NURS-FPX 4000 Enhancing Quality and Safety

NURS-FPX 4000 Enhancing Quality and Safety

NURS-FPX 4000 Enhancing Quality and Safety

Unsafe medication practices occur mostly during drug administration and are the common causes of avoidable patient harm in healthcare organizations globally. Medication errors can occur during drug prescribing, transcribing, dispensing, or administration (Wondmieneh et al.,2020). Nursing professionals play a major role in the incidence and prevention of MAEs. The purpose of this assignment is to discuss factors causing patient-safety risks in regard to medication administration, identify evidence-based solutions, and how nurses can coordinate care to promote patient safety.

Factors Leading to a Specific Patient-Safety Risk

Medication administration errors (MAEs) are the prevalent types of medication errors and are associated with adverse consequences for patients, healthcare providers, and health facilities. Wondmieneh et al. (2020) explain that commonly perpetrated MAEs are wrong patient, wrong drug, wrong dose, wrong route, wrong time, dose omission, failure to document, and technical errors. MAEs significantly affect patients by increasing morbidity, adverse drug events, mortality, prolonged hospital stay, and increased medical costs (Härkänen et al., 2019). The WHO explains that patients from developing countries experience twice as many disabilities caused by MAEs-related harm than those from developed nations.

Factors that cause MAEs can be grouped as nurse-related, physician-related, nurse-physician, and organizational factors. The nurse-related factors include old age, limited work experience, poor medication knowledge, poor dose calculation skills, failure to double-check drugs, inattention during drug administration, new hires, similar medication package, and insufficient training (Wondmieneh et al., 2020). Physician-related factors include physicians changing medication orders and failing to communicate clearly through documentation. In addition, ineffective communication between nurses and physicians is a major cause of MAEs. The most common organizational factor related to MAEs is a high workload for nurses characterized by high nurse-to-patient ratios that lead to fatigue and burnout (Härkänen et al., 2019). Busy shifts and units with a high patient flow have been found to have more MAEs. Furthermore, interruptions during drug administration and pharmacy procedures contribute to MAEs.

Evidence-Based and Best-Practice Solutions to Improve Patient Safety

MAEs can be prevented by cutting short any medication errors before they get to the patient by sticking to the five rights of drug administration and reporting MAEs, which improves patient safety. Salami et al. (2019) assert that increasing nurses’ drug knowledge effectively reduces MAEs. Another essential preventive measure to reduce MAEs is encouraging nurses to behave professionally. Adib & Eshraghi (2018) explain that elements of professional nursing behavior include reading medication labels, following MAEs, nurses being aware of medication errors, attending regular training on medication protocols, and precision. Furthermore, MAEs can be prevented by motivating the nurses to report them so that they can reflect on how to reduce the errors. Thus, organizations can offer a motivating mechanism for reported MAEs and build a conducive environment for error reporting (Salami et al., 2019). Nursing and hospital managers should also lower the nursing workload and ensure safe nurse-to-patient ratios, which can minimize errors caused by fatigue and distractions.

How Nurses Can Help Coordinate Care to Increase Patient Safety and Cost

Poor coordination of patient care poses a risk of preventable events like uncontrolled polypharmacy, medication errors, and ineffective follow-up care. Coordinating patients’ care among multiple providers and care settings is a big challenge. Nurses can participate in care coordination by ensuring patients’ multidimensional needs are met at the bedside, during the transition from one facility to another, and as they live in the community (Karam et al., 2021). Moreover, nurses can coordinate patient care through medication reconciliation. Nurses can adopt a methodical and comprehensive medication reconciliation process and perform it every time a patient transitions to a new level of care along the continuum of care. In addition, nurses can adopt practices that promote care coordination, like handoffs, huddles briefings, and multidisciplinary rounding, that simplify and standardize communication and improve patient safety by minimizing communication breakdowns (Karam et al., 2021). Furthermore, nurses can involve patients and their families in discharge planning and education and conduct follow-up visits with the patient post-discharge to address any concerns and foster compliance with the discharge plan.

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Stakeholders Needed for Quality and Safety Enhancements

Nurses need to collaborate with various stakeholders in the above care coordination approaches, including pharmacists, physicians, case managers, and social workers. Pharmacists and physicians can participate in medication reconciliation and provide education during discharge planning. The pharmacist can educate patients about their medications, including indications, potential side effects, and the adverse effects to look out for (Hanifin & Zielenski, 2020). Case managers are important in helping patients and caregivers navigate the discharge process, including understanding how to take their discharge medications to prevent errors caused by wrong doses (Hanifin & Zielenski, 2020). Besides, social workers can help follow up on patients and help patients to access community resources in medication management.

Conclusion

MAEs are related to poor medication knowledge and calculation skills, insufficient nurse training, high nursing workload, ineffective physician-nurse communication, and interruptions. Updating nurses’ knowledge, particularly about new drugs, reducing nurses’ workload, encouraging nurses to behave professionally, and reporting errors can significantly reduce MAEs.  Nurses can coordinate care by meeting patients’ multidimensional needs, medication reconciliation, multidisciplinary rounding, and involving patients in discharge education.

References

Adib, H. M., & Eshraghi, A. N. (2018). Assessing Nurses’ Clinical Competence from Their Own Viewpoint and the Viewpoint of Head Nurses: A Descriptive Study.

Hanifin, R., & Zielenski, C. (2020). Reducing medication error through a collaborative committee structure: An effort to implement change in a community-based health system. Quality Management in Healthcare29(1), 40-45. doi: 10.1097/QMH.0000000000000240

Härkänen, M., Paananen, J., Murrells, T., Rafferty, A. M., & Franklin, B. D. (2019). Identifying risks areas related to medication administrations-text mining analysis using free-text descriptions of incident reports. BMC Health Services Research19(1), 1-9. https://doi.org/10.1186/s12913-019-4597-9

Karam, M., Chouinard, M. C., Poitras, M. E., Couturier, Y., Vedel, I., Grgurevic, N., & Hudon, C. (2021). Nursing Care Coordination for Patients with Complex Needs in Primary Healthcare: A Scoping Review. International Journal of Integrated care21(1), 16. https://doi.org/10.5334/ijic.5518

Salami, I., Subih, M., Darwish, R., Al-Jbarat, M., Saleh, Z., Maharmeh, M., … & Al-Amer, R. (2019). Medication administration errors: Perceptions of Jordanian nurses. Journal of Nursing Care Quality34(2), E7-E12.

Wondmieneh, A., Alemu, W., Tadele, N., & Demis, A. (2020). Medication administration errors and contributing factors among nurses: a cross-sectional study in tertiary hospitals, Addis Ababa, Ethiopia. BMC Nursing19(1), 1-9.