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NURS-FPX 4020 Assessment 1 Enhancing Quality and Safety

NURS-FPX 4020 Assessment 1 Enhancing Quality and Safety


The pursuit of high-quality care and safety safeguards in healthcare is a pertinent health agenda that attracts political and public health interest. Quality improvement and safety enhancements in healthcare are integral to health promotion and preservation efforts. These interventions are pivotal in reducing the incidence of sentinel events in healthcare as well as medical and medication-related errors. Medication administration errors are one of the most common quality and safety compromises in healthcare. These errors have been implicated in over 7000 deaths. The healthcare costs for patients with medication-related health errors are approximately 40 billion dollars. Healthcare providers have been implicated in over 60% of medication-related errors, with nurses accounting for the majority of these cases. Wrong dosing is one of the most common causal factors for medication administration errors (Rasool et al., 2020). This paper details wrong dosing as a medication administration error in healthcare.

Factors Leading to Wrong Dosing

Wrong dosing encompasses under-dosing, overdosing, and extra-dosing. These errors occur when a patient is given medication at a dose not ordered or inappropriate to their indications, omission, or when a drug is given through the wrong route of administration. Several factors have been implicated as causal for wrong dosing. Illegible writing can lead to wrong dosing. Also, illegible dosing instructions have long been a plague to pharmacists and nurses. This issue is particularly a concern in manual prescription transmission and is accustomed to physicians being in a hurry to scribble down medications and dosing instructions. Nurses and pharmacists, in this case, have to make the best guess of the physician’s intentions. In rare cases of incorrect interpretations, the patients may end up receiving the wrong dose. Due to the negative implications of illegibility in prescriptions, many healthcare organizations have enforced policies on prescriptions imploring physicians to maintain responsibility during prescription. With electronic use, the manual transmission of prescriptions is slowly being phased out. It, however, remains a concern in healthcare institutions where electronic health records have not been fully implemented.

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Fragmented communications between nurses and pharmacists may also result in wrong dosing (Wondmieneh et al., 2020). Pharmacists, being experts in medication, are responsible for informing nurses on the administrative routes of drugs and the dosing instructions. Therefore, poor communication may result in dosing mistakes. The criticality of pharmacists in medication administration reinforced the need for streamlined nurse-pharmacist communication. This calls for the ever presence of pharmacists during medication administration to minimize nurse-related medication errors.

Inadequate nurses’ knowledge of the pharmacokinetic properties of some medications may contribute to nurses’ errors during medication administration. Pharmacokinetic knowledge of medication assists in determining the right dose of various medications as well as the most appropriate route of administration. Medications with narrow therapeutic indices are particularly delicate to handle. This is because minimal shifts in dosing may result in catastrophic health effects. Nurses’ pharmacokinetic knowledge can help them avert mistakes attributable to improper dosing or the use of inappropriate routes of administration.

Distractions during care provisions have also been implicated in extra dosing. Distractions during medication administration can be either on the physicians’ side or the nurses’ side. Physicians’ distraction may lead to lapses in clinical judgment and the consequential prescription of overdose or underdose. Nurses’ distractions during medication administration have also been implicated in extra dosing and administration of the wrong dose to the wrong patients. All these have detrimental effects on the patients and underpin the need for addressing them.

NURS-FPX 4020 Assessment 1 Enhancing Quality and Safety

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

Correcting dosing errors as a form of medication administration errors remains a priority patient safety enhancement measure. Best practices in reducing medication administration errors and, consequently, costs include expanding nurses’ knowledge of medications, fostering nurse-pharmacist partnerships, and creating a favorable environment for medication handling and administration (Manias et al., 2020). Expanding nurses’ knowledge of the pharmacokinetic properties of medications may be valuable in minimizing medication administration errors. This can be attained through a systematic approach entailing continuous medical education on these topics and equipping nurses with reference materials and educational resources on various medications. Valuable reference material for nurses includes medication leaflets, journals, textbooks, and other pieces of literature on medication handling and administration.

