod et.al, 2015).

It is important for nurses to communicate their views regarding current practices in medication administration so that they are able to recognize its long-term benefits and the advantages of an organized approach that will have positive and lasting benefits for patients. It is the responsibility of nurses to recognize their own patterns of behavior and level of skill with respect to medication administration and to be cognizant of any periods when they might experience distractions or other problems that could impact their actions in this regard. If they are distracted in one way or another, there is a greater chance that their actions related to medication administration could be compromised, thereby creating an increased risk of errors involving incorrect medications, dosing, and patient identification, among other concerns that influence patient safety.

It is important for nurses to evaluate their own behaviors and to recognize where they might be able to improve and develop their skillsets and level of focus to minimize distractions and to improve patient safety through accuracy in medication administration at all times. This will ensure that patients are treated in a professional manner and are able to gain the support and guidance that is necessary to address gaps in tools and/or resources that may impact medication administration in a negative manner. In addition, open discussions regarding how medication administration occurs may be useful in supporting changes in the practice as warranted that could also positively influence outcomes over the long term.

From a nursing-based perspective, the integration of technologies to support medication administration has numerous benefits for the practice environment, including the development of systems with built-in measures to minimize medication errors and improve patient safety. This process is instrumental in the development of a key set of factors that will influence the actions of the nursing profession and the practice system as a whole. It is anticipated that with systems such as barcode medication administration, there will be additional attention paid to the problems related to patient safety and the overall understanding of patient health and wellbeing, of which medication administration is a critical factor. This process also supports a greater understanding of why nurses might be prone to commit medication errors and what steps are required to resolve these concerns effectively. It is the responsibility of nurse managers to identify medication errors as a serious concern, to have a conversation with staff nurses regarding these practices, to obtain input regarding what is successful versus what requires further attention, and to recognize the value of developing methods that will improve existing processes and strategies to optimize patient needs above all other considerations. With the ultimate goal to improve patient safety, these efforts must be discussed among nurses so that future actions for nursing practice emphasize the importance of medication safety and its impact on patient health and wellbeing.

Conclusion and Recommendations

In the nursing work environment, the modification of existing procedural methods may influence how medication administration takes place; in addition, it may demonstrate an important step towards the discovery of other factors that will improve medication safety in hospitals. Nurses must serve as key leaders in this area and provide expert knowledge, data, and resources to accommodate patients and improve quality of care. It is important for nurses to recognize their responsibility to examine existing strategies, to determine if they have been successful or if modifications are required, and to identify the appropriate evidence that will support this process as best as possible. It is necessary to demonstrate these tools and resources to determine if there are feasible alternatives that could impact medication administration in a positive manner.

From a nursing-based perspective, tools and technologies may have a significant impact on medication administration and the reduction of errors that impact patient safety. Since patient safety is of primary importance, it is necessary to evaluate the conditions that exist and which contribute to medication errors as they occur. This process will demonstrate the importance of developing an environment in which nurses gain valuable knowledge and experience in supporting proper and timely medication administration that is safe and effective for all patients.  It also requires nurses to recognize their own limitations with the systems that are in place and to be able to address patterns where these errors occur in order to be successful in reducing errors and limiting the risks associated with patient safety. It is recommended that nurses must be able to identify patterns where medication errors might be prevalent in order to be successful in addressing these concerns and modifying strategies accordingly as needed. Nurses administer medications to their patients on a regular basis; therefore, they must be considered as a critical component of the discussion and support change within this area as required to facilitate improvements in patient safety and quality of care that will translate into successful treatment outcomes and improved quality of life for patients who receive medications in healthcare environments.

References

Alsulami, Z., Conroy, S., & Choonara, I. (2012). Double checking the administration of medicines: what is the evidence? A systematic review. Archives of disease in childhood, archdischild-2011.

Bonkowski, J., Carnes, C., Melucci, J., Mirtallo, J., Prier, B., Reichert, E., … & Weber, R. (2013). Effect of Barcode?assisted Medication Administration on Emergency Department

Medication Errors. Academic Emergency Medicine, 20(8), 801-806. Dickson, G. L., & Flynn, L. (2012). Nurses’ Clinical Reasoning Processes and Practices of Medication Safety. Qualitative health research, 22(1), 3-16.

Henneman, P. L., Marquard, J. L., Fisher, D. L., Bleil, J., Walsh, B., Henneman, J. P., … &

Henneman, E. A. (2012). Bar-code verification: reducing but not eliminating medication errors. Journal of Nursing Administration, 42(12), 562-566.

Freeman, R., McKee, S., Lee-Lehner, B., & Pesenecker, J. (2013). Reducing interruptions to improve medication safety. Journal of nursing care quality, 28(2), 176-185.

Keers, R. N., Williams, S. D., Cooke, J., & Ashcroft, D. M. (2013). Causes of medication administration errors in hospitals: a systematic review of quantitative and qualitative evidence. Drug safety, 36(11), 1045-1067.

Lawton, R., McEachan, R. R., Giles, S. J., Sirriyeh, R., Watt, I. S., & Wright, J. (2012). Development of an evidence-based framework of factors contributing to patient safety incidents in hospital settings: a systematic review. BMJ quality & safety, bmjqs-2011.

Leung, A. A., Denham, C. R., Gandhi, T. K., Bane, A., Churchill, W. W., Bates, D. W., & Poon, G. (2015). A safe practice standard for barcode technology. Journal of patient safety, 11(2), 89-99.

McLeod, M., Barber, N., & Franklin, B. D. (2015). Facilitators and Barriers to Safe Medication Administration to Hospital Inpatients: A Mixed Methods Study of Nurses’ Medication Administration Processes and Systems (the MAPS Study). PloS one, 10(6), e0128958.

Soerensen, A. L., Lisby, M., Nielsen, L. P., Poulsen, B. K., & Mainz, J. (2013). The medication process in a psychiatric hospital: are errors a potential threat to patient safety?. Risk management and healthcare policy, 6, 23.

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