Over the years, the issue of medication errors (MEs) has remained to be a significant challenge facing the healthcare sector in various countries across the globe. Australia is not exceptional as it has registered a large number of cases of the problem. Generally, the MEs encompass wrong prescription, dosage, and even failure to identify the respective drug interaction. In most cases, MEs are common in pharmacies, hospitals, and clinics where patients normally seek medication attention. MEs have the potential to harm or even cause the death of a patient. Other probable causes of MEs include poor patient education on matters pertaining to drug usage and miss communication among practitioners. Most healthcare facilities have adopted different ways of addressing the MEs challenges to ensure the safety of the patients is guaranteed. However, despite the efforts by hospitals to lower the issues, some still encounter such problems thus requiring the management to advance by formulating effective approaches to curb the possible happenings. By understanding the aspect of MEs, healthcare practitioners will be able to avoid conditions that can lead to MEs hence improving care delivery.
Justification
Healthcare system is complex and, in most cases, it might be challenging for the practitioners to identify various incidents that can threaten the safety of patients. Therefore, with the knowledge of MEs including factors causing them, it will be easier for nurses and other stakeholders within the hospitals to manage and prevent the impacts of the MEs. Furthermore, understanding the aspects of MEs makes it possible for the care providers to formulate an effective plan to reflect on essential areas that has the potential of improving their overall professional practices. In general, comprehending MEs results to developing proper strategies that enhance safety and quality care delivery.
Literature Review
NSQHS Standards
Generally, the need to facilitate safe patient care and to reduce the impacts of MEs in healthcare settings prompted the National Safety and Quality Health Service (NSQHS) body to formulate various standards. About six principles are in place to aid the NSQHS in effectively addressing the MEs issues. In hospitals, it is a challenge to overcome MEs following the complexity of the healthcare system. For instance, the usage of several drugs by a single patient or having multiple practitioners undertaking different roles in the clinics enhances the opportunity for MEs to occur. Therefore, NSQHS has outlined various requirements that all hospitals and other care-related facilities are expected to meet in order to promote quality care to minimize possible MEs. The NSQHS criteria ensure sick individuals have a standard base level of care that can receive from their respective healthcare organizations. Furthermore, the body provides healthcare facilities with a proper structure that guides their practices to enable them to offer safe and effective care services.
One of the critical aspects of NSQHS standards for the MEs issue is medication safety (MS). The MS standard is focused on ensuring that all practitioners prescribe, distribute as well as administer the right medicines and effectively monitor drug use. Furthermore, the clinical principles aim at making sure that patients have the relevant information about the respective drugs they intend to use and to further comprehend possible risks associated with such medicines. There are various policies linked to the MS standards including the High-Risk Medication Policy, the Medication Chart Policy, the Statewide Medicine Formulary Policy, and the Medication Review Policy. The mentioned guidelines play a significant role in highlighting and directing providers on the nature of medications and the hazards they bear. For instance, the Medication Chart Policy mandates the need to have medication charts that entail the prescribing as well as administering medicines for inpatient care. The approach is to ensure there is consistency in the medication process to facilitate safe prescriptions.
Based on the context of MS standards, issues such as failure to offer continuous education, inability to report medication, and limited training on administration can easily facilitate MEs occurrences. Therefore, it is essential for healthcare facilities to nurture cultures that allow practitioners to provide insight into cases of errors during their practices. The practice if fully embraced can easily enhance the safety and quality of care delivery in hospitals hence leading to customer satisfaction.
Most people are using prescription medications as well as an over-the-counter medicine in the country. Apart from the prescribed drugs, the public always has the tendency of supplementing medicine with a variety of herbs and potions to enable them to manage their health problem (Tariq et al., 2018). The practices complicate the roles of nurses in ensuring patients strictly use the right medicine and dosage for their respective sicknesses. The situation has resulted in a significant number of deaths as well as morbidity to the patients.
