Annotated bibliography and summary

Medication errors 

Near misses and adverse effects may or may not harm the patients, but they create panic and distrust in patients leading to lower quality of care. Medication errors are one of the major reasons for adverse effects (Desai et al., 2016). There are different types of medication errors, which include dosage errors, wrong or improper package information, drug-drug interactions, mismatch in patient’s electronic health records, and poor medication administration (Schmidt et al., 2017). Some of the errors can have an adverse effect on patients and even lead to morbidity and mortality. In their study, Kang et al. (2017) reported that at least five near misses every month, 14.8% of dispensing errors, 4.3% administration errors, and 43.9% prescription errors were from 32 pharmacies. However, only 37.1% prescription errors, 57.4% administration errors, and 43.7% dispensing errors were reported. Salar et al. (2020) highlighted that prevalence of errors varies from 32.1% to 94%. Also, 23%, 38%, and 39% of medication errors were associated with pharmacies, nurses, and general practitioners respectively (Salar et al., 2020). 

Medication errors increase the burden on dispensing, administration, and packaging units. Cumulatively, it leads to work burden on the nurses and reduces patient satisfaction level and trust in health care (Musharyanti et al., 2019). Further, blame culture due to medication errors lead to delay in care and creates conflicts. As a result, different systems and protocols such as the use of electronic error reporting, root cause analysis, use of tabards, mobile app-based anonymous reporting, training nurses to report errors, and other systems to reduce and prevent errors (Bosma et al., 2020). As a nurse, I prefer to not commit any kinds of medication errors and prevent errors by implementing different protocols and technologies to increase the quality of care. However, it is important to select a technique or combination of techniques that are efficient (Musharyanti et al., 2019). 

Personal experience with medication error

I worked in an ICU unit of an acute health care setting with an emergency unit nearby. I was assigned a 65-year-old man with cardiac arrhythmia and a 53-year-old woman who was under colonoscopy prep. While administrating medication, I was approached by the family of a patient who was in ER because of cardiac arrest. As ER had very few nurses, other patients started to approach me. It not only affected my schedule of medication administration, but it led to a medication error as I accidentally gave epinephrine to colonoscopy prep patients instead of midazolam. Further, I could not administer a prescription of Rythmol 150 mg as Rythmol SR 325 mg was sent from the pharmacy, but the prescription mentioned Rythmol 150 mg. Change in dosage can lead to complications (Salar et al., 2020). Because of no direct communication to the pharmacy, the medication administration was delayed. Also, due to blame culture, I had no anonymous channel to report the error. Later, the pharmacy unit argued that they sent the right medication and blamed me as I did commit a medication error for another patient. As a result, it is important to protect nurses from committing any medication administration errors due to interference from other patients (Kang et al., 2017) and analyze whether different techniques affect patient’s perceptions (Stewart et al., 2020). 

 

NHS FPX 4000 Assessment 2 Applying Research Skills

Identifying peer-reviewed articles relevant to health care issue

To analyze the error and find the solutions, only peer-reviewed journal articles from the last five years that concentrate on the use of tabards and medication error reporting systems were selected. Databases such as CINAHL Plus, EMBASE, MEDLINE, Cochrane Library, and SAGE were used to search the articles. Keywords such as tabards to prevent medication errors, medication error report system, preventing medication errors, and tabards for nurses to find the articles. Filters such as date of publishing, clinical trials, and language to filter the results. Out of 631 results, 20 quantitative articles were selected. Further, the final four articles were selected after analyzing the abstract, type of study, research methodology, journal type, and abstract. 

Credibility and relevance of information sources

Credibility ad relevance of sources was analyzed by identifying the qualification of the authors, the relevance of their qualification to the problem, previous research by authors on the topic, whether funding and bias included, year of publication and relevance to current nursing environment, methodology, sampling, and study type, and credibility of journals used to publish the articles. Peer-reviewed articles were selected for the annotated bibliography. 

Annotated bibliography

Kavanagh, A., & Donnelly, J. (2020). A lean approach to improve medication administration safety by reducing distractions and interruptions. Journal Of Nursing Care Quality, 35(4), E58-E62. https://doi.org/10.1097/ncq.0000000000000473

The article was published in the peer-reviewed journal of the journal of nursing care quality. The publication is current and the article is still relevant as it includes a novel approach to reduce interference and distractions during medication administration. 

