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NUR2000 Medications Management

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NUR2000 Medications Management

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Course Code: NUR2000
University: University Of Southern Queensland

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Country: Australia

Question: 

There is a specific, relevant and concise description the significance of problem (medication errors) and the impact this has on patient. This section is supported by current quality evidenced based literature
Identify three factors that cause medication errors and discuss why these factors lead to medication errors and impact on patient safety.

Answer:

Introduction:
Medication errors are the second most incidents evident in the Australian hospitals (Johnson et al. 2017). 18 % medication errors are reported in the Australian hospitals. Prescription and medicine order errors occur in approximately 5 – 11 % cases. Procedural occur in approximately 4 – 5 % cases. Approximately 5 – 8 % and 15 – 18 % clinical errors occur in individual patient medicine and ward medicine respectively (Roughead et al. 2016). Medication errors impact outcome of the patient with merely 4 – 21 % patients achieve necessary outcome as a result of medication errors. It also produces financial burden with approximately $ 6 billion loss. Moreover, inappropriate use medicines also cost approximately $ 380 million costs (NSW, 2013). Medication errors increase the stay of patient in the hospital by at least two days. Transition of care is mainly responsible for the medication errors. Most of the medication errors occur during intravenous administration of the medications (Johnson et al. 2017). Australian research on medication charts reported that at least one medicine is omitted from the medication chart for every three admitted patients (Johnson et al. 2017). It is necessary to understand the medication use process for effective medication administration and for avoiding medication errors. Stages in medication use process include prescribing, transcribing, dispensing, administration and monitoring stage. It is necessary to perform medication-error analysis to prevent medication errors (TGA, 2018). Hence, in this report medication-error analysis is performed by considering factors affecting medication errors and strategies to prevent medication errors.
Discussion:
Nursing staff: Nursing staff is one of the important systems factors responsible for the medication errors. Hours of nursing care and nurse’s skill mix affects medication errors. It is evident that when the doses numbers are in denominator; medication errors due to nursing staff are more in medical-surgical and obstetric departments. When patient’s duration of stay in the hospital is denominator; medication errors are more in Intensive Care Units (ICUs). It is evident that with increase in RN skill mix; there is decrease in 80 % medication errors (Atik, 2013). It is evident that; with decrease in the working hours for nurses resulted in approximately 30 % decrease in the medication error. Inadequate number of nurses and heavy workloads on the nurses are also responsible for the medical errors. It is evident that nurse’s workload with more than 12 hours lead to increased medication errors by three times (Roughead et al. 2016; Wheeler et al. 2018).
Communication: Communication among the healthcare providers is one of the important process factors responsible for the medication errors. Communication failures and incidents of medication errors are directly proportional. Sources of communication failure for medication errors include information resources on medication, clarification in medication orders, alteration in medication regimens and patient assessment parameters (Breeding et al., 2013). Medication error can occur because nurse need to communicate with different professionals like physician and pharmacist for the administration of the same medication to the single patient. Hence, exchange of information should be aligned among nurse, pharmacist and physician. Incomplete or illegal prescription lead to communication breakdown which lead to medication error. Difficult or illegible handwriting of physician on prescription are also responsible form medication error. Approximately more than 60 % nurses reported that; it is difficult to receive accurate information during transfer of the patients. Medical history is an important aspect for providing optimum care for the patients. However, due to ineffective communication; it would be difficult for the nurses to receive information about the medical history. As a result of communication error; there is possibility of wrong transcript of the medicines. It would lead to wrong administration of medication which would result in the adverse effect and harm to the patient. Medication errors during the transfer of the patients would result in more time consumption to get clarity on medication orders. It would result in the delay in the medication administration to the patients (Breeding et al. 2013; Atik, 2013).
