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During my time and Sentara College of Health Sciences I have learned a tremendous number of concepts that will help further my leadership role once I have transitioned into practice. But, there are a few that specifically relate to medication administration that I would like to cover. These include have a questioning attitude, following policies and procedures, and organizational skills.

1. Questioning attitude

-It's significant to comprehend the purpose, mechanism, and potential adverse effects of any prescription prescribed for a patient when providing care. You can ask yourself if the medication will be helpful or detrimental to the patient once you have a good understanding of both the patient and the substance. If it has the potential to be hazardous, we can challenge the doctor's orders and take the initiative to ensure our patient's safety.

-A leader who asks probing questions is able to uncover dangers, disprove presumptions, and get fresh perspectives. In order to ask good questions, nurses must make sure they fully comprehend the facts or circumstances, push limits, provide fresh perspectives, and identify the underlying causes of issues.

2. Follow Policies and Procedures

-Adhering to drug administration regulations and procedures is important for the safety of patients and employees. If I witness someone breaking the rules, I have the opportunity to assume leadership, inform my colleague, and, if necessary, escalate the situation.

-One of the most crucial aspects of being a leader is being able to set an example for others by following the rules. It also fosters respect and trust.

3. Organizational Skills

-Using my organizing abilities, I will be able to deliver medication to each patient on schedule. It, hopefully, will free up space for me to go assist my colleagues when they're busy. As a leader, having good organization enables me to set priorities, efficiently manage my time, and reduce stress and worry during the workday.

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Reporting Medication-related Incidents Involving Patients Aug 2021

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To promote and sustain nurses' participation in decreasing medication errors they can enhance the work environment, take action, and provide patient education.

1. Work Environment

Creating a healthy work environment for nurses takes effort from both individual nurses and the healthcare organizations they work for.

Healthy work environments are essential for nurses to contribute optimally to patient care (Ulrich et al., 2019).

Skilled communication, genuine teamwork, sound decision-making, meaningful recognition, proper staffing, and genuine leadership are all components of an optimal work environment. To contribute to this, the nurse needs to speak up for patients, coworkers, and oneself. Use the appropriate channels to report anything that you observe that appears unsafe or unethical. Communicate clearly and actively with patients, coworkers, and other medical professionals. Collaborate and cooperate as a team to develop strong bonds with your teammates.

It is necessary to create a supportive atmosphere free from punitive actions and a blame culture in order to encourage nurses to report medication delivery issues. Nurses are more likely to ask for assistance and report errors when they feel heard and comfortable on their units.

2. Taking action

Self-education: since nurses with a higher level of education have a lower rate of MAEs, nurses can obtain their bachelor's or master's degrees. This will help by increasing their levels of knowledge and practice in medication administration before entering acute care settings alone. A study found that 68.3% of these medication errors had been made by associate degree-prepared nurses as opposed to BSN degree-prepared nurses (26.2%) (Kerari & Innab, 2021)

Get involved in professional organizations to advocate for better working conditions and patient care.

Researching evidence-based practice articles on how to prevent medication errors.

Collaborate with your healthcare team to begin conducting your own research.

3. Patient Education

Health care professionals must provide adequate patient education about the appropriate use of their medications as part of any error prevention program. Proper education empowers the patient to participate in their health care and safeguard against errors. They may be able to address the error before the nurse gives the medication, if they are aware of what they should and should not be taking. Also, while the nurse is explaining medications it gives them extra time to check and make sure it is the right drug and patient.

Some examples of instructions to patients that can help prevent medication errors at home and in the hospital are:

A) Know names and indications of medications
B) Read the medication information sheet provided by your pharmacists
C) Do not share your medications
D) Check the expiration date of medications and dispose of expired drugs
E) Learn about proper drug storage
F) Learn about potential drug interactions and warnings

G) Know what medications you are prescribed

H) Ask for medication reconciliation frequently.

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Challanges and barriers for the nurse's involvement in preventing medication errors include interruptions during the medication administration process and fear of reporting errors.

Interruptions

When outside events happen that can divert attention and cause an activity to stop, that is known as an interruption (Sassaki et al., 2019). It is rare for nurses to complete a task without being interrupted; even though focus is essential to reduce errors and distractions. Consequences occur when nurses begin to rush their duties due to time wasted from these interruptions. Examples include emergencies, searching or needing materials, information exchanges, other nurses asking for medication verifications, alarms, and parallel conversations.

Nurses who were interrupted while administering medications were 2.42 times more likely committed MAEs than those who weren’t interrupted administering medication (Wondmieneh et al., 2020).