The purpose of the article is to reduce medication administration errors by reducing distractions and interruptions faced by nurses in health care. A lean approach was incorporated to first stream map the administration process, implement the solution, and evaluate the impact of the solution. The study was conducted in a 31-bed acute in-patient health care to collect data from four medication rounds every day. A sample size of 307 patients was monitored by applying QI and Lean management approach. Value stream mapping was implemented to identify interruptions, propose solutions, and implement the solutions to test the impact. A standardized me administration process along with a purpose-built medication administration room was used. A total of 200 interruptions were observed including 27% from patients, 21% from other nurses, and 17% from unrelated conversations. After the interventions, interruptions from other nurses and patients reduced by 97% and 76% respectively. The intervention reduced administration time and medication errors. The article was important as it highlighted that errors are caused by both nurses and patients. Thus, identifying and implementing solutions based on different interruptions improves the safety of the administration process to reduce errors. 

Palese, A., Ferro, M., Pascolo, M., Dante, A., & Vecchiato, S. (2019). “I am administering medication—please do not interrupt me”: red tabards preventing interruptions as perceived by surgical patients. Journal Of Patient Safety, 15(1), 30-36. https://doi.org/10.1097/pts.0000000000000209

The article was published in the peer-reviewed journal of the journal of patient safety. The publication is current and the article is still relevant as the use of tabards can reduce interruptions and reduce medication errors. 

The purpose of the observational study is to find the effects of red tabards in preventing interruptions, analyze patient’s perceptions regarding the use of three different tabards, and factors affecting it. The reason for selecting this article is it helps to identify the effects of medication administration strategies such as tabards. A total of 129 patients were observed and semi-structured interviews with 15 questions were conducted with 104 patients after implementing 3 different red tabards with do not disturb sign. The tabards reduced interruptions as the first tabard with the do not disturb sign had 48% interruptions compared to 38% interruption in tabard sign of only patients can interrupt. Despite the signs, 76.9% of patients disturbed the nurses where only 10% had an emergency. Two factors were associated with the patient’s negative perception. The factors were receiving timely medication and a positive attitude to interrupt nurses. The study is important as even though tabards reduced interruptions reducing administration error, it is important to implement protocols to reduce negative perceptions about medication administrative techniques in health care. 

Thompson, K., Swanson, K., Cox, D., Kirchner, R., Russell, J., & Wermers, R. et al. (2018). Implementation of bar-code medication administration to reduce patient harm. Mayo Clinic Proceedings: Innovations, Quality & Outcomes, 2(4), 342-351. https://doi.org/10.1016/j.mayocpiqo.2018.09.001

The article was published in a peer-reviewed journal. The publication is current and the article is still relevant as bar-code medication administration is a useful technology in reducing patient harm. The purpose of the study is to analyze the impact of bar-code medication administration (BCMA) in reducing administration errors. The tool was implemented in 5 units at 11 separate waves. The study was conducted from 2007 to 2013 in 61 nursing units. The adverse events were tracked and then compared with a pre-implementation period. It was found that administration errors, harmful medication errors, and actual patient harm reduced by 43.5%, 0.65 per 100000 errors to 0.29, and 55.4% respectively. The study highlights that use of BCMA technology is effective. 

Trakulsunti, Y., Antony, J., Dempsey, M., & Brennan, A. (2020). Reducing medication errors using lean six sigma methodology in a Thai hospital: an action research study. International Journal Of Quality & Reliability Management, 38(1), 339-362. https://doi.org/10.1108/ijqrm-10-2019-0334  

The article was published in a peer-reviewed journal. The publication is current and the article is still relevant as it compares Lean, Six Sigma, and LSS in reducing errors. 

The purpose of the action research is to analyze the effects of Lean, Six Sigma, and LSS by implementing LSS toolkit (Define, Measure, Analyze, Improve, Control (DMAIC)) to reduce medication errors. The setting included 855 beds, 3000 staff, and 3500 outpatients per day. The process included dispensing check, receive medication order, double-check prescription, problem identification, collaboration and pharmacy communication, and action steps. The study highlighted that increased interest in these tools to prevent medication errors. All the methodologies were effective in reducing errors. However, integrating Six Sigma and Lean tools led to better results as they included dose calculation criteria, nurse burden, potential error prediction, and improving the safety of medication administration. After implementing the tool in Thai hospital, dispensing errors reduced to 2 incidents per 20000 patients’ days to 6 incidents. The decrease rate was 66.66%. The study highlights that the DMAIC process helps in reducing medication errors even when the inpatient count is very high. 

