Multidisciplinary Decision Making Needed for Patient Transfers, Essay Example

Medication Errors

Medication errors are one of the most daunting problems in the medical setting because they are preventable and typically result as a consequence of human error.  Understanding the scope of this issue within an individual healthcare institution is beneficial because it allows medical professionals to comprehend the source of the problem and take concrete actions to implement changes.  Since 1992, the Food and Drug Administration has received more than 30,000 reports of medication errors due to a variety of mistakes ranging from incorrect spelling of the drug name when ordered by the physician, and incorrect use of combinations of drugs, to the application of non-beneficial doses (Food and Drug Administration, n.d.).  It is necessary to determine the incidence of these errors and the types of errors made to determine how to implement training programs to prevent these mistakes from occurring and impacting the quality of care that patients are able to receive.

Medication errors are a common cause for concern within research institutions because they are avoidable mistakes that can cause great damage to the patient population (source/sources needed). Overall, it is important to determine how to reduce these errors in light of modern technology available. In particular, electronic health record systems should be used to help health professionals track important medication data to avoid these errors (Aronson, 2010).  Honesty in reporting is an essential component of this need to ensure that all records are accurate.  It is plausible that implementing enhanced record tracking will contribute positively to reducing medication errors.

Therefore, the research question for this literature search that is posed is “What nursing practice factors are necessary to ensure that the implementation of electronic health record data will reduce the frequency of medication errors made in practice?”  It is hypothesized that the efficacy of such a medication reporting program would depend on the institution’s organizational culture.  If nurses can report their errors honestly, the number of reported errors initially would increase.

It is important to communicate these errors through the use of technology to ensure that all healthcare professionals are able to work towards minimizing these problems in practice.  Creating a culture of reporting will ensure that nurses understand the benefits of reporting mistakes.  For example, they might feel that their supervisors would not reprimand them for their honesty and ability to rectify a potentially damaging situation.  Overall, an examination of this question has the potential to contribute meaningfully to nursing practice.

While medication errors are found to be the fault of a variety of medical professionals, nurses tend to develop the closest relationships with patients.  This provides them with the unique ability to enact changes that can protect patients’ safety.  Many quantitative and qualitative research studies that attempt to identify medication errors at the local level incorporate the opinions of nurses who are on the front line.  A report issued to nurses indicated that approximately 64% of nurses have made a medication error at some point in their career (Cheragi, Manoocheri, Mohammadnejad, & Ehsani, 2013).  In addition, nurses reported almost making a medical error that they could have avoided approximately 31% of the time (Cheragi et al., 2013).

It was found that a majority of errors occurred in instances in which the prescribing physician utilized drug abbreviations instead of full names.  As a consequence, nurses tended to assume that the abbreviations stood for a drug other than the one(s) intended and the patients were delivered the wrong medication (Cheragi et al., 2013).  Even though this is problematic, such an error can be avoided easily by providing nurses with greater pharmacological knowledge or altering prescription writing practice in the institution to require full drug names to be written out.  These results are surprising because they indicate how steps could be taken immediately to reduce the probability of medication errors.  It also is interesting that many nurses accurately reported their involvement in making medication errors (source needed).  This demonstrates that similar studies could be implemented with an expectation of somewhat reliable reporting.

An experimental approach to resolve the incidence of medication error would require selection of an intervention to determine how to redesign nursing practices in a manner that could prevent future errors.  To do so, it would be valuable to determine the impact of communication methods between nurses used between shifts to convey important messages about patients.  Studies have shown that the quality of the practice environment reasonably could reduce the incidence of medication errors observed (sources needed).

Specifically, the provision of a supportive clinical environment has been linked to the reduction of this problem (Robert Wood Johnson Foundation, n.d.).  In these organizations, employees typically are provided with the comprehensive training they believe they need to engage in successful practice (Robert Wood Johnson Foundation, n.d.).  When nurses are able to participate in executive decisions, a supportive clinical environment is created.  They are able to provide direct feedback to their medical communities that allow them to implement high quality care.

