Introduction
Administering medications at the time prescribed by the treatment plan is critical to the patient’s health. However, wrong-time medication administration errors (WTMAEs) are a common problem threatening people’s safety. The current paper presents root-cause analysis errors in administration time in the progressive care unit. The assessment proposes an improvement plan based on evidence-based strategies to change the current practice and prevent errors. The paper also analyzes resources that should be mobilized to address the WTMAEs problem successfully.
Analysis of the Root Cause
As a staff nurse in a progressive care unit, this paper’s author works attentively to prevent medication administration errors (MAEs). In particular, careful monitoring and reflection of working processes are carried out. Subsequently, it was observed that there are often difficulties in administering the drugs to the patients at the appropriate time. The author noted several incidents, reported them to the nursing manager or compiled corresponding records in the Electronic Medical Administration Record (EMAR).
While the reported incidents did not have negative consequences, their recurrence carries significant risks. WTMAEs involve the administration of a drug an hour earlier or later than identified in the treatment plan (Martin et al., 2020). Many prescriptions require taking at certain hours to improve therapeutic impact and prevent side effects (Martin et al., 2020). Therefore, WTMAEs significantly influence patients and can delay treatment, harm, condition deterioration, and the need for additional treatment (Martin et al., 2020). Such consequences affect both patients and providers, creating an additional burden for medical staff. For these reasons, addressing the problem is critical to the progressive care unit.
The problem of errors in drug administration is widely discussed in the scientific literature. MAEs result from failures in one of the six rights of drug administration – the right medication, dose, time, patient, route, and documentation (Yousef et al., 2022). Therefore, for proper administration, nurses are supposed to ensure that all six mentioned aspects are maintained. In the incidents under investigation, a critical issue that did not go as intended is the difficulty in providing the correct timing of drug administration.
Studies and observations highlight several factors preventing drug administration at the right time. Raja et al. (2019) highlight the personnel shortage, lack of experience, difficulties in communication among staff, the incomprehensibility of prescribing writings, and ineffective distribution of workload. Furnish et al. (2021) also emphasize communication problems, lack of awareness of time-critical drugs, and no process optimization. Tsegaye et al. (2020) divide factors into groups – related to work, professionalism, and additional factors. Their study determined that time error is more common than other types and the key reasons are lack of training, poor communication, interruptions, and lack of guidelines (Tsegaye et al., 2020). The factors highlighted by the researchers are the most common causes of errors.
Considering the causes of the studied incidents, the author highlights several root causes that increase the likelihood of WTMAEs in the progressive care unit. First of all, the reasons are associated with the complexity of the condition of patients and the high workload. Another factor is regular interruptions, which disrupt the planned work schedule. Thus, the causes of incidents are associated with work-related and communication factors. While the severe condition of patients is an integral characteristic of the progressive care unit, the other two causes – workload and interruptions – can be controlled.
Application of Evidence-Based Strategies
Considering the causes of WTMAEs, one may highlight several measures to prevent errors. According to Furnish et al.’s (2021) study, optimizing electronic records can improve the efficiency of workflows. In particular, the researchers propose to apply special marks for drugs, whose administration should take place only at a specific time so that employees pay special attention to them. The study by Westbrook et al. (2020) also confirms that using electronic systems for medicines contributes to a decrease in errors. With a high workload, process optimization is critical to prevent MAEs.
A report on errors for subsequent analysis is another factor in their prevention. At the moment, the practice of a progressive care unit involves several ways of reporting for errors – creating records or contacting a manager. However, additional actions are also needed to analyze and evaluate MAEs. Mutair et al. (2021) collected evidence that error reporting systems, which suggest a non-punitive report, supporting environment, responsiveness, and expert analysis, contribute to improved safety in drug administration. Therefore, keeping an effective error reporting system and analyzing them is another critical step toward optimizing workflows under high workloads.
Finally, interruptions are a very influential and common factor causing MAEs. Studies by Huckels-Baumgart et al. (2021) and Kavanagh and Donnelly (2020) were looking for a solution to this problem and have proven that a separate room for preparing drugs reduces the likelihood of interruptions and errors. This problem is also significant to consider as a communication factor. Evidence from nurses collected by Laustsen and Brahe (2018) demonstrates that task focus, prioritization, and specialist collaboration can reduce interruptions. That is, a working culture, which will maintain the professionalism of nurses in focusing on the task and normalize communication in which employees can refuse and make a remark if they are interrupted, is needed.
Improvement Plan with Evidence-Based and Best-Practice Strategies
This paper offers an improvement that envisions several measures aimed at the root causes of WTMAEs in the progressive care unit – high workload and interruptions. The first part of the improvement plan involves optimizing the EMAR system to highlight drugs with time limitations. This step aims to draw attention to the time frame of drug administration to reduce the likelihood of WTMAEs (Burnish et al., 2020). The measure addresses the problem of high workload since, in such circumstances, there may be difficulties in assessing drugs and their characteristics.
The next step of the improvement plan is to create a process for reporting and analyzing MAEs made. The current report may be scattered, and there is a possibility of missing important information. Moreover, an expert review of the messages is needed to improve practice further. Therefore, there is a demand for specialists to receive error reports in a non-punitive and supportive manner (Mutair et al., 2021). This step is also aimed at the desired outcome of optimizing the workload and can reduce the likelihood of errors.
The following steps of the improvement plan aim to solve the problem of interruptions. One can address it by changing drug administration processes and transforming the working culture. The administration process requires focus from specialists; therefore, it is crucial to limit the influence of external factors. Means such as the organization of special rooms and quiet zones are effective measures for the preparation of medications (Huckels-Baumgart et al., 2021). They are aimed at the privacy of specialists to support their focus on prescribed medicines.
The transformation of the work culture, in turn, requires more effort as it is aimed at changing the behavior of employees. The new culture seeks to support the professional competencies of nurses in the administration of drugs and to develop their ability to focus on the task (Laustsen & Brahe, 2018). Moreover, work culture significantly affects the number and probability of interruptions. For this reason, the goal of transformation is the normalization of communication in which employees can stop the interruption, refuse it, and express the need to focus on administration and other operational aspects. A desirable result of these measures is to reduce interruptions and their effect on drug administration to decrease the amount of WTMAEs.
Implementing the plan requires many steps and measures and will take a long time. In particular, new processes require not only the technical organization but also the training of personnel for practical application. The most extended period will be needed to change the culture, as a shift in employee habits is expected. The preliminary period for the development and implementation of the plan is one year, with possible refinements when evaluating more accurate actions for each aspect.
Existing Organizational Resources
The improvement plan requires mobilizing hospital resources in all proposed steps. The optimization of EMAR involves the involvement of information technology specialists, if possible – the one from the current system provider. Other efforts imply involving existing staff and possibly hiring coaches to train the necessary behavior and analysis of errors. At the same time, it will take time for employees to reorganize workflows. Resources are also needed to create quiet zones – in particular, a special space where it will be convenient to prepare medicines.
Conclusion
Observation in a progressive care unit revealed a high probability of WTMAEs. Taking medications by patients at the wrong time reduces their therapeutic effect and can cause harm, worsening their health conditions and putting additional strain on the hospital. Errors occur due to the patients’ situations’ complexity and the high workload on staff. WTMAEs also happen due to many interruptions, which interfere with the workflow. Considering evidence-based strategies, the current paper proposes an improvement plan that includes changing EMAR and the error reporting process to optimize work processes and quiet zones with the work culture transformation to reduce interruptions.
References
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