Nursing Best Practices on Barriers of Preventing Medication Errors

Gladys Ng’ethe
More than 2 years after the first Institute of Medicine (IOM) report, reducing medication errors and enhancing patient safety remain among the most compelling issues in health care. The 1999 IOM report To Err is Human: Building a Safer Health System elevated the level of urgency needed to focus on how medical errors are killing thousands of people in the United States annually, and adding billions of dollars to the cost of health care.
Medication-related errors alone kill 7,000 people or more each year, and the rate of deaths for inpatients has dramatically increased in the past 15 years (Phillips, Christenfeld, & Glynn, 1998). Beyond medication errors themselves, there are also serious and potential adverse drug events (ADEs) that have a significant human and financial cost.
THE RIGHT REPORTING SYSTEMS.
Miscommunication/ Knowledge deficit:
Collaborative communication among healthcare providers is a prerequisite for safe and effective patient care. The Joint Commission suggests that communication is a key contributor to sentinel events and medication errors. Kirkpatrick (2003) stressed people in organizations typically spend over 75% of their time in an interpersonal situation; thus it is no surprise to find that at the root of a large number of directorial problems is poor information exchanges. Nurses are required to read back any verbal of telephone orders given. Noisy transmission (unreliable messages, inconsistency), receiver distortion: selective hearing, ignoring non-verbal cues are contributing factors erroneous messages.
Prescribers should avoid using abbreviations, including those for drug names because they can be misunderstood. Indecipherable handwritten prescriptions, metric vs apothecary systems, look alike- sound alike drug names, drug miscalculations, ambiguous or incomplete orders.
Identifying Vulnerabilities:
You cannot begin to correct a problem or susceptibility until you know that it exists. You cannot fix what you do not know about. Reporting systems appropriately used for self-reported information such as incident reports and many kinds of administrative data sets. Unfortunately, many organizations view the data in reporting systems as a true reflection of what is really happening in their organization according to Patient Safety(2007). This is in no way a reliable assumption. As far as patient safety is concerned, the reporting system should be looked at as a vulnerability detector, not as a measurement of incidence or prevalence. Realizing that clear communication and credibility are crucial to leading change, NCPS established a goal that people would accept: preventing harm to the patient (VA 2002).
SOCIO-ECONOMIC STATUS.
Insurance policies:
The relentless, decades-long rise in the cost of health care has left many Americans struggling to pay their medical bills. Workers complain that they cannot afford high premiums for health insurance. Patients forgo recommended care rather than pay the out-of-pocket costs. Employers are cutting back or eliminating health benefits, forcing millions more people into the ranks of the uninsured. And state and federal governments strain to meet the expanding costs of public programs like Medicaid and Medicare. A closer look at the people who admit to having prescription-filling problems shows that they come from all socio-economic strata, but are more likely to report low income or no insurance coverage. This suggests that financial burden rather than personal preference may be the culprit. Cohen (1997) found that elderly persons living below the poverty level were six times more likely to go without a necessary prescription than those with higher incomes.
Lack of unexpendable resources:
Kozer et al propose a few widely advocated potential systems improvements. For example, computerized physician order entry (CPOE) has been shown to be an effective technology for reducing prescribing errors. CPOE clearly has enormous potential for improving patient safety. At the most basic level, CPOE ensures that orders are complete, legible, and in a standardized format. When decision support is incorporated, CPOE can guide drug dosage, frequency, and choice of route or administration, as well as perform checks for drug allergy and drug-drug interactions. Handheld devices have considerable promise in hectic environments such as EDs and clinics, where it may be difficult to access a computer terminal while providing care. Robots have promise in reducing errors in drug dispensing; smart intravenous pumps may reduce administration errors, and bar coding can improve the reliability of the entire medication system.
The availability and quality of supervision is particularly important for preventing and catching mistakes by trainees. Prompt, direct faculty supervision is available in most EDs, and close supervision of trainees is fast becoming the expected standard of care. Real or perceived authority gradients (eg, seniority-based, gender-specific, cultural) are particularly problematic because they inhibit trainees from seeking help and dampen enthusiasm for open dialogue and feedback.
Nursing education must look beyond the finite skill of medication calculation and acknowledge system issues that plague most medication errors. Nursing must be experts in evaluating systems embedded within the medication administration process, and educators need to assume leadership with this daunting task. Risk factors could be proactively addressed and ultimately reduce the factors surrounding with medication errors. Hence, nursing faculty must foster critical thinking in risk reduction factors when administering medications and examine the entire continuum of the medication process with students.

BIBLIOGRAPHY
Phillips, D.P., Christenfeld, IV., Glynn, L.M. (1998). Increase in US medication-error deaths between 1983 and 1993. Lancet, 351, 643-644.
Joint Commission on the Accreditation of Healthcare Organizations. The measurement mandate. Oakbrook Terrace, IL: JCAHO; 1993.
Kirkpatrick, C. (2003) Safety first: The JCAHO introduces new patient goals. Nurses Week, 4(2), 23.
National Center for Patient Safety. 2005. "Safety Assessment Code Matrix." [Online information; retrieved 9/24/07.] http://www.patientsafety.gov /matrix.html.
Veterans Health Administration (VA). 2002. VHA National Patient Safety Improvement Handbook. [Online document created 1/30/02; retrieved 10/23/07.] VHA Handbook 1050.1. http://www.patientsafety.gov/NEWS/Pubs/NCPShb.pdf.
Cohen RA, Bloom B, Simpson G, et al. Access to Health Care. Part 3: Older Adults. National Center for Health Statistics. Vital Health Stat 19(198),1997.
Kozer E, Scolnik D, Macpherson A, et al. Variables associated with medication errors in pediatric emergency medicine. Pediatrics.2002; 110; 737 –742