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Strategies for Decreasing Medication Errors Research Paper

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Updated: Feb 12th, 2022

The prescription of medication occupies a significant part of the healthcare industry and bears numerous challenges for professionals and patients. According to Hayes et al. (2015), various incidents connected to medication administration remain “a substantial patient safety issue in the health care setting internationally” (p. 3063). Mistakes in medication prescription can have severe consequences for all the parties involved, including life-threatening situations, congenital disabilities, or other disabilities for the patients, lawsuits, fines, and professional problems for medical workers.

The U.S. Food and Drug Administration (2019) reports that it gets more than 100,000 reported incidents related to medication errors annually. Consequently, it is critical for organizations within the field to undertake measures and utilize effective procedures and strategies to reduce the number of medication errors. The purpose of this paper is to investigate the integration of information technology and medication double-checks to minimize the incidents through the change theory.

The healthcare industry widely offers medication as a treatment or assistance for various illnesses and diseases, which also carries a potential risk to patients. The World Health Organization states that a need to prescribe drugs for older adults and respond to complex needs can explain the growing number of potential threats (World Health Organization [WHO], 2016). Different institutions offer various definitions of medication errors explaining the nature of the issue. One of the descriptions is “a reduction in the probability of treatment being timely and effective,” which implies that specific factors influencing medication prescription and intake might have harmful effects (WHO, 2016, p. 4).

It is also critical to understand the reasons that lie behind the incidents related to this area. Those causes can be connected to different aspects of health care, including connection to professionals, patients, the work environment, medicines, or computerized information systems (WHO, 2016). It is essential to understand the possible causes of medication administration to provide more efficient solutions.

Different strategies can be used to work on the minimization of medication errors within healthcare settings. The implementation of various information technology tools can represent new possibilities for professionals to ensure proper drug prescription. The utilization of the bar code medication administration (BCMA), in combination with electronic health records (EHRs), can help to improve the situation. The process starts with the entry of a computerized order, followed by pharmacist verification and notes by the registered nurse about active medication order, and finished with scanning the patient’s bar code (Gann, 2015).

It is possible to note that this specific procedure includes checks by different professionals, which provides higher insurance of the proper medication administration. Preventable medication errors cost around $16 billion annually in the U.S. hospitals, and the integration of BCMA technology “can reduce medication errors by 65% to 86%” (Gann, 2015, p. 61). Hence, verification through bar codes that includes the utilization of EHRs is one of the alternatives that can contribute to the reduction of medication errors.

BCMA technology involves the computerized provider order entry (CPOE), which also represents one of the procedures that can be required to minimize the incidents related to drugs’ administration. The CPOE is considered to be a high-leverage prevention tool, and healthcare institutions keep to adopt it (Schiff et al., 2015). Still, it is crucial to mention that the use of CPOE solely hinders possible medication errors as well.

The CPOE carries such issues as wrong unit entry, errors with drug allergies, inappropriate frequency of medication, or element omission mistakes (Schiff et al., 2015). It implicates that the incidents can take place due to the wrong format of the order or related aspects. One of the studies revealed that out of 1 million reported errors, more than 6% were connected to the computerized order entry (Schiff et al., 2015). Therefore, the CPOE integration should be supported by other information technology tools, such as BCMA, because it decreases the chances of the incident to occur due to the more extensive measures.

Besides the EHRs, BCMA, and CPOE implementation, healthcare organizations can adopt other information technology mechanisms, such as the integration of automated dispensing cabinets (ADCs). The ADCs are “medication distribution systems that enable computerized storage, dispensing, control, order entry, bar-coded medication administration, and documentation,” and reduce medication errors, especially in the cases with time-critical drugs (Douglas et al., 2017).

Those cabinets involve various IT tools, aimed at improving the process. Medication administration includes five stages, including order and prescription, verification, dispensing and delivery, and monitoring and reporting (Douglas et al., 2017). The critical point is that potential errors can occur at any of the phases and lead to adverse consequences for the impacted patients. The technologies discussed in the paragraphs above aim to minimize the likelihood of incidents throughout the medication administration cycle, and the ADCs can facilitate and ensure its safety. Hence, the active use of ADCs enhances nursing professionals’ efficiency, and decreases the number of medication errors, positively influencing related aspects through the inclusion of numerous methods.

Another critical point for the professionals to undertake in attempts to prevent errors is double-checking medication procedures because insufficient checks represent one of the factors contributing to the emergence of medication incidents. The nurses have to comply with five significant rules or rights, which are crucial for the accurate medication administration, including the right patient, right medication, right dose, right route, and the right time (Athanasakis, 2015).

Consequently, each professional has to follow those aspects rigidly to ensure the patients’ safety. Checking measures occupy a substantial part along with the five mentioned rights. The medication check is a system-based strategy to account for the complexity of medical procedures and the human factor, which together or distinctively can cause errors (Athanasakis, 2015). Hence, checking procedures are introduced to address the combination of the factors leading to the incidents and to minimize their number through additional requirements and higher responsibility.

Nursing professionals hold an integral role in medication administration, which stresses the importance of double-checking to prevent severe issues. The WHO recommends emphasizing the significance of double-checking methods starting from the undergraduate level among future nurses (Athanasakis, 2015). Double-verification implies that two qualified nursing professionals independently check the medication before administering it to the patients, which increases the chances of identifying the errors if they exist. Although those procedures have proved to be effective, there are still drawbacks that require additional attention.

