Analyzing a Current Health Care Problem or Issue

According to Alqenae et al. (2020), the problem of medication errors is prevalent in many healthcare facilities globally. They occur during different stages of treatment in the hospital. When they occur, they have negative impacts on the patient. They can increase morbidity and mortality rates, decrease recovery times and prolong hospital stays (Alqenae et al., 2020). This paper describes medication errors, identifies the causes of medication errors, discusses interventions to minimize medication errors, and identifies applicable ethical principles.

Health Care Problem and Possible Causes

The problem of medication errors is common in healthcare facilities. Data demonstrates that more than 110,000 medication errors are reported in the USA annually (FDA, 2019). Medication errors are the leading cause of morbidities and mortalities that can be averted in the healthcare setting (Alqenae et al., 2020). The three main types of medication errors include prescribing errors, dispensing errors, and administration errors (Alqenae et al., 2020). Medication prescription errors are commonly committed by physicians. This occurs when a medication is prescribed irrationally. An example is prescribing medicine with the wrong indication, wrong dosage, wrong dosing frequency, and wrong route of administration (Manias et al., 2020). Furthermore, irrational prescribing can occur when prescriptions are made without adequate past medication history (Alqenae et al., 2020). This increases the likelihood of drug allergic reactions and drug toxicity resulting from polypharmacy.

Dispensing errors are commonly committed by pharmacists. They include failure to screen the prescriptions thoroughly to identify drug interactions, wrong dosages or dosing frequencies, polypharmacy, and inadequate patient counselling (Naseralallah et al., 2020). In addition, dispensing errors can be mechanical. Examples of such errors are giving inaccurate information concerning the medication, dispensing wrong dosages, dispensing the wrong drug, or wrong labelling of medications (Naseralallah et al., 2020). Pharmacists are responsible for enforcing rational drug use through the critical screening of prescriptions and patient counselling (Naseralallah et al., 2020). Failure to do so is detrimental to the patient, especially in primary healthcare settings.

Administration errors are commonly committed by nurses. Examples of such errors include overdoses, underdoses, wrong route of administration, giving medication to the wrong patient, and wrong administration techniques (Escrivá Gracia et al., 2019). Examples of improper administration include wrong intravenous push techniques or nasogastric tube administration techniques (Escrivá Gracia et al., 2019). Just like prescribing and dispensing errors, administration errors increase the incidences of adverse drug events, suboptimal clinical outcomes, and drug toxicities (Escrivá Gracia et al., 2019).

Medication errors are caused by various factors. Lack of open communication increases the likelihood of medication errors (Manias et al., 2020). This can be a lack of communication with patients or among healthcare providers. Open communication ensures that the right patient gets the right dosage of the drug. The other cause is the lack of policies. Defective or absence of policies that advocate for patient-centred services, accountability, and interdisciplinary collaboration increases the likelihood of education errors (Manias et al., 2020). The other cause is poor knowledge transfer in the organization. This is characterized by inadequate training sessions and a lack of continuous medical education programs (Manias et al., 2020). The other cause is staffing shortage. It increases staff burnout and fatigue and increases the likelihood of medication errors (Tamata et al., 2021).

Context, Importance, and the Population Affected by Medication Errors

According to Alqenae et al. (2020), medication errors can arise in various settings, such as healthcare facilities, hospitals, primary healthcare centres, pharmacies, and in the community (at home) when patients are discharged. Medication errors are commonly reported in healthcare settings and indicate deficiencies in the prescribing, dispensing, or administration of medications (Naseralallah et al., 2020). They can also arise in the community when patients are discharged or among outpatients. In the context of medication errors occurring in the community, the pharmacist will have failed to scrutinize prescriptions and identify potential drug interactions or contraindications (Naseralallah et al., 2020). Furthermore, medication errors at the community level are caused by wrong or inadequate dispensing instructions or dispensing of wrong medications (Naseralallah et al., 2020). Consequently, patients are predisposed to adverse events, severe allergies, and other drug toxicities.

