Enhancing Quality and Safety

Patient safety and quality care are two of the most significant challenges faced by health care facilities, nurses, physicians, and other health care professionals. Poor quality and issues to patient safety will lead to morbidity, mortality, increased cost of care and hospital stay, lower patient satisfaction, and job satisfaction, and other issues. Some of the most common patient safety issues are medication administration errors, poor patient handling, delayed care, hospital-acquired infections, patient falls, and other issues. The purpose of this paper is to analyze the medication administration issue relating to patient safety, best evidence-based practices, and analyze coordination between nurses and stakeholders. 

Patient-safety risk focusing on medication administration

Medication administration is a critical process where nurses play a key role. However, stakeholders such as physicians, pharmacists, informatics nurses, and other health care professionals contribute to it as the process includes medication prescription, dosage calculation, medication dispensing, and error monitoring. Error in any of the stages will lead to medication administration errors. This will result in adverse events. For example, the prescription error rate varied from 6% to 77.2% (Korb-Savoldelli et al., 2018), dispensing errors varied from 1.2% to 46% (Kumar et al., 2019), and wrong dosage and omission error varied from 8% to 26% in health care (Palese et al., 2019). Suclupe et al. (2020) found in their study that 6-25% of errors were caused by nurses. This indicates that human errors are a major factor. 

Another factor is interferences during medication administration. Interferences from patients or their families disturb the normal work process, which results in medication mix-up and delayed administration. Thomas et al. (2017) pointed out that nurses feel excessive cognitive load when there are distractions and interruptions. Frequency interruptions reduce throughput and efficiency, which culminates into errors. Also, conversations with other nurses during administration increase the risk of medication errors (Huckels-Baumgart et al., 2017). For example, nurses discussing about other patients during administration can lead to confusion. 

Nurse to patient ratio is another major factor as an increased number of patients per nurse increases burnout in nurses. Burnout leads to lower cognitive functioning and leads to poor decision-making and errors (Montgomery et al., 2020). Another major factor is poor communication between nurses, physicians, informatics nurses, and pharmacists as misinformation regarding dosage or wrong patient records in EHRs result in medication errors. These can result in adverse effects (Tsegaye et al., 2020). In their study, Tsegaye et al. (2020) found that the prevalence of administration errors was due to wrong assessment (27%), wrong evaluation (26.7%), and wrong time (38.7%). A significant relationship between lack of training, failure to adhere to administration rights, unavailability of guidelines, and medication errors was observed (Tsegaye et al., 2020). For example, the use of abbreviations, no knowledge regarding change of packaging and FDI regulations, and guidelines by IOM and QSEN result in medication errors (Montgomery et al., 2020). 

Risk factors include mortality, morbidity, and adverse effects. Every year, 7000 to 9000 patients in the US die due to medication errors (Tariq et al., 2021). The errors lead to increased hospital stay cost o $40 billion per year with more than 7 million patients affected by the issue (Thomas et al., 2017). Further, risk factors such as high volume, inexperienced staff, poor follow-up, monitoring, and policy enforcement, poor handwriting, errors in EHRs, workplace culture, external stress, and verbal orders contribute to the risk to patient safety (Tariq et al., 2021).

NURS FPX 4020 Assessment 1: Enhancing Quality and Safety

Evidence-based and best practice solutions

The first EBP solution is to train and educate nurses and health care staff to follow the guidelines provided by IOM and QSEN. The guidelines include being vigilant and verify medication with EHRs, check for allergies, assess the medication before administration, diligently calculate dosage (Armstrong, 2019), use memory aids and checklists, avoid workarounds, avoid conversations during administration, consider one patient at a time, clarify an unclear prescription, and avoid abbreviations (Pop & Finocchi, 2016). The process reduces cost as it prevents adverse effects of medication on patients. 

The second EBP is to implement a physician order entry system with medication error reporting and communication system to reduce prescription, dispensing, and administration errors (Thompson et al., 2018). The system is completely electronic where nurses, physicians, and pharmacists are directly connected to compare medication with prescription and EHR to detect any discrepancies. Further, implementing technology such as bar-code-based medication administration where each drug has a unique barcode helps in preventing dispensing errors and dosage errors (Thompson et al., 2018). Also, the use of voice tags to find the content of the syringe during dosage calculation reduces dosage errors (Wu et al., 2020). The process reduces cost as it prevents delay in care, hospital stay, wastage of medicine due to wrong dosage calculation, and morbidity. Trakulsunti et al. (2020) found that checklists and communication between nurses and pharmacists regarding the change in packaging information and dosage reduce confusion, which reduces delay in administration. 

The issue of interruptions can be solved by using different color tabards with messages on them. For example, red tabard with a sign “please do not approach, I am administering medication”, yellow tabards with a sign “only patients with an emergency can approach”, and a green tabard with sign “approach only after medication administration” help in preventing errors (Palese et al., 2019). Also, this increases the efficiency of nurses (Verweij et al., 2016). Apart from these EBP interventions, interprofessional collaboration strategies to promote effective and assertive communication and shared decision-making reduces medication errors (Manias, 2018). The protocol reduces cost as nurses will work efficiently with low medication errors. For example, nurses who are administering multiple patients are at higher risk of committing errors. 

Coordinated care among nurses to improve quality and patient safety

Burnout is common among nurses. As a result, communication and a supportive work environment are critical. Nurses can coordinate with each other during medication administration to handle any interruptions (Hammoudi et al., 2017). For example, a nurse can attend a patient of another nurse or external patient for the time being till the assigned nurse completes his or her administration to reduce mix-ups and confusion. Also, communicating with other nurses to identify allergies in a patient to create a patient-specific medication order prevents adverse effects (Huckels-Baumgart et al., 2017). For example, a patient might have an allergy to aspirin. A nurse can discuss with other nurses to find a suitable alternative to prevent allergies. This further reduces health care costs as the patient will not suffer from any negative outcomes (Bradley et al., 2016). 

