Evaluation of Streamlining the Medication Process, Article Critique Example

Introduction

An article by Benoit et.al addresses the significance of using different approaches to promote greater safety while dispensing medications in the intensive care unit. It is important for clinical professionals to evaluate conditions in the intensive care unit and to determine how to best approach concerns regarding medication safety to promote efficient and streamlined protocols in dispensing the appropriate medications.1 The most common means that contribute to medication errors are lack of knowledge, limited communication between dispensing parties, and providing the wrong medication dosages or formulations.1 Medication errors are common in intensive care units; therefore, it is the responsibility of staff members to examine existing strategies and to determine where deficiencies persist.1 Intensive care units must examine their existing processes and identify cost-effective initiatives to reduce medication errors on a consistent basis, as there are many concerns with patient safety in a variety of healthcare environments that may be attributed to workflow concerns.2 Furthermore, there are advantages to developing strategies that promote as few interruptions as possible in the intensive care unit during medication dispensation to reduce patient risk.3 Also, the use of a time out initiative has been effective in prior studies, with one study demonstrating that it is possible to have a 100 percent, error-free environment to dispense medications.4 The study seeks to convey the importance of interventions that are designed to reduce medication errors that may cause unnecessary harm to patients in the intensive care unit.

 Article Summary  

The primary objective of the article is to examine the most feasible method of promoting medication safety that will lead to the reduction of medication errors for patients in the intensive care unit.1 Greater control within the intensive care unit plays a significant role in reducing medication errors, and different forms of intervention must be analyzed to determine whether or not they reduce the prevalence of these errors.1 The study results that are derived from this project could be applicable to other organizations through increased adherence to specific guidelines to reduce medication errors in similar units, thereby increasing patient safety over time because this is a critical component of high quality patient care.

Comprehensive chart reviews were conducted in preparation for the intervention efforts and after the interventions had taken place.1The study took place in a multidisciplinary ICU in a hospital in Switzerland that provides tertiary care to its patients.1The study focused on residents, and oversight was provided by fellows and intensive care physicians.1 The study utilized an interrupted time-series design as a means of identifying trends, as well as the creation of methods to minimize negative trends.1 The intervention focused on prescribing and administration to minimize errors as much as possible.1 The selected data was derived from over 9,000 prescriptions for almost 300 patients over a period of 85 days.1 Therefore, multiple layers of data were possible for some patients in order to accomplish the study objectives.1 It was expected that the study intervention method would provide a greater reduction of medication errors, as well as an increased number of patient-days without these errors.1

The study results indicated that upon application of the intervention, the number of medication errors was reduced from 4.95 percent to 2.14 percent, a significant reduction.1 In addition, there was an increase in error-free patient-days from 59.3 percent to 79.8 percent.1The study data reflects positive trends in the reduction of medication errors, along with a decrease in multiple errors within a given day from 15 percent down to 4.7 percent.1 All patients entering the intensive care unit were considered for study inclusion; however, patients as determined by physicians might be excluded from the study based upon specific criteria.1  Due to the nature of the patient population being treated in the intensive care unit, it is important to recognize that this population is likely to require significant medications during the treatment phase; therefore, there is a much greater risk of medication errors for this population group.1 The study outcomes indicate that there are significant advantages in using interventions to reduce medication errors on several levels, including omissions and wrong dosages.1

The intervention addressed in the article demonstrates the importance of reducing medication errors in the intensive care unit. Different types of errors may be minimized or eliminated altogether when specific issues are addressed more closely and modified to improve patient outcomes. The study conveys the relevance of the different steps involved in medication administration so that problem areas are adjusted to reduce errors accordingly. By collecting data regarding medication administration, errors may be identified and strategies may be developed that support improved quality of patient care.

The article has several strengths, including the following: 1) the use of several intervention methods rather than a single method to determine how to reduce medication errors using a combination of methods to identify the most common medication errors; 2) the use of chart review as a source of data before and after the interventions had taken place to support an understanding of the extent and nature of medication errors within the ICU; and 3) a significant number of medication orders were examined to increase the effectiveness of the methods that were chosen, since a larger statistical sampling is likely to be effective in developing patterns of medication errors so that solutions may be identified.  Each of these strengths contributes to the study’s effectiveness because they emphasize that the methods used were valid and appropriate.

These methods provide a greater understanding of the difficulties associated with medication administration and chart review in real-time nursing environments. However, the study was limiting because 1) it does not effectively translate to the practices conducted in other countries because there are significant differences in how different countries dispense medications that may lead to significant differences in medication errors; 2) it does not explore the nature of the medication orders that were evaluated in the study and what types of medications were prescribed, thereby leading to findings that are limiting and that might not tell the whole story of these errors; and 3) it does not explore the short and long-term impact of medication errors on the patients under consideration, including side effects. This is significant because it is unknown whether or not these patients have significant side effects or other concerns that are likely to impact their overall health and wellbeing.1 Therefore, it may be difficult to utilize the same study methods in future studies, particularly those that seek to explore other avenues to evaluate medication errors. These limitations are considered because they address weaknesses in the research model and the areas where data collection was not necessarily effective.

Conclusion

Based upon the study results, it is likely that the selected interventions will play a role in supporting future evaluations of the impact of medication errors. However, the study may be limiting in that it does not provide a single solution to this serious problem, nor does it reflect upon the impact of these errors on patient outcomes. Therefore, additional factors must be considered in future studies in this area of focus. Nonetheless, the study is a good read and is likely to spark interest and discussion of this topic among health professionals. This article indicates that medication errors are a serious concern within intensive care units and that additional measures must be taken to prevent these errors from taking place. This article is useful to healthcare institutions because it considers the frequency of medication errors and their impact on patient care outcomes. By conducting various interventions, it is possible to prevent many of these errors and their negative influence on patient health and wellbeing.

References

Benoit E, Eckert P, Theytaz C, Joris-Frasseren M, Faouzi, M, Beney J. Streamlining the medication process improves safety in the intensive care unit. Acta Anaesthesiol Scand. 2012; 56: 966-975.

Dickinson CJ, Wagner, DS, Shaw, BE, Owens, TA, Pasko D, Niedner, MF. A systematic approach to improving medication safety in a pediatric intensive care unit. Critical Care Nursing Quarterly. 2012; 35(1): 15-26.

Anthony K, Wiencek C, Bauer C, Daly B, Anthony M. No interruptions please: impact of a no interruption zone on medication safety in intensive care units. Crit Care Nurse. 2010; 30(3): 21-29.

Nguyen EE, Connolly PM, Wong, V. Medication safety initiative in reducing medication errors. Journal of Nursing Care Quality. 2010; 25(3): 224-230.