Medical Errors in Nursing, Essay Example

Introduction

Medication errors are some of the most common reasons for the strict administration of health care procedures. Most deaths in health care facilities are as a result of medication errors by health professionals. Medical errors have attracted a lot of attention from the academic, government and professional organizations and most especially on the press. Focus is paid particularly on patient safety, nature of the errors and their effects on the patient and health delivery system in general.

Medical errors according to Sarudi (2001) are mistakes, inadvertent or unintended occurrences in health care delivery that may result to patient injury.  Nursing practice is the area medicine practice that has reported significant number of deaths due to the medication errors. According to the Institute of Medicine and National Academy of science report of 1999, medical errors are among the most common medical mistakes killing at least 1.5 million people per year and increasing hospital operations costs in many hospitals in the country (cited in Liang, 2001). Today there have been major efforts to reduce the number of medical errors in health facilities. Some of these efforts have led to tremendous changes in the practice in health care in the country.

Despite the implementation of the recommendations of the Institute of Medicine and National Academy of science report of 1999 and the numerous safety procedures advice in the practice of medicine today, and the strict rules in medication dispensation, there are still reported cases of medication errors even in some of the established health institutions. Several of these errors are attributed to nursing practice. Nursing practice has reported the highest number of medication errors than any other profession in health care. The errors are very diverse and arise from the various stages in health care administration. In 2000, CNN run an article “your health: medical errors attributed to nurses”. The report blames most medical errors on the practice of nursing. It mentions that there are a significant number of deaths in hospitals as a result of nursing errors (CNN, Sep 2000).

Examples of medical errors in nursing

There are various types of medical errors. They include ambiguous designations or labeling, similar nomenclature or labeling, equipment failure, illegible handwriting, improper transcription, improper dosage calculation, labeling errors, improper transcription, and excessive workload medication unavailable among others.

Such errors have been known to cause serious impacts to the health of the patient and also may lead to death. The errors also are known to affect family members of the patients, the government, the medical facility and also the professional body.

Examples of cases of medical errors in nursing

Four nursing home residents in Dayton, Ohio were killed in December 2001 when nitrogen was mistakenly delivered to the nursing home instead of oxygen. A maintenance worker mistakenly exchanged the tap fittings and nitrogen was delivered in the home’s oxygen supply (Liang, 2000). Such mistakes are very common in nursing homes operations. Its operations and the population it serves make the occurrence of such errors possible.

Another case of medical errors in care giving is the case of Denver neonatal medication error case (Curtin, 1997) where two neonatal nurses were charged for criminal homicide when penicillin medication error caused neonatal death. The nurses received tenfold amount of penicillin from the pharmacy. The physician of the new born had given the correct prescription but the pharmacy had made a tenfold error. They also used wrong method of administration which caused lethal pulmonary embolus in the new born.

Reasons for the occurrence of medical errors in nursing

Having established the reality of medical errors as a result of nursing errors, it is imperative to note some of the common reasons that have been put forward as the reasons for the occurrence of medical mistakes in nursing. The 2005 National Institute of Medicine report, established some of the potential effects of medication errors. However, its focus shifts sharply and provides an analysis of the areas of medicine that are to blame for the medical errors.

One of the major reasons that have given to explain the occurrence of medical errors as a result of nursing is on the competence of the nurses. The National Institute of Medicine 2005 report blames this on flawed medical practices. The report suggests that some individuals who are not qualified to provide health care are employed to provide care to patients despite the fact that they have been adequately trained. Given that many health care facilities only employ individuals that have certifications indicating that they have undergone training in health care provision, their professional competence is not that clear. Some of the nurses are not professionally competent. Professional competence of the trained nurses therefore is the major reasons that such medical errors do occur. Some of the mistakes are as result of the level of training that the nurses have undergone and whether they have been adequately tested to prove that they can provide efficient health care.

Still on the training and professional competence of the nurses, minimum entry level for nursing education and administration is also to blame for the frequent occurrence of the medical errors due to nursing. The entry exams and tests for admissions to nursing education schools have been suggested to be inadequate and does not efficiently test the ability of the individual on some the core areas of nursing administration. One such area core to nursing administration that is not well tested by the nursing education entry exams according to Sarudi (2001) is mathematics. According to him, medical calculations form a large number of medical errors that are reported in health facilities due to the nurses’ inability to make accurate medical calculations which result to inaccurate drug dosage administration. In the recent times, there have been efforts made to counter the occurrence of such problem through the introduction of computers to aid in the calculations and provide proper patient records. Kaushal et al (2001) also agree that some of the medical problems arising from nursing are as a result of the mathematical inabilities of the nurses that make them unable to make accurate calculation of dosage. Other mathematical problems leading to medical errors include anxiety in the students and mathematical formulas which are wrongly applied in nursing practice. All these problems are as a result teaching methods and dismal learning results analysis. Given that most of the nursing students successfully completed science based courses such as chemistry which heavily requires the need for calculations skills; nursing curriculums do not put major emphasis on re-teaching these skills. The result is that the graduates are incapable of making accurate dosage calculations.

