Medication Errors in Nursing, Literature Review Example

This paper reviews current literature on the causes of medications errors in order to determine some best practices in nursing to prevent these errors.

In an article in the 2005 Annual Review of Nursing, Carlton and Blegen claim that “Patient injuries resulting from drug therapy are among the most common types of hospital adverse patient events.” (Carlton & Blegen, 2005, 20). They also cite “several studies suggest that approximately one-third to one-half of adverse drug events are preventable” (Ibid., 20). Their review of the factors causing errors include too many hours worked by nursing staff, too few RNs on duty relative to less-trained personnel, patient acuity, less experienced and/or educated nurses, and certain medications (Ibid., 23–29). Gurwitz concurs about the severity of the problem and cites the elderly in nursing homes as particularly vulnerable by pointing out that “about 350,000 adverse drug events—more than half of which are preventable—occur each year in the 1.55 million residents of U.S. nursing homes. There are almost 20,000 fatal or life-threatening adverse drug events per year, of which 80% are preventable” (Gurwitz, 66).

A more recent review of the literature on medication errors by Brady, et al. points out that medication errors are due to both system and individual errors.  They claim: “It is imperative that managers implement strategies to reduce medication errors including the establishment of reporting mechanisms at national and international levels to include the evaluation and audit of practice at a local level” (Brady, et al., 2009, 679).  They also point out that simple mathematics has become an essential skill for nurses in computing dosages, and claim: “Acquisition and maintenance of mathematical competency for nurses in practice is an important issue in the prevention of medical error.” (Ibid., 679).

Nurses’ mathematical skills seems to be an area of deep concern. In Polifroni, et al.’s assessment of medication errors the authors claim that “11% to 14% of medication errors are related to mathematical errors” (Polifroni, et al., 2003, 455). The paper also cited work that showed that between 9% and 38% of junior-level nursing students could not pass a 7^th grade mathematics exam (Ibid., 456). These authors conclude that “the current approach to reducing medication errors through addressing system issues is inadequate and will continue to be until the basic mathematical skills of practitioners are addressed” (Ibid., 458).

Technology can help play a role in improving medication error rates, however. In one study by Greenfield, nursing students using personal digital assistants (PDAs) demonstrated increased accuracy and speed in answering questions using PDAs rather than those who have equal access to books only. Another study by DeYoung et al. studied the effect of encoding medications with bar-codes to determine if that would reduce the number of medication errors in an adult intensive care unit. The study concluded that the medication error rate was reduced by 56% with the use of bar coded medications. They saw a similar drop in the number of times a medication was administered at the wrong time. (DeYoung, et al., 2009, 1114–1115).

Fields reports on an initiative to implement new intravenous safety measures using a new computerized system. She claims that key to successful implementation of their new system was a “blame-free, collaborative workplace; the use of sophisticated self-assessment tools and root cause analysis; evidence-based best practice rules incorporated into system software; efficient, effective nursing education; high compliance; and an effective hospital-vendor relationship” (Fields, 2005, 78-79). Their implementation has resulted in a safer work environment for nurses, improved patient safety, improved patient satisfaction and perceived safety, and reduced costs from standardization. (Ibid., 86).

Wolf’s 2007 assessment of the impact of technology on medication errors is mostly positive. He claims, “It is the human-machine and human-human connections that will lead to safer practice in the high-consequence systems of health-care institutions” (Wolf, 98).

One important issue in medication errors is the ethical implications such errors have. Erlen addressed this point in a 2001 article. She identified issues such as harm to patients, disclosure of errors to patients, erosion of trust between patient and medical care providers, and the possibility of compromising the quality of patient care. One key conclusion she presented was that “Nurses’ appropriate ethical responses to medication errors such as whistle blowing, advocating for change and disclosing errors to patients and families need to be supported” (Erlen, 2001, 85).

Gibson’s article offers a somewhat different perspective on the problem, as she concludes: “the discussion should not be read as implying that policies and procedures to guide nursing practice should not exist; rather, they need to be in forms that (en)able nurses to provide safe and effective care through recognition of their knowledge and skills and appreciation of their clinical judgement” (Gibson, 115).

The key conclusions from this review of the literature on medication errors are, first of all, that the problem itself is important and warrants strong attention, both from individual nurses and from all levels of management. Possibly half or more of medication errors are preventable. Some of those errors arise from systemic errors (overworked nurses, lack of standardization, inadequate math skills of the nurses, etc.) and some are individual human mistakes. Technology, while helpful, is not a panacea for the problem of medication mistakes. There are ethical issues regarding such errors that need to be addressed, too. While there is no easy solution to this problems, nurses need to have a real voice in helping to reduce medication errors.

References

Brady, A-M., Malone, A-M., Fleming, S. (2009). A literature review of the individual and systems factors hat contribute t omedication errors in nursing practice. Journal of Nursing Management, 17, 679-697. DOI: 10.1111/j.1365-2834.2009.00995.x

Carlton, G. & Blegen, M. A. (2005). Medication-Related errors. Annual Review of Nursing Research. Springer-Verlag, 19–38.

DeYoung, J. L., VanderKooi, M. E., & Barletta, J. F. (June 15 2009). Effect of bar-code-assisted medication administration on medication error rates in an adult medical intensive care unit. American Journal of Health-System Pharmacy, 66 (Jun. 15 2009), 1110–1115.

Erlen, J.A. (July/August 2001). Medication Errors: Ethical Implications. Orthopaedic Nursing, 20 (4), 82–85.

Fields, M. (January/February 2005). Intravenous medication safety system averts high-risk medication errors and provides actionable data. Nursing Administration Quarterly, 29 (1), 78–87.

Gibson, T. (2001). Nurses and medication error: A discursive reading of the literature. Nursing Inquiry 2001, 8 (2), 108–117.

Greenfield, S. (March 2007). Medication error reduction and the use of PDA technology. Journal of Nursing Education, 46(3), 127–131.

Gurwitz, J. H. (October 2001). Medication errors: following the script. Nursing Homes Long Term Care Management, October 2001, 66–70.

Polifroni, E.C., McNulty, J., & Allchin, L. (October 2003). Medication errors: More basic than a system issue. Journal of Nursing Education, 42 (10), 455–458.

Wolf, Z. R. (April 2007). Pursuing safe medication use and the promise of technology. MEDSURG Nursing, 16 (2), 92–100.