Introduction
Although medication errors are infrequent in clinical practice, they present a severe threat to the patients’ safety. To cover all aspects of medication errors, this presentation will include several significant points on the issue. First, the presentation includes an overview of the problem and its risks to the patients’ safety. Next, the presentation provides an explanation of the main factors that contribute to medication errors, according to the peer-reviewed literature. The presentation will include information about current initiatives geared towards reducing the number of medication errors and the issues that interfere with the implementation of the initiatives. Then, the presentation will define communication issues that relate to medical errors and, lastly, provide a conclusion with an overview of the discussion on the subject.
Overview
The medication errors are included in a separate area of issues in the clinical practice due to the high risks to the patients’ safety and complexity. According to Gracia et al. (2019), the index of global medication errors is 1.93%. The main areas of concern that present the highest level of risk for the patients are concentrated in the administration of antibiotics (8,15% error rate) and administration of medications delivered via nasogastric tubes (11,16% error rate) (Gracia et al., 2019). Overall errors in duration, concentration, and infusion rate of medications are presented in 2.94% of cases (Gracia et al., 2019). The medication errors in Intensive care units present the most danger to the patients’ safety due to the critical nature of the patients’ diseases and the potentially severe consequences of medication errors.
The main factors of medication errors
There is no clear criterion for the causes of medical errors, so there is no possibility to clearly state the main factors that influence the number of medication errors. However, there is clear evidence of some factors that significantly impact the occurrence of medication errors. First, the human factor plays a major role in medication errors. The wrong understanding of the drugs qualifies as an error, late provision of medication from the schedule, wrong dose calculations, lack of double-checking, and low adherence to protocols also qualify as medication errors.
Most of the reports state that majority of medication errors happen in the stage of medication administration. However, there are several cases of medication errors occurring during the steps of prescription and transcription. At this stage, the factors that predict medication errors include distortions like the use of abbreviations, lack of a dose in the prescription, and scheduling of antibiotics administration.
Nurses’ low level of knowledge of the drugs they use in patients’ treatment is a frequent reason for medication errors. According to Gracia et al. (2019), a low level of drug knowledge is a common issue, as the majority of nurses’ training programs imply that the medication errors occur predominantly in the pharmacotherapeutic administration stage. The use of high-level clinical judgment helps to prevent the occurrence of medication errors. Critical thinking, double-checking, a high level of cautiousness and adherence to protocols, and increased interaction with patients and other professionals can help eliminate the human factor of medication errors.
Current initiatives in reducing medication errors
Although human-related errors are a big part of the issue, they follow as consequences of the existing system. The medication system as a whole needs to be revised in order to improve the situation with medication errors. U.S. Food and Drug Administration (FDA) currently encourages reducing mediational errors by eliminating confusing drug names, introducing concise labeling and different containers for drugs with multiple strengths, and providing directions with prescriptions. In the recent changes made to reduce confusion in medications, FDA required the manufacturers to put barcodes and allowed healthcare professionals to check the correct dosage and administration of medications through barcode scanning. FDA states that consumers should understand and be informed about what drug they are using and for which purposes; they also are free to express their concerns about certain medications to the manufacturers.
Current initiatives focused on preventing medication errors in clinical settings are presented either by a set of strategies geared towards redesigning the system or training programs for healthcare professionals that increase their knowledge of drugs. A significant point in preventing medication errors is the introduction of electronic medical records and electronic prescriptions. Due to the fact that a considerable amount of misinterpretation occurs because of illegible writing, the use of electronic information helps to eliminate misunderstandings of prescriptions. However, the problem of the absence of thorough directions and instructions with prescriptions remains. A number of centers offer education courses on pharmacotherapy and error prevention for healthcare professionals. The strategies for improvements in medication errors should include redesigning the system and increasing the level of drug knowledge among healthcare professionals.
Issues that interfere with the implementation of improvements
Among the issues with implementing improvements in medication errors, the primary reason is the high cost of improvements. In an article by Vilela and Jericó (2019), the authors attempted to calculate the cost of implementing medication error-preventing technologies in a high-complexity hospital. As an improvement implementation, the authors used 13 preventive technologies divided by three stages of administration, prescription, and dispensing, and the price included the cost of labor and findings required for materials and equipment.
According to the research, the average cost of implementing preventive technologies per year is around R$10.259.505,10 (almost 2 million in US dollars) (Vilela & Jericó, 2019). The exact cost divided for each patient is estimated to be around R$ 55,72 per year, or 10 United States dollars. The most costly improvements in terms of labor are the implementation of its technology and the introduction of an electronic prescription system. In terms of material and equipment expenses, improved infusion pumps and electronic medication dispensing systems are the most expensive.
Communication issues related to medication errors
Although there could be environmental-related reasons for the medication errors or individual person-related reasons, the most common area for the occurrence of medication errors is communication. Due to a lack of effective communication between healthcare professionals and patients, the flow of important data about patients’ allergies, medication history, and other vital details stops. The most frequent communication issues related to medication errors include mistakes in medical documentation, clinical handover, informal communication, and an overall misunderstanding of orders. As almost half of the medication errors occur due to communication issues, the situation could be improved without the implementation of expensive equipment through training programs on effective communication.
Conclusion
In conclusion, the presentation defined the main factors of medication errors: healthcare personnel’s low level of knowledge of the drugs, communication-related issues like mistakes in medical documentation, misinterpretation of orders due to illegible handwriting, and lack of instructions. The high cost of implementing improvement technologies prevents the progress of eliminating medication errors. Without significant funding, the healthcare system could improve the situation with medication errors through training on effective communication.
References
Gracia, J.E., Serrano, R.B., & Garrido, J.F. (2019). Medication errors and drug knowledge gaps among critical-care nurses: a mixed multi-method study. BMC health services research, 19(1), 1-9.
Vilela, R., & Jericó, M. C. (2019). Implementing technologies to prevent medication errors at a high-complexity hospital: analysis of cost and results. Einstein, 17(4), 1-7.