The problem of medication errors is important to me because, as a clinician, I have a role in upholding patient safety through patient-centered services. Medication errors are a manifestation of poor healthcare services to the patient (Escrivá Gracia et al., 2019). The global incidences of these medication errors are high. They can lead to suboptimal outcomes when inadequate dosages, dosing frequencies, wrong medications, or wrong administration techniques are used (Manias et al., 2020). They can lead to adverse events, toxicities, or allergies when overdoses or the wrong medication are administered (Manias et al., 2020). Therefore, this is a problem of concern that should be addressed to ensure patient safety.

Medication errors affect people of all age groups in the inpatient and outpatient departments of healthcare facilities. They are common in the pediatric and neonatal populations admitted to intensive care units (Alghamdi et al., 2019). Common problems in this population are prescription and administration errors. The drugs associated with most education errors in this population are anti-infectives (Alghamdi et al., 2019). The adult population is affected in the outpatient and inpatient settings. In this population, they are related to prescribing, dispensing, and administration (Alqenae et al., 2020). Antibiotics are associated with the most medication errors in the adult population. Furthermore, analgesics, oral hypoglycemic agents, and cardiovascular agents are common causes of medication errors and toxicities in the adult population (Alqenae et al., 2020).

Potential Solutions for Medication Errors

Healthcare facilities can embrace various interventions to address the problem of medication errors. The first intervention is enforcing pharmacist-directed medication reconciliation. Pharmacists should thoroughly screen prescriptions to identify potential drug interactions, the correctness of doses, contraindications, and polypharmacy (Naseralallah et al., 2020). Furthermore, they should exercise accuracy when dispensing, counselling, and compounding medication (Naseralallah et al., 2020). By so doing, the initiative will solve medication errors related to prescribing and dispensing. The second intervention is the use of computerized physician order entries (CPOE) (Manias et al., 2020). The CPOE technology has clinical decision support tools that detect drug interactions, contraindications, allergies, and correctness of dosage (Manias et al., 2020). This helps to minimize medication errors.

According to Manias et al. (2020), interprofessional collaboration through open communication can help to minimize medication errors. Nurses, physicians, and pharmacists should exchange information regularly when they consult, seek clarifications, or provide the latest advances in clinical practice (Manias et al., 2020). This can facilitate early detection and prevention of medication errors. The other strategy is conducting routine training and continuous medical education (Manias et al., 2020). This will equip members of the interdisciplinary team with adequate knowledge and skills for detecting and preventing medication errors. The other strategy is the advocacy of the protocol requiring counterchecking before medication is administered (Manias et al., 2020). The countercheck should be conducted by a different clinician. This increases the likelihood of detecting medication errors, such as overdoses, overdoses, wrong administration techniques, or wrong patient (Manias et al., 2020).

Successful implementation of the computerized physician order entries requires the utility of a certified electronic health record (EHR) system and adherence to meaningful use guidelines. Meaningful use guidelines direct physicians and healthcare facilities to use certified EHR and embrace CPOE, sharing permissible information and checking for drug interaction, contraindications, and allergies (Nair & Dreyfus, 2018). Therefore, adherence to meaningful use guidelines will promote the utility of CPOE and reduce medication errors.

Ignoring the problem of medication errors will have negative impacts on patients and the healthcare facility. Patients’ morbidity and mortality rates will be increased by the high incidence of medication errors. Patients’ recovery rates will decrease, and they will have to incur extra financial expenses in managing their diseases and toxicities or adverse effects caused by medication errors. Healthcare facilities will gain a bad reputation due to low recovery rates, prolonged hospital stays, and patient dissatisfaction with service delivery.

Ethical Principles

The four ethical principles should be considered in the implementation of the solutions. Beneficence advocates for actions that benefit others, whereas non-maleficence refers to the ability to do no harm (McDermott-Levy et al., 2018). Interventions like CPOE, counterchecking of medication, and pharmacist-led medication reconciliation should uphold beneficence and non-maleficence by aiming at promoting the wellbeing of the patient. All members of the interdisciplinary team should ensure that the treatment regimen is appropriate and has the least possible adverse events or toxicities.