Other studies have demonstrated that electronic communications are being used more frequently in health care (Weaver, Lindsay, & Gitelman, 2012).  Typically, communication is used between the physician and the patient, but it is also plausible to implement this level of communication between hospital employees.  Prior to the use of cell phones, hospital administration implemented the use of beepers and a hospital announcement system to send messages to personnel.  However, the advent of cell phones makes it easier to send these messages and allows these messages to become more personalized.  Thus, a plausible intervention would be to use cell phone text messaging applications as a way for nurses to quickly contact one another and to send important messages.  This would allow communications to be documented and easier to refer to during practice.

In order to implement the use of cell phones properly, it is important to consider ethical use and the need to track the information transferred between nurses.  Therefore, all phones will be required to be connected to the hospital server and messages will be sent that run through the hospital e-mail.  Thus, copies of this information will be sent to the information technology team. If a mistake is made, the information from these messages can be used to provide the nurse with mistake-specific training.  Furthermore, if the mistake is not the fault of the nurse, administration will be able to better determine the function or individual responsible for the error.

Critics of smartphone use in health care believe that the use of cell phones in the clinical environment would be a cause of distraction (Gill, Kamath, & Gill, 2012).  If phones are not used effectively, this behavior likely would contribute to an increase in the incidence of medication errors observed.  However, an emphasis on proper use must be placed to ensure that cell phone use would act as an improvement to the healthcare system. Cell phones have many useful applications that would allow health care professionals to optimize practice.  In particular, implementing their use could reasonably improve communication between employees and contribute to the reduction of medical errors.  This might result as a consequence of increased discussions that employees could have regarding preventing negative results of errors and eliminating errors altogether.

Determining how to improve the quality of care that patients receive is a hallmark problem in the medical field. Many professionals postulate that this problem could be solved by providing health care professionals with an enhanced means to communicate effectively (Wager, Lee, & Glaser, 2010).  As such, many training programs have been created at the local level to ensure that this occurs.  One of the most significant steps that an organization could make on this matter is the use of electronic health record systems in the hospital (Wager et al., 2010).  The use of this technology is promoted by United States health care law (source needed) and can be implemented in many different ways that contribute to the quality of health care that patients receive.  Since these systems bypass the use of paper records, it is easier for health care professionals to be certain that the records they are reading are accurate.  Thus, they are less likely to fall victim to misreading written information.  Even though these systems are valuable and have the potential to reduce medication errors, the incidence of medication errors are still high in many cases (source needed).  It is necessary to take action to implement additional interventions to contribute to the resolution of this problem.

One of the biggest communication problems occurs between shift changes (Baggs, 2013). As a consequence of altering staff, very few individuals have a complete understanding of the work that was done prior to the completion of the previous shift.  Some researchers have proposed that it would be beneficial to leave a recorded message for the individual covering them to highlight what is needed for each patient and to give the nurse coming on shift a general sense of the work still needing to be done and how that work should be prioritized (Chapman, 2010).  This is a beneficial way of ensuring that employees who have just started their shifts have a better understanding of what they need to do.

However, the recording process is somewhat time consuming, requires a quiet area, and the information contained may not be usable if the message is long.  Using a text message system is a valuable way to counter the problems created by this reporting system because it is easier to refer to the information given (source needed).  In addition, this method will ensure that urgent information is shared.  For example, nurses will be able to more readily report medication errors or what is being done to resolve mistakes that have already been made through this process.  If the issue is addressed by more than one nurse over time, it is likely that the detrimental effects caused by the medication error will be reduced more quickly and effectively.

Independent of the communication strategy implemented, it is important for healthcare organizations to determine training programs that could be used to increase the level of communication that occurs between employees (Baggs, 2013).  For a cell phone intervention to be successful, it would be necessary for researchers to provide training for those who will participate (Baggs, 2013).  The simple implementation of the cell phone is not enough to ensure that the intervention will be successful.  Instead, employees must be provided with information concerning proper use to ensure that the messages they send to other employees will be succinct and meaningful.

