Understanding Medication Errors in Nursing Practice

Nursing is the most fundamental profession in the provision of medical services. They are involved in the collection, preparation, and administration of medication for patients upon prescription by the relevant authorities. Though the execution of medical doctor’s orders, research has shown nurses are prone to errors, wrong medical formulary preparation, administration of the wrong medication, mixing of different patient medications, and wrong side administration, among others. The presence and the occurrence of one among these medication errors pose a significant risk to the health and recovery of patients administered and outpatient. According to Gorgich, Barfroshan, Ghoreishi, & Yaghoobi (2015), the source of medication error in nursing practice is a common phenomenon. Despite this, research has shown that the ability of the nurses to detect the error in its early states plays a pivotal role in the prevention of its progression and severity on the health of the patient (Gorgich et al., 2015; Polit & Beck, 2018). According to Fathi et al. (2017), the source of medication error in nursing can be traced from pharmaceutical production to labelling, poor communication among health care professionals, prolonged working hours, and exhaustion to among other factor, which effects nurses from all walks of life.

Medication errors can vary from lethal to mild depending on the kind of medication offered and the indented use of the medication in treating the patient. Although no organization is free from errors, in healthcare organizations, the source of nursing error varies from one organization to another. Therefore, it is essential to formulate preventative measures within the health care organizations to prevent recurrence of medication error among nurses due to organizational or healthcare professional factors (Johari, Shamsuddin, Idris, & Hussin, 2013).

Significant to Nursing

This information is significant to nursing as medication errors among nurses is a global challenge that has been shown to increase patient mortality rate, increased hospital stay, as well as the increased cost of provision of care. Nurses should be at the forefront of reporting these cases whenever they arise because it not only enhances quality healthcare but also elevates their stand in the profession. And since they spend a lot of time with their patients than any other person, they should have the interest of the patients at heart when delegating their duties. 

Aim

This paper will explore the literature review on medication errors in different settings and the underlining causes to these errors, while exploring solutions to omit or reduce such errors among nurses.

Method

Search Strategy

Databases searched included Google Scholar, Journal of Nursing Health and Science, International Journal of Community Health and Public Health, Online journal of Nursing Issues, US National Library of Medicine, National Institute of Health among other nursing research journal provide critical insight on medication errors among nurses in different level of their career and experience. The paper used various keywords and expressions “medical errors among nurses”, “causes of medical errors”, “intervention to medical errors”, “nursing perception of medical errors”, “nursing students”, “prevention”. For articles to be include in the literature review, they had to meet the specific criteria of being published between 2013 to 2019, had full journal structure, and published as peer-reviewed journals to ensure the most current information was being examined.

Results

Over 100 journals met these criteria’s, therefore four were selected due to their relevance on medication errors among nurses.

Finding

Study One

A cross-sectional study published by Mahesh, Saba, & Gopi (2016) explored the nurses experience on medication errors, and administrative practices, in which 199 nurses were chosen by simple random sampling from Vydehi Hospital in India were included. The study was conducted over one month and included nurses from various wards of the hospital. A semi-structured questionnaire was administered on all nurses in a selected sample size (Mahesh et al., 2016). Chi-Square was used to analyse data, as the study was exploring two nominal (Polit & Beck, 2018). The research sought to establish the frequency of medication errors by nurses, the sources of the errors, and the ability of nurses to prevent or report medical errors (Mahesh et al., 2016). According to the researchers, 97% of the nurses reported completing the 7 rights of administering medication before the administration of any medication, as well as only administering medication for two patients maximum at one time (Mahesh et al., 2016). Inadequate medication labelling was the leading cause of medical errors among nurses as well as poor preparation methodology (Mahesh et al., 2016). According to Mahesh et al. (2016) there was also an increased association between years of experience and diminished cross-checking medication label before administration. When self-reporting medication errors is discussed, nurses often feel it will impact their career negatively (Mahesh et al., 2016). However, if managers put forth a positive and reassuring attitude would encourage nurses to speak up about near misses and medication errors in their practice (Mahesh et al., 2016 & Polit & Beck, 2018). Mahesh et al. (2016) suggests healthcare authorities to provide medication specific training for nurses to minimize medication errors. Limitations to the study included it being limited to one hospital setting.

Study Two

Johari, Shamsuddin, Idris, & Hussin (2013) conducted a study to determine medication errors among nurses in government run hospitals in North Malaysia. A cross-sectional study design was implemented using a self-administered questionnaire (Johari et al., 2013). The study consisted of three demographics; 1 to 4 years, 5 to 10 years and above 11 years of experience as a nurse from various wards of the hospital (Johari et al., 2013). Johari et al., (2013) explored the level of knowledge of medication among nurses and its contribution towards medication errors. The study ruled out that years of experience was not the primary contributor to medication errors but medication knowledge, high workload, increased number of new staff without extensive knowledge in nursing practice, and complicated doctors’ orders were the leading contributors to medication error (Jorhari et al., 2013). A nurses experience only impacted their attitude towards patient and did not affect their knowledge of medication or their practice (Jorhari et al., 2013). Providing proper training for new staff and relaxation rooms for nurses to destress would assist in prevention of medication errors as stuff is overworked (Jorhari et al., 2013). The study was limited by a lack of a control group as well as authenticating the information collected from the self-administered questionnaire. Further investigation is need, as this study focused on one government run hospital.

