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Medication Errors

Marian Smith

Rasmussen College

COURSE#: NGR5101: Research and Evidence-Based Practice

Mary Englert

January 25, 2021

Medication Errors

A significant report by the Institute of Medicine (IOM) on medication errors recommends

that, despite all the advancements in patient safety, medication errors remain very common, and

the health care system can do much more to prevent them. Among the astonishing statistics from

this report: an estimated 1.5 million Americans are injured every year in hospitals, and the

average hospitalized patient undergoes at least one medication error each day (Wolcott and

Bootman., 2007). The one significant medical error that affects the daily patient in the United

States is incorrect medications or medication dosages. Nurses should be using the six rights (the

right patient, the right dose, the right route, the right time, the right medication, and the right

documentation) and using a second nurse to check insulin doses and other high-risk medication

errors. Nurse leaders can continue educating and reenforcing these practices as one helpful

intervention tool.

According to Escriva (2019), this study aimed to identify the main medication errors,

their causality, and the highest risk areas in critical care. Performed was a systematic analysis

using the prescription, transcription, and administration records of 2,634 dose units of

medications administered to a total of 87 critically ill patients during 2018 (Escriva, 2019).

The study was carried out following the conditions of respect for the fundamental human

rights and the ethical postulates that affect biomedical research with human beings,

following the criteria established by the Declaration of Helsinki and the Good Clinical

Practices of the European Union. The research protocol was also previously approved by

a Clinical Research Ethics Committee (Escriva, 2019. pg. 2.7 Ethical considerations).

The study uses quantitative variables: age, days of hospitalization, number of prescribed

medications, and qualitative variables: primary diagnosis, prescribed drugs, drugs transcribed to
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the nursing chart/administration sheet. In critical care, an unacceptable number of medication

errors are still performed, placing the origin of several of them in the causality and contributing

factors identified in the prescription stage (Escriva, 2019). An exhaustive review of medical

pharmacotherapeutic records carried out by credible personnel such as nurses, doctors, and

pharmacologists are especially valid for detecting adverse events and potential adverse events in

the prescription and transcription. Thus, providing us with an accurate vision of the errors made

at the origin of the pharmacotherapeutic process makes this reliable and valid evidence for the

study.

This writer finds that all studies were useful in identifying why medication errors may

happen within the unit. The studies are filled with viable information and will aid in the nursing

leadership to identify why the errors may be occurring within the unit and help set interventions

that may help prevent them. They all use a format of EBP research using the steps involving

ethical responsibility, such as cultivating a spirit of inquiry within an EBP (evidence-based

practice) culture and environment and then asking a clinical question. They all seemed to search

for and collect the most relevant best evidence and critically appraise the evidence. They

integrated the best evidence with one’s clinical expertise and values in making a practice

decision or change. Finally, they evaluated outcomes of the practice decision or change based on

evidence. The rationale for keeping the studies for advanced nursing practice would be for nurse

leaders to identify what kind of medication errors are common and what interventions could be

implemented to eliminate errors. Medication administration is a critical component of nurses’

performance, and since medication administration is a complicated activity, there is a high

possibility of errors in this process.

According to Escriva (2019), the research focuses on a broad spectrum of medication

errors and their determinants or causes. This study uses a multiple method design in which

quantitative data predominate (analysis of medication errors), nesting other qualitative

(determinants of medication errors) and quantitative data (the level of drug Knowledge). This

comparative research was done with random sampling with an interval level of measurement.

The purpose of this research examined the relationship between the level of education of

registered nurses and the number of medication errors made. In researching the relationship

between possible relating factors and medication errors, patient safety could be significantly

enhanced, and healthcare costs can be reduced. As nurse leaders, we can look at our nursing

staff's education and experience level and compare it to the number of individual staff errors to

see if there is a correlation. We can then perhaps adjust the staffing and have a new two-year RN

paired with a BSN nurse or an experienced two-year RN (registered nurse). The researcher

would have taken many steps to ensure ethical and professional responsibility prior to this study

would be both patient and staff confidentiality for the staff who made the error and the patient

who may have received it but also the ethical responsibility of reporting the error so that the

patient can get appropriate care. Many hospitals have policies in place to follow in reporting

errors. According to this writer, it is just doing “the right thing” by reporting.

This writer may not use this study. After all, it may not be a reliable study because it

would depend on the random samples are obtained and what educational factors and experience

contribute to the nurses' knowledge. There have been nurses with thirty years’ experience who

make mistakes, and sometimes it is said that new nurses are more careful and make fewer

mistakes. The research is too unreliable, and not enough statistics found in the studies on this

topic. Although studies are compared in narrative and integrative reviews, a rigorous
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methodology with explicit criteria for reviewing the studies is often not used, and a summary

statistic is not generated. Therefore, conclusions and recommendations by authors may be

biased.

Several articles tell the story that this is happening in all areas of medicine in every

country. The types of medication errors that occur are from merely giving the wrong medication,

not checking whether the patient has an allergy to the medication and failing to check whether

other medicines the patient takes might interact with the prescribed drug. No one is immune.

There are actions that patients can take to prevent medication errors, such as maintaining active

medication lists and bringing their medications to appointments. Nurses and nurse leaders can

educate patients on these interventions.

These articles all point out the common medication errors and a few excellent

interventions on preventing medication errors. However, there is no hundred percent foolproof

answer to this everyday occurrence and significant concern. Patient safety is fundamental to

high-quality patient care. A step essential toward improving the health care system's safety

would be to ensure that it is aware of its errors. Improvement is why this research evidence is so

important to validate and use. As nurse leaders, we need to keep looking for improvement and

safety measures to be in place to improve policies and protocols within the unit and continuing

education for our staff.

References

Aspden P, Wolcott J, Bootman JL, et al, eds; Institute of Medicine, Committee on Identifying

and Preventing Medication Errors. Washington DC: National Academies Press; 2007.

ISBN 0309101476.

de Freitas Junior, W. C., Alves, V. C., Silva Ramos, J., Rodrigues Garbis Chagas, S., Ferreira da

Mata, L. R., Carrilho Menezes, A., & Teodoro Couto Ribeiro, H. C. (2019). Distractions

and interruptions in medication preparation and administration in inpatient units. Revista

Eletronica de Enfermagem, 21, 1–8. [Link]

Escrivá Gracia, J., Brage Serrano, R., & Fernández Garrido, J. (2019). Medication errors and

drug knowledge gaps among critical-care nurses: a mixed multi-method study. BMC

Health Services Research, 19(1), 640. [Link]

Escrivá Gracia, J., Aparisi Sanz, Á., Brage Serrano, R., & Fernández Garrido, J. (2021).

Medication errors and risk areas in a critical care unit. Journal of Advanced Nursing

(John Wiley & Sons, Inc.), 77(1), 286–295. [Link]