Employees will be required to listen to several examples of useful messages, and they will have the opportunity to craft their own messages during the training program to reinforce the concepts learned.  It is also important to collaborate with administration to accomplish this task due to the many implications this intervention will have for them.  As a whole, the use of cell phones in the hospital setting will make it easier for professionals to provide their patients with high quality care.  Phones could be used for many communication purposes not just to convey messages that will help reduce the incidence of medication errors within a particular institution.  It is clear that there is an apparent utility of these cell phones, and their use will justify the expense.  In low-budget institutions, it is even reasonable for employees to use their personal cell phones for this purpose, as many individuals have unlimited texting plans.

It is plausible to generate a qualitative understanding of the use of cell phones in the clinical setting as such use impacts the incidence of medication errors.  In particular, such a project would be concerned with determining the number of medication errors that have been prevented as a consequence of the text messaging system.  Furthermore, the amount of time that nurses spend with patients at baseline, compared to the amount of time nurses spend with patients following the implementation of the intervention, will allow us to understand whether the use of the text messaging system contributes to nursing practice efficiency.  Some qualitative understandings could be gathered using this method as well, although doing so would not be necessary to support or reject the hypothesis.  While it appears that quantitative data is necessary for most experimental designs, it also would be valuable to generate qualitative data that supports this understanding (Leedy & Ormrod, 2013).

To ensure that meaningful information is collected, it is reasonable to determine the impact of cell phone use within my individual hospital department.  Furthermore, since previous studies have indicated the relationship between medication error reporting and reliability, it would be reasonable to determine nurse opinion and related efficacy of this trial to determine whether it would be valuable to continue implementing this intervention after the experiment’s completion (Baggs, 2013).  Furthermore, patients in each department could be sampled to determine how they rated their care prior to and following the implementation of cell phone communication.  Since medication errors have the potential to impact individuals independently of age, gender, and medical condition, all in-patients in a department can be seen as potential candidates.  Individuals that consent to participation could be asked to join the study and be issued a survey.  Sample size is also dependent on the number of individuals that are willing to participate (Leedy & Ormrod, 2013). Correct determination of sample size is necessary to ensure that well-powered results are generated.

The variable that will be measured is nurses’ perceptions of interventions implemented to reduce medication errors, as well as patients’ perceptions of the quality of care that they are receiving.  It will be necessary to retrieve data at both the baseline and after the implementation of a new health record recording protocol to determine impact on practice (Leedy & Ormrod, 2013).  The procedure will be implemented by issuing different surveys to nurses and patients. Patients will be provided with a patient satisfaction survey and nurses will be asked to provide detailed opinions about the intervention based on guided questions.

The aim of this practice will be to determine whether incidence of general medication errors have impacted the patient’s perception of care.  The assumption is that patients will perceive the quality of care they receive as increased if they are not victims of medical errors.  A statistical analysis will be conducted to determine differences in attitudes from baseline to the end of the research project.  Staff attitudes and patient satisfaction will be measured to gain a comprehensive understanding of the intervention’s impact on hospital operations.  Baseline information will be collected prior to the application of the intervention and will reflect medication error data before the experiment begins.

Since the sample being used is meant to be reflective of the local healthcare organization, it will be beneficial to encourage as many individuals as possible to participate.  To ensure that there is no misrepresentation, it will be important for participants to understand that their answers will not be judged.  To prevent misunderstanding, surveys will be issued in a legible font size with clear language (Saladana, 2012).  To control for bias, results will be blinded during analysis.  All answers will be organized using Excel prior to analysis and coded for qualitative understanding.

It is apparent that nurses have the ability to intervene directly with care that patients are provided, to address problems associated with medication errors, and to prevent these errors in practice (Anderson & Townsend, 2010).  Since a variety of healthcare institutions have completed work to address medication errors in the past, it is reasonable to consider the problems they detected within their organization.  Further, it would be prudent to investigate how the interventions these organizations implemented contributed to issue resolution (Aronson, 2009).

