Medication errors and professional practice of registered nurses

Abstract

This Australian study identified and described the incidence of medication errors among registered nurses, the type and causes of these errors and the impact that administration of medications has on the professional practice of registered nurses. Mostly, medication errors were attributed to documentation issues, including: illegible handwriting, misunderstanding abbreviations, misplaced decimal point, misreading and misinterpreting written orders. Several human factors were attributed to potential causes of medication errors, including: stress, fatigue, knowledge and skill deficits. Environmental factors, namely, interruptions and distractions during the administration of medications, were also attributed to potential errors. The study found professional nursing practice involving administration of medications had a strong education, patient and ethical focus. Over a quarter of the respondents indicated that further training in medication administration would positively impact on their nursing practice. The registered nurses also highlighted they would appreciate more time to spend with patients when administering medications. Medication errors are not the sole responsibility of any single professional group, therefore, collaboration with other health professionals is central to establishing processes, policies, strategies and systems that will reduce their occurrence. The organisation and those nurses employed within it share an accountability to ensure safe administration of medications to patients. Based on study results, several recommendations are directed towards preventing or reducing medication errors and supporting nurses in providing best practice.

An education intervention to improve nursing students' understanding of medication safety

“…This is supported by Nichols et al (2008) who report that more than two thirds of doctors describe poor communication during hand over of care, combined with insufficient guidance from more senior colleagues as contributing to medication error. In the same study, nurses also reported that poor communication within the nursing team contributed to error, while Deans (2005) found that written communication was a significant contributing factor. In particular, misreading, misinterpreting, or illegible handwriting could account for nearly one fifth of errors (Deans, 2005).…”

“…In the same study, nurses also reported that poor communication within the nursing team contributed to error, while Deans (2005) found that written communication was a significant contributing factor. In particular, misreading, misinterpreting, or illegible handwriting could account for nearly one fifth of errors (Deans, 2005). This would suggest that an increased awareness of the importance of accurate and unambiguous communication can improve medication safety.…”

“…Interruptions and distractions were found to contribute to more than a quarter of medication errors in one Australian study (Deans, 2005), yet in the absence of clinical experience students may find this notion difficult to grasp. Similarly, the potential for adverse medication events that result from the use of two or more medications with similar sounding or looking names and labels can be seen as another system error whose impact may be challenging to realise with limited clinical experience (Australian Commission on Safety and Quality in Health Care, 2011; Gaunt, 2013).…”

“…More recently there has been recognition in the literature that medication adverse events are related to systems failures (i.e. team, task, environment, individual and system factors) (Deans, 2005;Evans, 2009;Popescu et al, 2011;Roughead and Semple, 2009) associated with the complex process of medication administration, rather than individual or professional group factors (Roughead and Semple, 2009). Reported factors that increase the likelihood of a medication error occurring include knowledge-based mistakes, poor communication (Nichols et al, 2008), polypharmacy, and poor compliance with medication assessment practices such as medication reconciliation (Latimer et al, 2011).…”

“…Research indicates medication events or errors are often a result of system failures, that is, errors related to team, task, environment, individual and system factors (Deans, 2005;Evans, 2009;Popescu et al, 2011;Roughead and Semple, 2009). The multifaceted nature of medication administration involves the contribution of medical staff, pharmacists and nurses.…”