Consequently, it is essential to integrate proper training and encouraging dedication among the nurses, as well as to implement an automated double-checking mechanism (Hewitt et al., 2016). The healthcare institutions can reach a high level of double-verification efficiency with the help of proper preparation and utilization of various technology tools, such as pyxis medical station.

The paragraphs above investigate potential solutions to integrate to improve the situation in the healthcare industry related to the presence of medication errors. According to Wojciechowski et al. (2016), the institutions need to possess an ability to respond to the fast-changing environment to “maintain equilibrium and survive” (man. 4). Thus, organizations within the field must practice professional collaboration, new technologies, and strategic tools to address the complex issues that they face. Lewin’s change theory or three-stages model for change management is one of the frameworks that can be used to implement new procedures and measures.

The model includes such steps as unfreezing, changing or moving, and refreezing (Wojciechowski et al., 2016). Through those stages, the organization will be able to introduce new solutions for the existing problems and adapt to the current circumstances and internal and external factors influencing its activities.

It is essential to look through the stages of the change theory according to the advancements necessary to integrate to improve medication administration. The unfreezing step will involve creating awareness among the personnel about the real issue and providing possibilities for the professionals to recognize the significance of the problem through education and additional information about the change. During the changing and moving stage, the leadership team has to demonstrate the advantages of the newly implemented measures and emphasize the necessity of the shift to robust technologies through training sessions and team brainstorming.

The cycle of the change model will be concluded with the refreezing stage, throughout which the innovations will be implemented into the workflow, and the work on maintaining new procedures will be performed. In such a way, the execution of planned activities directed at improving the current issue with medication administration through Lewin’s theory will create a smooth and efficient change environment for the professionals.

The next crucial point is the evaluation process of the implemented information technology systems. Assessment of the integrated programs represents a critical element and is one of the vital factors for the successful adoption of new applications in the healthcare industry. It will be useful to use a formative method to evaluate the integrated information technologies, such as BCMA or double-nurse verification. This method implicates the assessment of the program’s effectiveness and the description of early experiences, which is critical because the general purpose of IT application is an improvement (Nelson & Staggers, 2016).

Thus, healthcare institutions can utilize formative evaluation after implementing new systems. Some of the aspects covered throughout this process are knowledge development, oversight, and compliance with new strategies and programs, assessment of merit or worth, and improvements within the organization (Nelson & Staggers, 2016). Hence, this method will help to generate measurable and realistic data for the analysis that will help to determine advancement’s achievements, impact, and further development.

In conclusion, medication administration has numerous challenges and potential risks with emerging errors and requires attention and improvement. Possible strategies for the enhancement of the drug prescription by the nursing professionals and minimization of medication incidents include the utilization of information technology, such as BCMA, EHRs, CPOE, ADCs, and independent double-checking prescribed drugs. Those systems offer advantages for the efficiency of the activities connected to medication, striving to facilitate the process for the nurses and decrease the number of medication mistakes that can cause severe outcomes.

Healthcare organization can integrate new programs and systems through the model of change management that offer three stages to achieve smooth implementation of innovation, personnel’s adaptation, and transfer to the new standards. It is also critical to remember to integrate a proper evaluation plan, using the formative method to assess the results and the influence of the applications on the desired areas. Thus, carefully implementing new strategies to combat the issue of medication incidents is a critical step to improve the overall situation.

References

Athanasakis, E. (2015). The method of checking medications prior to administration: An evidence review. International Journal of Caring Sciences, 8(3), 801-818. Web.

Douglas, C., Desai, N., Aroh, D. A., Quadri, M., Williams, R., Frank Aroh, I. I., & Nyirenda, T. (2017). Automated dispensing cabinets and nurse satisfaction. Nursing Management, 48(11), 21-24. Web.

Gann, M. (2015). How informatics nurses use bar code technology to reduce medication errors. Nursing, 45(3), 60-66. Web.

Hayes, C., Jackson, D., Davidson, P. M., & Power, T. (2015). . Journal of Clinical Nursing, 24(21-22), 3063-3076. Web.

Hewitt, T., Chreim, S., & Forster, A. (2016). Double-checking: A second look. Journal of Evaluation in Clinical Practice, 22(2), 267-274. Web.

Nelson, R., & Staggers, N. (2016). Health informatics: An interprofessional approach (2nd ed.) [eBook edition]. Elsevier.

Schiff, G. D., Amato, M. G., Eguale, T., Boehne, J. J., Wright, A., Koppel, R., Rashidee, A. H., Elson, R. B., Whutney, D. L., Thach, T. T., Bates, D. W., & Seger, A. C. (2015). Computerized physician order entry-related medication errors: Analysis of reported errors and vulnerability testing of current systems. BMJ Quality Safety, 24(4), 264-271. Web.

The U.S. Food and Drug Administration. (2019). Working to reduce medication errors. FDA. Web.

Wojciechowski, E., Pearsall, T., Murphy, P., & French, E. (2016). A case review: Integrating Lewin’s theory with lean’s system approach for change. Online Journal of Issues in Nursing, 21(2), man. 4. Web.

World Health Organization. (2016). Medication errors: Technical series on safer primary care. World Health Organization.

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