Quality Improvement for Medication Errors
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Quality Improvement for Medication Errors
Medical science has prioritized the reduction of medication errors since the inception of quality improvement as a core clinical and nursing practice. Medication errors occur while prescribing, transcribing, preparation, dispensing or administration of drugs. The errors represent a significant source of financial and human burden, exposing healthcare facilities to legal liabilities while exposing patient to physiological risks. The report follows a quality improvement study undertaken in a general community hospital. The paper familiarizes the reader with the effect of continuous quality improvement in the reduction of medication errors and the subsequent improvement in patient outcomes. Throughout the study, the actions of the nurse leader highlight an increasing demand for electronic healthcare records and evidence-based practice. It is critical that healthcare facilities adopt interventions based on proven medical models, cause analysis and collaborative practice to substantially reduce medication errors. While not all medication errors results to patient mortality or morbidity, its relatively high incidence rate and operational cost implications make the problem worthy of consistent scientific attention.
Medication errors pose significant risks to patient safety while threatening the financial sustainability of healthcare institutions. According to Wang et al. (2015), medication administration errors (MAEs) are drug provision lapses that actually reach the patient, posing a threat to their general safety. At least one person dies every day while 1.3 million people are injured annually from medication errors in the United States. The nurse leader was adamant in her focus to eradicate MAEs, since they stem from human behaviours. A systematic review of literature highlights error-inducing conditions, including poorly written communication in drug prescriptions, patient documentation and transcription (Wang et al. 2015). MAEs also occur due to lapse in medicine supply and storage, high nurse and pharmacist workloads and patient factors (acuity and availability). Research shows that medication errors have a direct effect on the quality of patient care (Wang et al. 2015). The finding underpins why the nurse leader and the medical organization directed leadership to implement continuous quality improvement to negate the problem.
Continuous Quality Improvement (CQI) is applied to optimize the process of drug administration. Over the course of one-year, a multicenter study that assesses how nurses practiced oral medication preparation and dissemination via NGT was carried out. Pereira et al. (2020) used the approach in two Brazilian hospitals to establish standards for NGT drug administration. According to the authors, the design of the quality improvement plan begins with an internal analysis on nurses’ skills, knowledge and familiarity with NGT. The assessment ascertains whether nurses know how to control release in enteric coated dosages because preparation entails crushing the solid medication (Pereira et al. 2020). The evaluation helps determine the incidence rate of wrongful medication preparation and administration. The nurse leader acts as the observational officer, documenting what nurses do and respective workloads. The approach shows that variation in working hours should be considered as a significant cause of medication errors. The findings facilitated the development of QI objectives while guiding on who should be included in the team for the QI project.
Quality improvement adopts a cyclic execution approach with a multidisciplinary team spearheading the project. Good practice starts with the multidisciplinary team receiving clear information on the purpose of the project, processes and potential benefits (Yousef & Yousef, 2017). Members of the team discuss and exchange experiences and knowledge regarding the matter at hand. The team uses the first phase to decide when the next cycle of human training should begin. Deliberations are made as per the observations collected in the internal analysis. The second cycle entails transitioning from theoretical to practical training under the oversight of the principle investigator (Yousef & Yousef, 2017). With training, the QI team gradually implements the changes over a specific period. The approach empowers nurses to be more competent compared to providing theoretical education alone. The third cycle observes nurses and their rate of medication errors, noting points vulnerable to error while comparing the data to the initial observation. Any newly identified gaps are addressed using the same iterative cycle, starting and ending in observation.
Medication errors represent a global threat to patient and nurse safety. In recent years, healthcare leadership has been consistent in its integration of total quality management in the prevention of medication errors. Literature outlines certain conditions heighten the possibility of medication lapses, especially poor communication in any of the drug processing stages. Literature also outlines organizational factors, including variation in work hours and heavy workloads. MAEs are presented as the most prevalent type of medication errors, however, they are preventable. In the implementation of continuous quality improvement, an iterative cycle is preferred for better depth and breadth of collaborative practice. Healthcare institution should plot on how to implement the Plan-Do-Study-Act cycle to meet specific internal needs. The adoption of electronic health records is equally recommended for more efficient exchange of experience and knowledge. Technological advancements are key to reducing and preventing medication errors. Science affirms that with collaborative practice and digitalization, healthcare facilities can effectively avert the human-based fault. Including some of the findings in a hospital’s risk management plan is bound to result in successful quality improvements.
References
Pereira, R., deSouza, F., Rigobello, M. & Gimenez, F. (2020). Quality improvement programme reduces errors in oral medication preparation and administration through feeding tubes. BMJ Open Quality, 9(1), doi: 10.1136/bmjoq-2019-000882
Wang, H. F., Jin, J. F., Feng, X. Q., Huang, X., Zhu, L. L., Zhao, X. Y., & Zhou, Q. (2015). Quality improvements in decreasing medication administration errors made by nursing staff in an academic medical centre hospital: a trend analysis during the journey to Joint Commission International accreditation and in the post-accreditation era. Therapeutics and Clinical Risk Management, 11, 393–406. https://doi.org/10.2147/TCRM.S79238
Yousef, N. & Yousef, F. (2017). Using total quality management approach to improve patient safety by preventing medication error incidences. BMC Health Service Research, 17(621). https://doi.org/10.1186/s12913-017-2531-6