NHS FPX 4000 Assessment 2 Applying Research Skills

Summary

Medication administration errors can be reduced by implementing a combination of techniques such as tabards, monitoring, reporting, and issue solving protocols such as lean approach management, BCMA, and LSS. Tabards helped in preventing distractions, BCMA, LSS, and Lean approach prevented reduced errors. Thus, by integrating these techniques, it is possible to prevent errors, reduce errors, increase timely care, and address patient satisfaction issues. The annotated bibliography helped me to understand that errors cannot be completely removed, but it is possible to predict and prevent errors by analyzing each issue to implement solutions. Tabards can be effective, but patient satisfaction levels need to be considered. 

References

Bosma, B., Hunfeld, N., Roobol-Meuwese, E., Dijkstra, T., Coenradie, S., & Blenke, A. et al. (2020). Voluntarily reported prescribing, monitoring and medication transfer errors in intensive care units in The Netherlands. International Journal Of Clinical Pharmacy, 43(1), 66-76. https://doi.org/10.1007/s11096-020-01101-5

Desai, M., Patel, N., Shah, S., Patel, P., & Gandhi, A. (2016). A study of medication errors in a tertiary care hospital. Perspectives In Clinical Research, 7(4), 168. https://doi.org/10.4103/2229-3485.192039

Kang, H., Park, H., Oh, J., & Lee, E. (2017). Perception of reporting medication errors including near-misses among Korean hospital pharmacists. Medicine, 96(39), e7795. https://doi.org/10.1097/md.0000000000007795

Kavanagh, A., & Donnelly, J. (2020). A lean approach to improve medication administration safety by reducing distractions and interruptions. Journal Of Nursing Care Quality, 35(4), E58-E62. https://doi.org/10.1097/ncq.0000000000000473

Musharyanti, L., Claramita, M., Haryanti, F., & Dwiprahasto, I. (2019). Why do nursing students make medication errors? A qualitative study in Indonesia. Journal Of Taibah University Medical Sciences, 14(3), 282-288. https://doi.org/10.1016/j.jtumed.2019.04.002

Palese, A., Ferro, M., Pascolo, M., Dante, A., & Vecchiato, S. (2019). “I am administering medication—please do not interrupt me”: red tabards preventing interruptions as perceived by surgical patients. Journal Of Patient Safety, 15(1), 30-36. https://doi.org/10.1097/pts.0000000000000209

Salar, A., Kiani, F., & Rezaee, N. (2020). Preventing the medication errors in hospitals: A qualitative study. International Journal Of Africa Nursing Sciences, 13, 100235. https://doi.org/10.1016/j.ijans.2020.100235

Schmidt, K., Taylor, A., & Pearson, A. (2017). Reduction of Medication Errors: A Unique Approach. Journal Of Nursing Care Quality, 32(2), 150-156. https://doi.org/10.1097/ncq.0000000000000217

Stewart, D., MacLure, K., Pallivalapila, A., Dijkstra, A., Wilbur, K., & Wilby, K. et al. (2020). Views and experiences of decision‐makers on organisational safety culture and medication errors. International Journal Of Clinical Practice, 74(9). https://doi.org/10.1111/ijcp.13560

Thompson, K., Swanson, K., Cox, D., Kirchner, R., Russell, J., & Wermers, R. et al. (2018). Implementation of bar-code medication administration to reduce patient harm. Mayo Clinic Proceedings: Innovations, Quality & Outcomes, 2(4), 342-351. https://doi.org/10.1016/j.mayocpiqo.2018.09.001

Trakulsunti, Y., Antony, J., Dempsey, M., & Brennan, A. (2020). Reducing medication errors using lean six sigma methodology in a Thai hospital: an action research study. International Journal Of Quality & Reliability Management, 38(1), 339-362. https://doi.org/10.1108/ijqrm-10-2019-0334

NHS FPX 4000 Assessment 2 Applying Research Skills