Generally, MEs have the potential of occurring at any level of disease management. According to Tariq et al. (2018), the most common stages of patient care that MEs are more likely to occur include transcribing, ordering, administering, monitoring, dispensing, and even documenting. However, based on the research by the authors, the issue is more frequent at the prescribing stage. At this phase, possible wrong dosage, frequency, or even inappropriate medication easily takes place. According to the findings, about 30% to 70% of MEs are always identified by practitioners at the ordering step (Tariq et al., 2018). Tariq et al. (2018) iterate that some of the causes of MEs are incorrect duration which entails receiving the medication for either a shorter or longer period than the stated time. Furthermore, the authors pointed out improper dosage which encompasses underdose, overdose, and having an extra dose (Tariq et al., 2018). In addition, a lack of patient education is a potential facilitator of poor patient action (Dendere et al., 2019). When sick individuals do not have proper information concerning drug usage, they might consume the medicines inappropriately thus endangering their lives.
Moreover, other possible causes of MEs are linked to issues such as illegible writing. According to Tariq et al. (2018), physicians usually write the drug prescription while in hurry making them denote unclear labeling. Therefore, it becomes a challenge for the patients of the pharmacists to make a possible guess following the unreadable writing. In addition, the aspect of distraction has contributed effectively to the MEs issue in healthcare. Based on the research findings by Tariq et al. (2018), practitioners undertake various roles in healthcare facilities including talking to patients, ordering laboratories, and checking patient progress. When physicians are asked to write drug prescriptions while their minds are occupied with all the activities, they tend to experience judgment problems thus leading to MEs.
Health Policy
Currently, the healthcare industry has undertaken significant measures to curb the MEs problem by developing and adopting a number of information technologies that can be used by practitioners to aid their practices. According to the research by Alotaibi and Federico (2018), technology has proven effective in lowering the cases of MEs in hospitals. Issues such as identifying drug interaction, compliance, and following guidelines have been positively impacted by the emerging integration of technology into healthcare settings. Generally, patient safety is promoted through the avoidance and prevention of adverse incidents. In the last three decades, the Institute of Medicine (IOM) report indicated that “To err is human,” this aspect prompted healthcare organizations to supplement providers with technology (Alotaibi & Federico, 2018). The approach aimed at changing the overall healthcare environment by lowering the possible human error during medication.
Hospitals and other care facilities have currently integrated technology into their practices as part of their health policies to facilitate patient safety. Alotaibi and Federico (2018) iterate that computerized physician order systems contain clinical decision support systems (CDS) which prevent errors from happening by guiding practitioners on the administration frequency, required doses, and even route. A significant number of healthcare facilities in Australia have incorporated such technology to allow for electronic ordering, tests, and consultation. The platforms reduce the burden physician used to have that could easily result in medication incidents. Based on the research, CDS enables healthcare professionals to access sensitive and specific patient information (Alotaibi & Federico, 2018). Therefore, the providers can make rational decisions at the appropriate time limiting the chances of MEs. In general, the effectiveness of the technology has facilitated hospitals to integrate them into their system and initiate their implementation to improve overall patient safety.
Australian Statistics
In Australia, MEs have become a significant problem affecting the healthcare system. According to the research by Australian Commission on Safety and Quality in Health Care agency, approximately 3% of admissions in Australian hospitals are related to MEs (“Australian Commission on Safety and Quality in Health Care,” n.d.). Based on the findings, the patients are more likely to take the wrong medication, consume excessive doses, or taking underdose leading to MEs. The investigation indicates that the cost associated with the admissions annually sums to about $1.2 billion (“Australian Commission on Safety and Quality in Health Care,” n.d.). The figure directly shows how the errors are expensive and require a significant amount of money.
Furthermore, the research posits that most people in the country are using multiple prescriptions. For instance, some individuals take four or above medicines at once (“Australian Commission on Safety and Quality in Health Care,” n.d.). In most cases, the persons are guided by hospitals and other specialists in the healthcare field. Most of the drugs that people use are regarded as higher risk following the narrow range of therapeutic leading to a possible overdose. Unsafe medical practices are the core cause of increasing cases of MEs in the region. In addition, among the people using several medicines, a big percentage is elderly people thus their likelihood of making mistakes is high. Even though medication issues are common, the majority of public and private healthcare units have adopted an array of medication programs to enable them to lower the occurrences of MEs.