Reporting Errors

Nurses may not want to report errors for fear of individual blame instead of the system, no feedback after reporting MAE, negative response from reporting MAEs, lack of clear definition for errors, and fear of reprimand and punishment (Afaya et al., 2021)

Personal reasons such as criticism from colleagues because they felt they would be embarrassed or discriminated against if they reported MAEs.

Fear that reporting would negatively impact their job records, or they might lose their job.

Fear of being labelled as incompetent and an inadequate nurse.

Fear of legal actions against nurses by patients or their families.

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Analysis: Importance of nurse involvement 

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Analysis: Importance of nurse involvement 

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Medication errors can happen at any point in the medication process, but the majority of them happen during the administration of the medication. Since registered nurses are heavily involved in the administration of medications in clinical settings, their involvement is crucial to resolving or improving this problem (Kerari & Innab, 2021).

Strong data suggests that the frequency of MAEs is directly correlated with the education level, experience level, and attendance at training courses of nurses. As a result, nurses can assist by earning a higher degree, completing additional training, experience, or practice.

MAEs were twice as likely to be made by nurses who didn't follow medication administration rules than by those who did. (Wondmieneh et al., 2020).

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Nursing Skill Check: Medication Validation Administration 

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By abiding by the three checks, six rights of medicine administration, and reporting errors, nurses can enhance patient safety by preventing medication errors from occurring before they reach the patient (Wondmieneh et al., 2020)

1. Three checks of medication administration from West Coast University (2020):

Compare the medication administration record (MAR) and the prescriber's order.

While during preparation of the medicine compare the medication label against the MAR

At the patient's bedside, perform another comparison of the pulled medication and the MAR.

Perform the 6 rights of medication administration on each check: right patient, medication, dose, time, route, and documentation.

When used, these steps help improve correct drug administration. Nurses use this to prevent medication administration errors by triple checking with the five rights. If nurses are in a rush and skip them, then they are increasing the risk for making a mistake.

2. Reporting errors

Different literatures showed that majority of medication errors are not reported due to fear of blame and punishment (Wondmieneh et al., 2020)

Failure to report errors will make the problem worse and could result in worse outcomes for the patient because they won't receive the necessary treatment. When mistakes are disclosed in a supportive setting, organizations can learn from them, detect patterns, and take preventative measures.

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Nursing Skill Check: Medication Validation Administration

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-While it is widely believed that human mistake is the primary cause of medication errors (MAEs) in acute care settings, system faults are increasingly being acknowledged as a contributing issue (Kerari & Innab, 2021).

-Errors in the administration of medications (MAEs) can have a negative impact on patient outcomes and the healthcare system.

Impact on healthcare systems

Cost of errors: It has been estimated that the annual global cost of drug errors is $42 billion.

Impact on Nurses

It was discovered that nurses who performed MAEs experienced psychological discomfort, a lack of confidence, and punitive measures—particularly when the error causes significant patient injury. Additionally, they suffer from patients' and patient families' lost trust as a result of MAEs (Wondmieneh et al., 2020)

Adverse Outcomes to Patients

Increased morbidity and mortality in acute care settings. According to the Institute of Medicine, pharmaceutical mistakes result in anywhere from 44,000 to 98,000 fatalities annually in the United States.

Extended hospital stays as a result of treating the side effects of the pharmaceutical error instead of concentrating solely on the original diagnosis.

Increased distrust in hospital systems

One in every thirty individuals receiving medical care experiences medication-related injury, with over 25% of these cases being classified as serious or life-threatening. Medication-related injury accounts for half of preventable medical errors. (World Health Organization, 2023).

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What is the problem?

-The problem is medication errors. Defined as any preventable event that may cause or lead to inappropriate medication use or patient harm, while the medication is in the control of the health care professional, patient, or consumer (AMCP, 2019).

Who is affected?

-Unsafe medication practices and medication errors are a leading cause of injury and avoidable harm in health care systems across the world (WHO, n.d.). Medication errors affect patients and healthcare systems; therefore, they affect anyone who is receiving or giving medication.

How?

-Medication errors occur based on either error of omission or commission. Commission errors are when a medical professional does something that should not have been done or the wrong action was taken (Rodziewicz et al., 2023). Such as a doctor prescribing a dose of medication that is too large or administering a drug to which a patient has a known allergy. Omission is the failure to do something that should have been done or an action not taken. For example, a doctor failing to prescribe a medication or a nurse not giving the medication.

When?

-Errors can occur at different stages of the medication use process (WHO, n.d.). The process includes prescribing, transcribing, documenting, dispensing, administering, and monitoring.

Why?

-Weak medication systems and/or human factors such as fatigue, poor environmental conditions or staff shortages affect prescribing, transcribing, dispensing, administration and monitoring practices can be why medication errors occur and result in severe harm, disability and even death (WHO, n.d.).

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