According to McDermott-Levy et al. (2018), autonomy grants patients an opportunity to participate actively in the decision-making of their treatment plans. Interventions like CPOE should ensure that the patient is actively involved in the decision-making. An example is the selection of the best contraception method or deciding whether to undertake a surgical procedure or use medication to solve a medical problem (McDermott-Levy et al., 2018). The principle of justice advocates for treating patients fairly (McDermott-Levy et al., 2018). Pharmacist-led medication reconciliation should be done for all patients in equal measure. Counterchecking of medication before administration should also be applied to all patients.

Conclusion

Medication errors are the leading cause of morbidities and mortalities that can be averted in the healthcare setting. The three main types of medication errors include prescribing errors, dispensing errors, and administration errors (Manias et al., 2020). Examples of solutions for medication errors include pharmacist-directed medication reconciliation, CPOE, interprofessional collaboration through open communication and routine training, and continuous medical education (Manias et al., 2020; Naseralallah et al., 2020).

References

Alghamdi, A. A., Keers, R. N., Sutherland, A., & Ashcroft, D. M. (2019). Prevalence and Nature of Medication Errors and Preventable Adverse Drug Events in Paediatric and Neonatal Intensive Care Settings: A Systematic Review. Drug Safety, 42(12), 1423–1436. https://doi.org/10.1007/s40264-019-00856-9

Alqenae, F. A., Steinke, D., & Keers, R. N. (2020). Prevalence and Nature of Medication Errors and Medication-Related Harm Following Discharge from Hospital to Community Settings: A Systematic Review. Drug Safety, 43(6), 517–537. https://doi.org/10.1007/s40264-020-00918-3

Escrivá Gracia, J., Brage Serrano, R., & Fernández Garrido, J. (2019). Medication Errors and Drug Knowledge Gaps Among Critical-Care Nurses: A Mixed Multi-Method Study. BMC Health Services Research, 19(1), 1–9. https://doi.org/10.1186/s12913-019-4481-7

FDA. (2019). Working to Reduce Medication Errors. https://www.fda.gov/drugs/information-consumers-and-patients-drugs/working-reduce-medication-errors#:~:text=A%20medication%20error%20is%20defined,Medication%20Error%20Reporting%20and%20Prevention.

Manias, E., Kusljic, S., & Wu, A. (2020). Interventions to reduce medication errors in adult medical and surgical settings: a systematic review. Therapeutic Advances in Drug Safety, 11. https://doi.org/10.1177/2042098620968309

McDermott-Levy, R., Leffers, J., & Mayaka, J. (2018). Ethical Principles and Guidelines of Global Health Nursing Practice. Nursing Outlook, 66(5), 473–481. https://doi.org/10.1016/j.outlook.2018.06.013

Nair, A., & Dreyfus, D. (2018). Technology Alignment in the Presence of Regulatory Changes: The Case of Meaningful Use of Information Technology in Healthcare. International Journal of Medical Informatics, 110(September 2017), 42–51. https://doi.org/10.1016/j.ijmedinf.2017.11.012

Naseralallah, L. M., Hussain, T. A., Jaam, M., & Pawluk, S. A. (2020). Impact of Pharmacist Interventions on Medication Errors in Hospitalized Pediatric Patients: A Systematic Review and Meta-Analysis. International Journal of Clinical Pharmacy, 42(4), 979–994. https://doi.org/10.1007/s11096-020-01034-z

Tamata, A. T., Mohammadnezhad, M., & Tamani, L. (2021). Registered Nurses’ Perceptions on the Factors Affecting Nursing Shortage in the Republic of Vanuatu Hospitals: A Qualitative Study. PLoS ONE, 16(5 May), 1–17. https://doi.org/10.1371/journal.pone.0251890

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