Further, burden-sharing and shared decision-making increase throughput, which is critical in managing burnout. Coordinating with nurses regarding health complications, adverse effects, guidelines by organizations, and dosage calculation increases drug administration competencies and knowledge (Pop & Finocchi, 2016). Also, assisting and educating other nurses to understand the use of EHRs, medication error reporting systems, and other technology increases skills and knowledge (Huckels-Baumgart et al., 2017). It is important in decreasing costs and errors (Manias, 2018). For example, a nurse can assist another nurse in reporting and logging information regarding mismatch in prescription and dispensed drug result in adverse effect prevention. 

Stakeholders and safety enhancement

The nurse needs to coordinate between stakeholders such as informatics nurses, pharmacists, physicians, therapists, nurse leaders, patients, and nurse specialists such as anesthesiologists. Patients are important stakeholders as they help the nurses and physicians in assessing the condition by providing information relating to their health history, allergies, and other details (Abukhader & Abukhader, 2020). Also, their consent in selecting a treatment is critical. For example, nurses have to inform the patients about medication errors to select an EBP intervention (Bradley et al., 2016).

Informatics nurses are important as they feed data into EHRs and coordinate with others to check any discrepancies in information stored and medication. Also, they help in error reporting and correcting processes (Hammoudi et al., 2017). The physicians are the central part of medication administration along with nurses and pharmacists as they prescribe medications and dosage. Coordinating with them to prevent and correct any medication error is critical. Failing to coordinate with them will result in errors during administration (Manias, 2018). The pharmacist’s role in medication administration prevents most of the errors as they dispense the medicine. They can evaluate medicine and dosage by comparing with the patient EHR data to prevent errors (Abukhader & Abukhader, 2020). Finally, nurse leaders are also important as manage all the resources and conflicts. For example, they will resolve any issues in practice by coordinating with everyone. 

References

Abukhader, I., & Abukhader, K. (2020). Effect of medication safety education program on intensive care nurses’ knowledge regarding medication errors. Journal Of Biosciences And Medicines, 08(06), 135-147. https://doi.org/10.4236/jbm.2020.86013

Armstrong, G. (2019). QSEN safety competency: the key ingredient is just culture. The Journal Of Continuing Education In Nursing, 50(10), 444-447. https://doi.org/10.3928/00220124-20190917-05

Bradley, C., Luder, H., Beck, A., Bowen, R., Heaton, P., & Kahn, R. et al. (2016). Pediatric asthma medication therapy management through community pharmacy and primary care collaboration. Journal Of The American Pharmacists Association, 56(4), 455-460. https://doi.org/10.1016/j.japh.2016.03.007

Hammoudi, B., Ismaile, S., & Abu Yahya, O. (2017). Factors associated with medication administration errors and why nurses fail to report them. Scandinavian Journal Of Caring Sciences, 32(3), 1038-1046. https://doi.org/10.1111/scs.12546

Huckels-Baumgart, S., Niederberger, M., Manser, T., Meier, C., & Meyer-Massetti, C. (2017). A combined intervention to reduce interruptions during medication preparation and double-checking: a pilot-study evaluating the impact of staff training and safety vests. Journal Of Nursing Management, 25(7), 539-548. https://doi.org/10.1111/jonm.12491

Korb-Savoldelli, V., Boussadi, A., Durieux, P., & Sabatier, B. (2018). Prevalence of computerized physician order entry systems–related medication prescription errors: A systematic review. International Journal Of Medical Informatics, 111, 112-122. https://doi.org/10.1016/j.ijmedinf.2017.12.022

Manias, E. (2018). Effects of interdisciplinary collaboration in hospitals on medication errors: an integrative review. Expert Opinion On Drug Safety, 17(3), 259-275. https://doi.org/10.1080/14740338.2018.1424830

Montgomery, A., Azuero, A., Baernholdt, M., Loan, L., Miltner, R., & Qu, H. et al. (2020). Nurse burnout predicts self-reported medication administration errors in acute care hospitals. Journal For Healthcare Quality, Publish Ahead of Print. https://doi.org/10.1097/jhq.0000000000000274

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

Pop, M., & Finocchi, M. (2016). Medication errors: a case-based review. AACN Advanced Critical Care, 27(1), 5-11. https://doi.org/10.4037/aacnacc2016172

Tariq, R., Vashisht, V., Sinha, A., & Scherbak, y. (2021). Medication dispensing errors and prevention. Retrieved 17 March 2021, from https://www.ncbi.nlm.nih.gov/books/NBK519065/.

Thomas, L., Donohue-Porter, P., & Stein Fishbein, J. (2017). Impact of interruptions, distractions, and cognitive load on procedure failures and medication administration errors. Journal Of Nursing Care Quality, 32(4), 309-317. https://doi.org/10.1097/ncq.0000000000000256

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

Tsegaye, D., Alem, G., Tessema, Z., & Alebachew, W. (2020). Medication administration errors and associated factors among nurses. International Journal Of General Medicine, Volume 13, 1621-1632. https://doi.org/10.2147/ijgm.s289452

Verweij, L., Smeulers, M., Maaskant, J., & Vermeulen, H. (2016). Quiet please! drug round tabards: are they effective and accepted? A Mixed-Method Study. Journal Of Nursing Scholarship, 46(5), 340-348. https://doi.org/10.1111/jnu.12092

NURS FPX 4020 Assessment 1: Enhancing Quality and Safety