Another aspect that has been attributed to the occurrence of medical errors as a result of nursing incompetence due to dosage administration is the case of misinterpretation, misreading or misadministration of dosage. Such problems occur as a result of misfiling of physician order entries. These are computer generated patient orders imputed by a physician and accessed by another physician on another end to complete medical administration. Should such information be misfiled then medical errors are always bound to occur. Despite the fact computers were introduced to medical administration to reduce medical errors related to misreading to ineligible handwriting, there is no prove that it has worked to reduce such medical errors. Though there is no very clear connection of such problems to nursing education, there is still emphasis on improving nursing training curriculums in reduction of medical errors.

Error reporting also contributes to the occurrence of medical errors in nursing. Medical professionals according to Liang (2000) consider some of their members who have made medical errors to be incompetent. Given the consequences of reporting medical errors, most health care professionals cover up their mistakes. This then does not give room for such mistakes to be corrected leading to the occurrence similar mistakes in the future. Only nurses who report their mistakes are aware that reporting helps in identifying and correcting the reoccurrence of such problems. However, there are very few cases where nurses report their mistakes. In some cases nurses who report their colleagues of mistakes are often disliked by their fellow nurses. This is because of strict hospital board regulations and also state nurse board regulations which limit the number of times that a practitioner can be reported for mistakes. Many boards still correlate mistakes with incompetence. Some have even strict regulations indicating that when you are reported for more than three strikes your license is revoked. Given that such systems do not take into consideration the severity of the mistake but rather on the number of the mistakes by an individual, most cases of medical errors are not reported. Such rules and systems by medical boards do not allow correction of medical errors and therefore perpetuates the occurrence of such errors. The fear of personal and professional repercussions due to reporting medical errors play a major role in the occurrence of similar medical errors that could have been long corrected. Although medicine is a profession that should not condone professionalism, it should be noted that the fear of the disciplinary actions to be taken by employers and organizations after a mistake has been committed plays a big role in the occurrence of medical errors especially in nursing. Some of these errors are not even as a result of an individual’s mistake but rather as a result of environmental influence or system procedures that needs to be addressed. When such medical error go unreported, planning averting medical errors will be difficult and will be repeated until system errors are fixed.

In nursing practice teachings, there are very import rights that need to be adhered to in medical administration. ‘Right patient’, ‘drug’, ‘route’ and ‘time’. Sometimes in normal practice, these regulations are not strictly followed. However, there are other external forces that may trigger the occurrence of errors that occur even if these rights are followed. A good example is the case of prescription handwriting errors. Before the introduction of technology especially the introduction of computerized physician entry forms, prescription errors formed a big number of medical errors by nurses.

As already mentioned, there are other reasons that are unrelated to the training that can lead to the occurrence of medical errors in nursing. A good example is the working environment. Today, there are more than 17,000 nursing homes in the united state serving more than 1.8 million patients. Given the high number of patients and the number of health providers present in the country today, the provision of quality health care especially nursing care is very difficult. Due to the high demand for the care services, most health care providers find themselves working under very difficult working conditions. Most of them work under very stressing working environments characterized by long working hours. The likelihood for the occurrence of mistakes in health dispensation in such conditions is very possible. There are numerous reports on popular press indicating that most health care professionals especially nurses working for private homes work under very strenuous working conditions to meet the high number of patients that admitted by the operators.

With the big population of those in need of nursing care, there are unavailable resources to take care of this big population. Some unscrupulous investors engage in the business of health giving despite the fact they do not have proper resources. With the demand for nursing care being high, the demand for nursing professionals is equally high. There are some cases where the government has derived nursing care programs to gather for the needs of the population. Such programs are faced by lack of adequate trained staff.  This calls for introduction of training programs for nursing care givers to handle the rising need.  Such programs such as home care nursing care givers have contributed to high number of medical errors. Some reported cases include professional misconduct by the home care givers. Such individuals are not attracted by the passion of providing care to those in need but rather by benefits derived by enrolling on the programs. Use of services of such individuals in care giving definitely leads to the occurrence of medical errors in nursing care giving. Employing poorly trained and unqualified nurses also increase the number of medical errors in nursing.

References

Curtin, L.L. (1997). When negligence become homicide. Neonatal Network, 16(6), 5-6.

Kaushal, R., Bates, R W., Landrigan, C., McKenna, K. J., Clapp, M. D., Federico, F., & Goldmann, D. A. (2001). Medicationerrors and adverse drug events in pediatric In patients. Journal of the American Medical Association, 285, 2114-2120.

Liang, B.A. (2000). Promoting Patient Safety Through Reducing Medical Error: A Paradigm of Cooperation Between Patient, Physician, and Attorney, 24 S. ILL. U.L.J. 541, 542-43 (2000).

Liang, B.A. (2001). The Adverse Event of Unaddressed Medical Error: Identifying and Filling the Holes in the Health-Care and Legal Systems. 29 July, Med. & Ethics 346 (2001).

Nyman, J.A & Geyer, C. R. (1989). Promoting the Quality of Life in Nursing Homes: Can Regulation Succeed? 14 July. HEALTH POL., POL’Y & L. 797, 803 (1989).

Sarudi, D. (2001). Medication errors: Coping with guilt. Hospitals and Health Networks, 75(2), 26.

CNN.com /Health (2010). Your Health: Medical Errors Linked to Nurses. Retrieved on February 27, 2010, from http://www.cnn.com/2000/HEALTH/09/15/your.health/index.html