Challenges Nurses Face in Utilizing Critical Reflection
Generally, it is vital for health professionals to reflect on their practices. However, there are a number of constraints that hinder the providers from engaging in effective critical self-reflection to improve their performance. According to the research conducted by Cleary et al. (2018), emotional intelligence is a crucial aspect of nursing. Sometimes, it can be challenging for a physician to reflect on their emotions, especially if the cases require the person to admit mistakes. In such situations, some nurses may fail to properly review their involvement thus leading to poor analysis. In addition, another common barrier to effective critical thinking is limited time. Generally, healthcare practices are demanding and nurses are always ever busy. The tight schedule leaves the professionals with inadequate periods to ponder about their work.
Furthermore, some doctors especially the ones who have been working for long hours can have difficulty depicting specific areas that require adjustments. Being that such providers are familiar with almost all aspects, the identifying core issue remains an issue in their nursing practice. Without the ability to effectively engage in critical reflection, the possibility of lowering MEs diminishes since the practitioners are not aware of what to change to make their work efficient to enhance patient safety. Therefore, limited self-evaluation deprives physicians of positively impacting their professional involvement.
The Outcomes of Reflections
Reflection is an effective approach that has the potential of improving patient care in the hospital or home settings. Health professionals should engage in frequent self-evaluation to determine critical areas that require adjustment to enhance their ability to deliver appropriate nursing services. Some of the reflection outcomes include an increase in the clinician’s confidence. When physicians ponder and evaluate themselves, they are more likely to have the proper insight into their practice thus making them poised. In this perspective, practitioners can easily acknowledge their mistakes and rectify them since they do not feel timid. Furthermore, the end result of reflection in nursing is effective decision-making. Generally, by going through past experiences, it becomes easier to relate the earlier events with current situations. Therefore, providers through evaluating various scenarios develop the ability to make proper clinical choices leading to quality care.
In addition, through reflection, healthcare providers are capable of formulating practical evidence-based services to improve the quality of patient care. The aspect will result in improved patient outcomes as the practices will guarantee proper practices. Moreover, clinicians can easily develop effective skills to solve various problems. Reviewing past experiences will allow the providers to relate different incidents and thus overcome such situations in the future. Therefore, engaging in professional evaluation has the potential of influencing positive patient care and thus increase the safety of sick individuals in hospital settings. Reflection can thus be used as a significant tool for improving effective care in healthcare facilities and nurse managers should encourage various providers to embrace the behavior.
Furthermore, proper engagement metacognitive is essential as it allows clinicians to enhance their accuracy. Since some MEs occur during diagnostic stages, it is necessary for doctors to have total awareness of the situation to avoid possible biases in their practices. According to the research conducted by Royce et al. (2019), cognitive bias is a key contributor to several medication incidents. Therefore, when nurses reflect and properly comprehend their clinical reasoning, they are more likely to minimize the chances of experiencing MEs in healthcare facilities.
Relevant and Irrelevant Strategies to MEs Issue
Currently, most healthcare facilities have adopted various strategies to enable them to deal with MEs in their settings. According to the research by Tariq et al. (2018), some of the major approaches used to minimize the occurrence of MEs include avoiding the use of abbreviations while writing orders. The move is aimed at lowering the possibility of misinterpretation by professionals. In addition, specifying the drug indication is an essential approach for reducing the misuse of medicines with multiple uses. Even though Tariq et al. (2018) proposed a number of useful strategies, some plans such as blame and shame, transfer to different departments, and loss of clinician privileges are not relevant techniques for reducing MEs. Based on the research by Dendere et al. (2019), using a patient portal is an essential strategy that allows medics to easily identify MEs. By using such platforms, practitioners have the potential of improving healthcare delivery through effective patient-provider communication. Even though the article majorly focused on the impact of patient portals, it did not depict some irrelevant issues concerning the MEs. Implying that, the strategy suggested by the researchers is significant to the MEs concerns.
Furthermore, nurses should be relieved from most of their activities to enable them to have the ability to concentrate. According to the research by Jember et al. (2018), care providers make significant MEs due to the work burden thus lowering the responsibilities is an appropriate strategy for minimizing MEs. In addition, the failure of the nurse managers to take action against the reported cases of MEs is an irrelevant approach. It demoralizes practitioners from reporting such cases in the facilities. Some cases of MEs are directly linked to the emotional status of health professionals. Based on the research by Cleary et al. (2018), it is essential to assess and promote the emotional intelligence of nurses in the workplace. When the approach is undertaken, the resilience of providers increases thus they can be able to perform their duties effectively hence avoiding MEs. In addition, teaching practitioners about cognitive baseness is an effective method that hospitals can use to prevent the occurrence of diagnostic errors (Royce et al., 2019). Through critical thinking, providers will have the ability to examine and evaluate various situations thus minimizing incidents. Moreover, most healthcare facilities have adopted the trend of using technology to assist care providers in performing some crucial tasks. The approach has proven relevant because system such as CDS guides nurses during administering drugs to patients. Therefore, the strategy is vital in facilitating quality patient care through lowering MEs.