Study Three

Fathi et al., 2017 conducted a convenience sampling study of 500 nurses, using a self-constructed questionnaire to explore medication errors among nurses in a teaching hospital in West Iran. The study took place over three months, examining the barriers nurses faced when reporting medication errors (Fathi et al., 2017). The research established that the frequency of medical errors among nurses was 17% in Iraq (Fathi et al., 2017). Heavy workload was indicated as the primary cause of medication error among nurses, unclear physician orders, decreased patient-nurse ratio, and unfamiliarity with medications (Fathi et al., 2017). Despite increased self-reporting of medication error, the researchers found out that fear was a significant cause for not reporting medication errors or near misses, followed by a lack of error knowledge and finally the supervisors perception of a medication error (Fathi et al., 2017). As an intervention, strategies such a reducing workload would be effective not only for nurses but also for the patients (Fathi et al., 2017). According to Polit and Beck (2018), the best method of intervention can be designed accordingly for each health authority and be effective to reduce the occurrence. The study indicated two limitations; was carried out in a government funded hospital and did not focus on the private and social security hospital; secondly, the method of self self reporting lacked authenticity as its self-generated questions and many participants from varying demographics (Fathi et al., 2017).

Study Four

A study by Gorgich et al., (2015) took the approach of viewing medication error causes from the view point of nurses and nursing students. A cross-sectional descriptive study was conducted, which consisted of 327 nurses from Khatam-al-Anbia Hospitals and 62 interns from the nursing and midwife program from Zahedan University, through convenience sampling (Gorgich et al., 2015). Nurses were required to have least one year experience in their present position, while nursing student were required to have completed pharmacology course to participate in the study (Gorgich et al., 2015). A three part questionnaire was used to collect data (Gorgich et al., 2015). The study established that the primary cause of medication error among nurses was burnout due to high workloads, while nursing students’ medication errors was due to medication calculations (Gorgich et al, 2015). Nursing student using unreliable online calculators is more likely to make medication errors, any shortcuts in the process are dangerous and, therefore, unacceptable (Polit & Beck, 2018). The study suggested a reduction in workload by increasing the number of nurses in each health care facility as a precautionary measure for exhaustion and introducing electronic medicine cards for patients may assist in reducing medication errors (Gorgich et al., 2015). Changing techniques to eradicate medical-related error is required to more forward (Polit & Beck, 2018). A lack of control group limited the research, as it only viewed nurses and nursing students working in healthcare facilities. It also covered a large number of nurses within one nursing facility, thus raising a question the applicability of the study finding in all healthcare facilities.

Discussion

Implications of Findings for Nurses

This literature review highlighted the factors which contribute to medication errors by nurses in health care facilities around the world. The above studies highlighted significant errors, and provided solutions to significant medication errors. It brought into the light one sensitive issue in nursing medication error; self-reporting. Although medication error is a common phenomenon in nursing, the ability of nurses to report it to their leaders has been a problematic issue. According to the review, this has been attributed to the fear of accompanying repercussions. Nurses may feel isolated, therefore having a good relationship between doctors and nurses will ensure that after reporting the cases of medical errors, nobody feels victimized (Polit & Beck, 2018). 

Conclusion

Medication error in nursing is a sensitive issue and, therefore, should be treated with the urgency it deserves. Nurses should be encouraged to report any inaccuracies in the treatment process of the patients. However, most of the healthcare workers, such as nurses do not report such cases for fear of being victimized and even losing their jobs (Fathi et al., 2017). Since the majority of medication errors are never reported by the nurses, managers of medical facilities need to have a supportive response to nurses who report such medication errors to improve patient care (Fathi et al., 2017) . Healthcare authorities need to establish and change their current techniques to eradicate medication-related errors (Jorhari et al., 2013). Once health authorities encourage multidisciplinary teams to work as a unit and good relationships between the doctors and nurses are established, it will ensure that after reporting the cases of medical errors, nobody feels victimized. 

Limitation

The research topic is widely covered around the world, therefore, the literature review included only relevant journal.

References

1. Fathi, A., Hajizadeh, M., Moradi, K., Zandian, H., Dezhkameh, M., Kazemzadeh, S., & Rezaei, S. (2017). Medication errors among nurses in teaching hospitals in the west of Iran: what we need to know about prevalence, types, and barriers to reporting. Epidemiology and Health, 39. doi: 10.4178/epih.e2017022
2. Gorgich, E. A. C., Barfroshan, S., Ghoreishi, G., & Yaghoobi, M. (2015). Investigating the Causes of Medication Errors and Strategies to Prevention of Them from Nurses and Nursing Student Viewpoint. Global Journal of Health Science, 8(8), 220. doi: 10.5539/gjhs.v8n8p220
3. Jeetu, G., and Girish, T. (2010). Prescription Drug Labeling Medication Errors: A Big Deal for Pharmacists. Journal of Young Pharmacists, 2(1), 107–111. doi: 10.4103/0975-1483.62218
4. Johari, H., Shamsuddin, F., Idris, N., & Hussin, A. (2013). Medication Errors Among Nurses in Government Hospital. IOSR Journal of Nursing and Health Science, 1(2), 18–23. doi: 10.9790/1959-0121823
5. Mahesh, M., Saba, H., & Gopi, A. (2016). Nursing perceptions of medication administration practices, reasons for errors and reporting of errors in a tertiary care hospital, Bangalore. International Journal of Community Medicine and Public Health, 459–464. doi: 10.18203/2394-6040.ijcmph20160432
6. Polit, D. F., & Beck, C. T. (2018). Essentials of nursing research: Appraising evidence form nursing practice (9th ed), Philadelphia, PA:Wolters Kluwer.