Distractions and interruptions: Distractions and interruptions are another important process factor responsible for medication errors. Distractions and interruptions lead to disturbance in the preparation and administration of medications which would lead to wrong administration of medication. Distractions and interruptions are usually associated with high work load, poor supervision, ward rounds, face-to-face and telephone conversations. Noise and electronic devices also play important role in the distractions and interruptions for nurses. It is evident that specific clinical departments like paediatric ward, emergency department, medical-surgical unit and operating room are more vulnerable for distractions and interruptions.  As a result of distractions and interruptions, there is possibility of administration of wrong drug at the wrong time and with wrong dose calculations (Wheeler et al. 2018; Breeding et al. 2013).
Conclusion:
Medication errors are common in the Australian hospitals. Careful identification of factors responsible medication errors and implementation of effective prevention strategy would be helpful in prevention of medical errors. Mitigation of the medication errors an be effectively achieved through knowledge of medication administration process. Evidence would be helpful in improving quality of care by administering correct medication. Most up-to-date evidence and patient empowerment would be helpful in reducing medication errors. Evidence based practice need to be implemented in the daily clinical practice. Use of current research would be helpful in altering the medication for improving the clinical outcome. Evidence based practice also would be helpful in the critical evaluation of existing practice and implementation of new policies and procedures. Challenges encountered in the clinical practice can be effectively addressed and round the clock practice to the patients can be provided through evidence-based practice (Levett-Jones, 2018).
Follow accurate medication reconciliation procedure: Healthcare organisation should have medication reconciliation procedure for transfer of patient from one unit to the another.  Nurse need to verify and review the medication order for correct patient, correct medication, correct dosage, correct route and correct time of administration. Standardised medication reconciliation forms are available from the various sources (Roughead et al. 2016; Levett-Jones, 2018).
Double check and triple check procedures: Nurses should ensure that all the new medication orders are checked by another shift nurse or incoming shift nurse. Both the nurses should ensure that patient’s medication orders are noted and transcribed accurately. Both the nurse should ensure that medicine is being administered with reference to six rights like right client, right route, right drug, right dose, right time and right documentation (Levett-Jones, 2018).
Proper documentation: Proper documentation includes activities like medication labelling, legible documentation and proper recording of the administered medication. It is evident that improper documentation can lead to medication error. It is essential to prepare and maintain proper document for the administration of medication. Illegible handwritten medication order is one of the significant factors responsible for medication errors; henceforth, replacement handwritten medication would be helpful in avoiding medication orders (Levett-Jones, 2018; Atik, 2013).
References:
Atik, A. 2013, ‘Adherence to the Australian National Inpatient Medication Chart: the efficacy of a uniform national drug chart on improving prescription error’, Journal of Evaluation in Clinical Practice, vol.19, no. 5, pp. 769-772.
Australian Government. Department of Health. Therapeutic Goods Administration. (TGA) (2018).  Adverse events: Australian statistics on medicines. Retrieved from https://www.tga.gov.au/publication/adverse-events-australian-statistics-medicines on 16.12.2018.
Breeding, J., Welch, S., Whittam, S., Buscher, H., Burrows, F., Frost, C., & Wong, A. 2013, ‘Medication Error Minimization Scheme (MEMS) in an adult tertiary intensive care unit (ICU) 2009-2011’,  Australian Critical Care, vol. 26, no. 2, pp. 58-75.
Johnson, M., Sanchez, P., Langdon, R., Manias, E., Levett-Jones, T., Weidemann, G., Aguilar, V., & Everett, B. 2017, ‘The impact of interruptions on medication errors in hospitals: an observational study of nurses’, Journal of Nursing Management, vol, 25, no. 7, pp. 498-507.
Levett-Jones, T. M. 2018, ‘Medication administration’, in A. Berman, S. Snyder, T. Levett-Jones, P. Burton & N. Harvey (eds), Skills in Clinical Nursing, Pearson Australia, Melbourne, VIC, pp. 240-48.
Levett-Jones, T. M. 2018, Clinical reasoning: learning to think like a nurse, 2nd edn, Pearson Australia, Melbourne, VIC. 
Ministry of Health. New South Wales (NSW). (2013) Medication Handling in NSW Public Health Facilities. Medication Handling in NSW Public Health Facilities. Viewed 16 December 2018 ?https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2013_043.pdf>
Roughead, E.E., Semple, S.J., & Rosenfeld, E. 2016, ‘The extent of medication errors and adverse drug reactions throughout the patient journey in acute care in Australia’, International Journal of Evidence-Based Healthcare, vol. 14, no. 3, pp. 113-22.
Roughead L, Semple S, Rosenfeld E. Literature review: medication safety in Australia. Sydney: Australian Commission on Safety and Quality in Health Care; 2013.  Viewed 16 December 2018, ?https://www.safetyandquality.gov.au/publications/literature-review-medication-safety-in-australia>.
Wheeler, A. J., Scahill, S., Hopcroft, D., & Stapleton, H. 2018, ‘Reducing medication errors at transitions of care is everyone’s business’, Australian Prescriber, vol. 41, pp. 73–7.

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