Expanding nurses’ knowledge will bridge the information gap on some medication that contributes to wrong dosing. Fostering nurses- pharmacist partnerships in care provision is another important strategy that may reduce medication administration errors. Pharmacists, in this regard, play a vital role in informing nurses on medication knowledge utilizable in drug administration. Streamlining communication between nurses and pharmacists may eliminate most errors resulting from nurses’ knowledge inadequacy when administering medications.

Creating a favorable environment for medication handling may also help minimize medication errors. A clinical environment that is devoid of distraction may eliminate medication-related errors that are attributable to nurses’ or physicians’ distractions. This can be attained by asking other clinicians to refrain from distracting physicians when they are seeing their patients. Nurses can also be asked to embrace the culture of not disrupting their fellows when administering medications. These measures can minimize distraction and subsequent errors.

How Nurses Can Help Coordinate Care to Increase Patient Safety with Medication Administration and Reduce Costs

Nurses play a role in coordinating care approaches in healthcare. To help coordinate care that enhances patients’ safety, nurses should form healthy partnerships with other healthcare providers such as pharmacists, share valuable patient information that may guide dosing and administration requirements on the patients, and communicate openly and frequently with other members of clinical healthcare teams (Russ-Jara et al., 2021). Frequent and open communication provides a platform for peer consultation and may enable nurses to consult on dosing and route considerations in their patients. Information sharing is integral to coordinative approaches as it enables the establishment of patients and disease factors that may influence treatment plans. These measure optimizes medication administration processes and lowers medication administration errors that may drive the cost of care higher and have detrimental effects on the patients.

NURS-FPX 4020 Assessment 1 Enhancing Quality and Safety

Stakeholders with Whom Nurses Coordinate to Enhance Safety Concerning Medication Administration

Pharmacists, physicians, and healthcare administration are stakeholders with whom nurses can coordinate to drive safety enhancement with medication administration. Physicians being the primary prescribers, have a role in prescribing the right doses to patients. Physician-related errors have been implicated in medication-related errors. Nurses can coordinate with physicians to ensure correct dosing by informing them about patients and disease factors that may influence dosing considerations. Nurse-pharmacist coordination is also important. Pharmacists provide vital medication information, including dosing and route considerations, as well as drug interactions that may influence dosing. This may minimize dosing-related errors. In addition, the hospital administration plays a role in facilitating an enabling environment for medication handling. Nurses can notify the hospital’s administration of infrastructural limitations that may cause distraction and result in medication errors.


Medication-related errors remain a source of quality and safety compromise. Wrong dosing is an example of medication administration error that may result from distraction during medication administration and inadequate nursing knowledge of medications. Expanding nurses’ knowledge of medicines and eliminating distractions are some measures that can minimize medication administration among nurses. Nurses play a role in this regard. Their coordination with pharmacists, physicians, and the hospital administration may provide a platform for addressing these causal factors, thus minimizing errors and eliminating costs that would have otherwise been incurred in managing medication errors related to adverse events. 


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 Safety11, 204209862096830.

Rasool, M. F., Rehman, A. ur, Imran, I., Abbas, S., Shah, S., Abbas, G., Khan, I., Shakeel, S., Ahmad Hassali, M. A., & Hayat, K. (2020). Risk factors associated with medication errors among patients suffering from chronic disorders. Frontiers in Public Health8.

Russ-Jara, A. L., Luckhurst, C. L., Dismore, R. A., Arthur, K. J., Ifeachor, A. P., Militello, L. G., Glassman, P. A., Zillich, A. J., & Weiner, M. (2021). Care coordination strategies and barriers during medication safety incidents: A qualitative, cognitive task analysis. Journal of General Internal Medicine36(8), 2212–2220.

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).

See Also: NURS-FPX 4020 Assessment 2 Root-Cause Analysis and Safety Improvement Plan


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For this assessment, you will develop a 3-5 page paper that examines a safety quality issue pertaining to medication administration in a health care setting. You will analyze the issue and examine potential evidence-based and best-
practice solutions from the literature as well as the role of nurses and other stakeholders in addressing the issue.

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