To achieve this goal, information has been drawn from both primary and secondary sources.  Primary sources included original research conducted by healthcare professionals regarding an epidemiological understanding of medication errors made within healthcare institutions, as well as interventional studies that attempted to reduce this percentage (Leedy & Ormrod, 2013).  Secondary sources were used that draw from the understandings presented in primary sources (Leedy & Ormrod, 2013).  Using this information helps apply connections between primary and secondary source material.  Overall, such research is necessary to produce a rationale for the student’s proposed study.  The literature has indicated that there are many gaps incurrent knowledge of medication errors, and additional analysis on this topic is warranted and beneficial.

Overall, it is apparent that there is a need to conduct research that will help medical professionals determine how to reduce the incidence of medication errors effectively.  It is the nurse’s responsibility to contribute positively to patient care.  Nurses can do so more reasonably by ensuring that harm will not befall patients.  Since medication errors are preventable, it is important to alter practice in a manner that prevents their occurrence.

To do so, technology can be implemented.  Electronic health record systems currently are being used to address some medication error problems, but this benefit could be supplemented by requiring the use of cell phones to increase nurse communication between shifts. Doing so will allow those individuals beginning their shifts to have a recorded message with information they will need throughout their shift.  They will be able more readily to address problems that have arisen in the previous shift and have not yet been addressed fully.  Furthermore, these methods ensure accountability and make it easier for supervisors to determine which individuals are able to and willing to communicate effectively.  Training programs can be provided to help with this implementation, which will ensure that a more significant level of compliance is being met.

References

Anderson, P., & Townsend, P. (2010).  Medication errors: Don’t let them happen to you. American Nurse Today, 5(3). Retrieved from http://www.americannursetoday.com
/medication-errors-dont-let-them-happen-to-you/

Aronson, K. J. (2010). Medication errors: Definitions and classification. British Journal of Clinical Pharmacology, 67(6), 599-604. http://dx.doi.org/10.1111/j.1365-2125.2009.03415.x

Baggs, J. (2013). Multidisciplinary decision making needed for patient transfers. American Journal of Critical Care, 22(6), 464. http://dx.doi.org/ 10.4037/ajcc2013116

Chapman, K. (2010). Improving communication among nurses, patients, and physicians. American Journal of Nursing, 109(11), 21-25. http://dx.doi.org/10.1097/01.NAJ
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Cheragi, M. A., Manoocheri, H., Mohammadnejad, E., & Ehsani, S. R. (2013). Types and causes of medication errors from nurse’s viewpoint. Iranian Journal of Nursing Midwifery Research, 18(3), 228–231. Retrieved from http://www.ncbi.nlm.nih.gov/pmc
/articles/PMC3748543/

Creswell, J. W. (2014). Research design: Subtitle missing (4th ed.). Thousand Oaks, CA: Sage.

Food and Drug Administration. (n.d.). Strategies to reduce medication errors: Working to improve medication safety. Retrieved from http://www.fda.gov/Drugs
/ResourcesForYou/Consumers/ucm143553.htm

Gill, P. S., Kamath, A., & Gill, G. S. (2012). Distraction: an assessment of smartphone usage in health care work settings. Risk Management and Healthcare Policy, 5, 105–114. http://dx.doi.org/10.2147/RMHP.S34813

Hamer, S., & Collinson, G. (2005). Achieving evidence based practice: A handbook for practitioners (2nd ed.). New York, NY: Baillere Tindale.

Leedy, P. D., & Ormrod, J. E. (2013). Practical research: Planning and design (10th ed.). Upper Saddle River, NJ: Prentice-Hall.

Saladana, J. (2012). The coding manual for qualitative researchers. Thousand Oaks, CA: Sage.

Robert Wood Johnson Foundation. (n.d.). Better environments for nurses mean fewer medication errors. Retrieved from http://www.rwjf.org/en/library/articles-and-news/2012/08/better-environments-for-nurses-mean-fewer-medication-errors.html

Wager, K., Lee, F., & Glaser, J. (2010). Health care information systems: A practical approach for health care management (2nd ed.). San Francisco, CA: Jossey-Bass.

Weaver, B., Lindsay, B., & Gitelman, B. (2012). Communication technology and social media:

Opportunities and implications for healthcare systems. The Online Journal of Issues in Nursing, 17(3). http://dx.doi.org/10.3912/OJIN.Vol17No03Man03