The topic of medication administration errors (MAEs) is widely researched in the sphere of healthcare. It has many smaller subtopics based on the type of drugs and possible interventions to reduce the number of mistakes. The information about this research problem may be found in various scholarly resources. The importance of this literature review lies in locating articles that show gaps in knowledge and present new areas for future research in the sphere of MAEs and prevention strategies (Polit & Beck, 2017). This review investigates five articles discussing MAEs, insulin administration, and double-checking.
Review
First of all, it may be necessary to research current data regarding the rate of MAEs. Nguyen, Nguyen, Haaijer-Ruskamp, and Taxis (2014) offer some estimates related to MAEs, especially insulin administration errors. According to the authors, these types of mistakes are widespread in clinical settings and may lead to adverse patient outcomes. The study investigated two hospitals and found that error rates were rather high – almost 30% (Nguyen et al., 2014). Moreover, the research also revealed that most of these mistakes led to or could have led to severe outcomes. Multiple types of errors were discussed in the study, including the time of the administration, the utilized technique, and the procedure’s omission. The authors concluded that interventions needed to focus on nurses’ education.
When discussing insulin administration, it is important to note that they are considered high-alert medications. Wang et al. (2015) presented a study that offered a trend analysis of possible intervention techniques dealing with MAEs. According to the authors, double-checking was mentioned as a required procedure for such drugs’ administration. Nonetheless, it should be noted that the study was not focused on this strategy alone, employing a complex system of educational and optimization initiatives instead. Therefore, the use of double-checking was not flashed out in the study, but its connection to insulin administration was established. The researchers concluded that quality improvements could be achieved with accredited frameworks.
The research on using double checking presents different results of its success. For example, Athanasakis (2015) conducted an evidence review that included multiple studies comparing single and double-checking. The author also explored the concept of double-checking and the inconsistency of its definition. It was found that there were many drawbacks to using the system of double checks, including nurses’ reliance on others to detect possible mistakes, misunderstanding of guidelines leading to conflicts, and the inability to implement this strategy in understaffed settings. However, such benefits as patient safety, nurses’ critical thinking, and collaboration were found as well. As a result, the author concluded that while double-checking was regarded as a standard procedure in many hospitals, the evidence about its impact on the rate of MAEs remained inconclusive.
The adherence to double-checking can play a significant role in the success of the intervention. Alsulami, Choonara, and Conroy (2014) investigated the level to which nurses followed the hospital’s guidelines about the procedure. They found that only 30% of all administration procedures were double-checked by nurses (Alsulami et al., 2014, p. 1404). Although in this particular example, the errors were established as causing minimal or no harm to patients, such a low rate of compliance can be significant for future research. Notably, the study by Nguyen et al. (2014) related to insulin administration showed different results, stating that all mistakes could potentially cause harm. Similar to the analysis mentioned above, Alsulami et al. (2014) found that dosing was one of the most frequent problems. However, the rate of medication errors was significantly lower than that in the study by Nguyen et al. (2014). Such inconsistency may be explained by the difference in settings and the hospitals’ types.
Low rates of adherence may be connected to nurses’ opinions about double-checking and its effectiveness. For instance, Schwappach, Pfeiffer, and Taxis (2016) gathered and analyzed oncology nurses’ views on this procedure. Through this survey, they found that double-checking was used in the majority of settings and was generally viewed as positive and appropriate for one’s clinical practice. Moreover, nurses highlighted the useful nature of joint checks as opposed to independent checks by multiple professionals. However, double-checking was regarded as an essential procedure by nurses overall. This and the previously discussed studies reveal a difference in nurses’ views on the double-checking procedure. Also, it shows that the rate of adherence to this practice may significantly affect its success.
Conclusion
Overall, the sphere of MAEs as a whole is studied by scholars from many sides, although insulin injections take up only a small part of this research. Moreover, although double-checking is regarded as an essential practice in many hospitals, its impact on the rate of MAEs is not well-researched, leaving many possibilities for future investigations. The combination of double checks and insulin administration-related errors presents a topic that has to be researched further to acquire more knowledge and develop an effective intervention. Currently, available evidence shows that mistakes related to insulin administrations are widespread and harmful, and their monitoring and mitigation are necessary to improve patient safety. The favorable view of double-checking by nurses and organizations can be taken as a foundation for a change proposal.
References
Alsulami, Z., Choonara, I., & Conroy, S. (2014). Pediatric nurses’ adherence to the double-checking process during medication administration in a children’s hospital: An observational study. Journal of Advanced Nursing, 70(6), 1404-1413.
Athanasakis, E. (2015). The method of checking medications prior to administration: An evidence review. International Journal of Caring Sciences, 8(3), 801-818.
Nguyen, H. T., Nguyen, T. D., Haaijer-Ruskamp, F. M., & Taxis, K. (2014). Errors in preparation and administration of insulin in two urban Vietnamese hospitals: An observational study. Nursing Research, 63(1), 68-72.
Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer.
Schwappach, D. L. B., Pfeiffer, Y., & Taxis, K. (2016). Medication double-checking procedures in clinical practice: A cross-sectional survey of oncology nurses’ experiences. BMJ Open, 6(6), e011394.
Wang, H. F., Jin, J. F., Feng, X. Q., Huang, X., Zhu, L. L., Zhao, X. Y., & Zhou, Q. (2015). Quality improvements in decreasing medication administration errors made by nursing staff in an academic medical center hospital: A trend analysis during the journey to Joint Commission International accreditation and in the post-accreditation era. Therapeutics and Clinical Risk Management, 11, 393-406.