Reducing Nursing Medical Errors

Reducing Nursing Medical Errors 

Medical errors are currently the third leading cause of death in the United States claiming the lives of 250,000 people annually.  When one looks at the Centers for Disease Control and Prevention’s (CDC) website they will see that the third leading cause of death is actually respiratory disease which claims the lives of about 150,000 people a year.  However, according to the patient safety experts at Johns Hopkins, the CDC does not classify medical errors as a cause of death and is not placed on the death certificate (“Study Suggests”, 2016).  While there are multiple medical errors that can result in accidental death, I want to focus specifically on medication errors.  By reducing nursing workload and fatigue, preventing interruptions during medication preparation and administration, and ensuring the nurse is knowledgeable about the drug they are going to administer we can reduce the amount of medication errors and provide a safer environment for patients. 

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Medication error is defined as any preventable event that can lead to improper or inappropriate use of medication or harm the patient (Aires et al., 2016).  Currently, medication administration accounts for 40% of all clinical activity conducted by nurses (M. Di Muzio, Dionisi, Di Simone, & F. Di Muzio, 2019).  The workload of nurses is related to the amount of time they spend caring for patient’s which is impacted by the patient’s exact needs.  Workload can be affected by a patient’s level of dependence, the severity of their disease, the environment of the institution, the physical space itself, and the profile of the team workers (Aires et al., 2016).  In a study conducted with 49 nurses, 85.7% of the nurses had experienced some type of medication error on their unit.  Out of those errors 49% were dosage errors, 36.7% were medication errors, 30.6% were patient errors, 18.4% were time errors, and 16.3% were route errors.  (Aires et al., 2016).  The study showed an elevation of workload and inadequate staffing had the greatest contributing factor to medication errors.  More commonly than not health institutions who have inadequate staffing numbers of nurses result in compromising care and safety of patients increasing the risk for medication errors (Aires et al., 2016).

Currently a well-researched topic is nursing fatigue.  Unfortunately, there are many negative outcomes and consequences for patients and nurses who are linked to nursing fatigue (Ferris, 2015).  Nurses play an important role as members of a healthcare team, but when fatigued and sleep-deprived they are putting their patients and themselves at risk (Scott, Arslanian-Engoren, & Engoren, 2014).  A study conducted by Scott, Arslanian-Engoren, and Engoren (2014) researched the effects of inadequate sleep on clinical-decision regret.  In their study, nurses reported moderately high fatigue, significant sleep deprivation, and daytime sleepiness affecting their ability to be alert, vigilant, and safe (Scott et al., 2014).  A survey was filled out by 605 full-time nurses, however, only 546 (90%) answered the question about decision regret.  Out of the 546 nurses, 157 (29%) reported decision regret (Scott et al., 2014).  The nurses who had decision regret were more likely to work 12-hour nightshifts than nurses who did not report decision regret (Scott et al., 2014).  Their research shows that nurses who experience impairments as a result of fatigue and sleep loss are less likely to report clinical-decision regrets such as medication errors leaving the problem unknown and unresolved. 

According to Westbrook, Woods, Rob, and Dunsmuir (2010) there is a significant relationship between interruptions and procedural failures and clinical errors in medication administration.  A study conducted by Flynn, Evanish, Fernald, Hutchinson and Lefaiver (2016) labeled the four main sources of interruptions as (1) patient-related, (2) phone calls, (3) verbal (face-to-face interaction), and (4) unavailability of resources.  To decrease these interruptions, they implemented a guideline called the Nurses Uninterrupted Passing Medications Safely (NUPASS).  The study was conducted on three different PCCU floors.  The largest decrease in interruptions after implementation of NUPASS was phone calls by 48% (Flynn, Evanish, Fernald, Hutchinson, & Lefaiver, 2016).  The overall percentage of medication errors decreased in all three PCCUs after the implementation of the NUPASS guidelines.  Medication errors in PCCU1 decreased from 11% to 3%, PCCU2 decreased from 2% to 1%, and PCCU3 decrease from 9% to 1% (Flynn et al., 2016).  According to Flynn (2016), the decrease of interruptions was highly dependent on teamwork during peak medication administration times.

• References
• Aires, K., Barlem, J., & Souza, C. (2016). CONTRIBUTION OF THE WORK LOAD TO THE OCCURRENCE OF MEDICATION ERRORS IN NURSING. Journal of Nursing UFPE,10(12), 4572-4580. doi:10.5205/reuol.9978-88449-6-ED1012201619
• Barker, L. M., & Nussbaum, M. A. (2011). Fatigue, performance and the work environment: A survey of registered nurses. Journal of Advanced Nursing,67(6), 1370-1382. doi:10.1111/j.1365-2648.2010.05597.x
• Di Muzio, M., Dionisi, S., Di Simone, E., Cianfrocca, C., & Di Muzio, F. (2019). Can nurses’ shift work jeopardize the patient safety? A systematic review. European Review for Medical and Pharmacological Sciences,23(10), 4507-4519. doi:10.26355/eurrev_201905_17963
• Flynn, F., Evanish, J. Q., Fernald, J. M., Hutchinson, D. E., & Lefaiver, C. (2016). Progressive Care Nurses Improving Patient Safety by Limiting Interruptions During Medication Administration. Critical Care Nurse,36(4), 19-35. doi:10.4037/ccn2016498
• Sagherian, K., Steege, L. M., Geiger-Brown, J., & Harrington, D. (2017). The Nursing Performance Instrument. Journal of Nursing Research,1. doi:10.1097/jnr.0000000000000215
• Sears, K., Obrien-Pallas, L., Stevens, B., & Murphy, G. T. (2016). The Relationship Between Nursing Experience and Education and the Occurrence of Reported Pediatric Medication Administration Errors. Journal of Pediatric Nursing,31(4). doi:10.1016/j.pedn.2016.01.003
• Study Suggests Medical Errors Now Third Leading Cause of Death in the U.S. – 05/03/2016. (n.d.). Retrieved from https://www.hopkinsmedicine.org/news/media/releases/study_suggests_medical_errors_now_third_leading_cause_of_death_in_the_us
• Treiber, L. A., & Jones, J. H. (2018). After the Medication Error: Recent Nursing Graduates Reflections on Adequacy of Education. Journal of Nursing Education,57(5), 275-280. doi:10.3928/01484834-20180420-04
• Zimmerman, D. M. (2016). Impacts & Innovations. Medication Safety: Simulation Education for New RNs Promises an Excellent Return on Investment. Nursing Economic$,34(1), 49-51. doi:10.1107/s2053229614016301/cu3059sup1.cif