Evaluation and Action Plan
Generally, it is vital for health professionals to undertake routine reflection on their practice. The approach is essential since it allows them to have the proper insight into their involvement in delivering safe and quality care services to the respective patients. Even though the aspect might be challenging, an appropriate action plan can easily enable practitioners to effectively assess themselves accordingly. Several strategies can be applied to ensure care providers reflect on their professional practices. It is necessary to undertake such activities with an open mind and be able to adjust following the outcome of the evaluation.
The field of healthcare is complex and continuously evolving hence it requires practitioners to engage in education practices. Through reflection, a nurse will be in a position to depict critical areas that should be adjusted in order to acquire the latest and relevant information. By updating the knowledge, it will be easier to perform various tasks effectively and in an efficient manner thus avoiding cases of MEs in the facility. Therefore, undertaking education is an essential strategy that can enable clinicians to positively impact their professional practice.
In addition, it is important for the practitioners to determine key areas that require improvement. During the provision of care services, it is necessary for the nurses to identify what they can do differently to influence the care outcome. For instance, a clinician should evaluate whether the need to develop effective rapport with patients has the potential of increasing their participation in care delivery. If there is a positive correlation, then it is necessary for the respective physician to relate accordingly with the sick person.
Furthermore, another critical approach to reflect professional practice is through inquiring feedback from colleagues within the healthcare facility. Generally, sometimes it can be challenging to evaluate oneself, therefore, nurses should ask their workmates about their individual performance. Based on the results, the respective practitioners must take the necessary action to improve where needed in order to impact the practice.
Conclusion
MEs are a common issue in the healthcare system and it affects the quality of care delivery. Several factors including poor communication and lack of patient education on the nature of medication are some of the key aspects causing MEs in hospitals and other nursing homes. Most healthcare facilities have formulated various strategies including the use of CDS technology to improve the safety of patients in the settings. The issue of MEs is a major concern that has prompted the NSQHS to establish the standards that guide the practitioners as well as consumers to minimize cases of MEs. Australia has reported a significant number of people affected due to MEs. By engaging in professional reflection, nurses can be able to change and improve their practices. Effective self-evaluation allows providers to identify significant areas that need immediate adjustment thus making them more efficient in care delivery. Based on the research finding, most cases of MEs are directly linked to the work burden that nurses undertake in the facilities. When practitioners are overwhelmed, they tend to rush the practices hence leading to the omission of crucial aspects.
References
Alotaibi, Y. K., & Federico, F. (2018). The impact of health information technology on patient safety. Saudi Medical Journal, 38(12), 1173. Web.
Australia joins international push to halve medication errors. Australia joins international push to halve medication errors | Australian Commission on Safety and Quality in Health Care. (n.d.). Web.
Cleary, M., Visentin, D., West, S., Lopez, V., & Kornhaber, R. (2018). Promoting emotional intelligence and resilience in undergraduate nursing students: An integrative review. Nurse education today, 68, 112-120. Web.
Dendere, R., Slade, C., Burton-Jones, A., Sullivan, C., Staib, A., & Janda, M. (2019). Patient portals facilitating engagement with inpatient electronic medical records: A systematic review. Journal of medical Internet research, 21(4). Web.
Jember, A., Hailu, M., Messele, A., Demeke, T., & Hassen, M. (2018). Proportion of medication error reporting and associated factors among nurses: A cross sectional study. BMC nursing, 17(1), 1-8. Web.
Royce, C. S., Hayes, M. M., & Schwartzstein, R. M. (2019). Teaching critical thinking: A case for instruction in cognitive biases to reduce diagnostic errors and improve patient safety. Academic Medicine, 94(2), 187-194. Web.
Tariq, R. A., Vashisht, R., Sinha, A., & Scherbak, Y. (2018). Medication dispensing errors and prevention. StatPearls Publishing.
