Examining Strategies For Improving Medication Administration Nursing Essay

Examining Strategies For Improving medical checkup specialty Administration Nursing EssayProviding business organization for the patient is the responsibility of draws. Nurses ar the adept who atomic number 18 dear with patients. They are responsible and account fitted to reconcile sure that the treatments and needs of patient are fulfilled. Medication nerve is a part of the nurses responsibility in ordinateing to make sure clients get the mitigate practice of medicine as supposed. Medication boldness illusion is a universal health help concern.Thus the strategy in improving medical specialty administration system is important to enhance safety.The administration of medical specialty by nurses is the final step in a process that involves two-fold steps carried out by a number of health professionals (medical practitioners, pharmacists and registered nurses). The accuracy, efficiency and safety of administration of musics rest primarily with nurses. Medication ad ministration is an activity that is inclined(predicate) to defects, in part be bring on of the development of new medical devices and new drug products that available to fulfill the demand in health care setting. Thus to frustrate practice of medicine administration defect, six rights should be main concern for the nurses in giving music.There are m some(prenominal) type of medical actus reus that leads to blur and may jeopardize patients safety. According to Hughes and Ortiz (2005) the most common type of medical fracture that happen universally is medication error. Senior citizens are at the highest jeopardize of being affected by this type of errors, since they are the largest consumers of medication (New Tech Media, 2006). However, this is especially true in regards to medication errors. A proper understanding of the bring factors that increase medication errors is the first step toward preventing them. There are many factors, such as training deficiencies, undue ti me pressure, and nursing shortages that may deplete contri providede to medication errors. The amount of nursing education and the age of nursing experience are two factors that may ingest relationship to medication errors. out-of-pocket to the fact that nursing staff is a large cost to hospitals, these organizations are constantly trying to manage expenses. This is supported by Yang (2003) who farmings nursing professionals typically map the largest employee group in hospitals, and have become a primary target for redesign measures. Consequently, medication errors are costly and seem to be proportional to the staffing of nurses. Since nurses make up such a large portion of the staff population, it is important to understand the incidents that influence behind these medication errors. These issues of medication errors were present even at the time when Benjamin Franklin entraped Americas first hospital and he stated that patients ultimately suffer and die without good nursin g care (Clarke, 2003).1.2 PROBLEM STATEMENT health care professionals work is hectic and stressful. All the heavy workload had causes the nurses to pay much little attention in giving proper medication administration to patients.I discovered during my clinical posting that mosttimes the nurses tend to take for granted so as whether the patient did consume the medications given or not later leaving the medication on the patients bedside .Occasionally proper procedure was not followed by nurses for medication administration. It happens when the nurses just copy down the name of patient in a piece of opus during pass over the report , without rechecking in the patients medication administration record. This unintentional act sometimes pass on lead to medication administration error when bed of the patient is exchange with another patient or the patient has been transferred to the other ward or may be action from the hospital .There is also happen an error due to some of the nurse s borrowing medication from another patients cart and administering an unlabelled medication or syringe. This outlaw(a) practice will harm the patients and whoremonger cause medication administration errors. On the other cases, the nurses do not follow the correct time for medication administration. For instance, they just merely combine the medication that should be given at 4p.m with 6p.m. In that case, the effectiveness and toxicity of medication stomach be query. Thus, medication error can be some way again linked to an inconsistency applying the six rights of medication administration.Definition of termsNurses A person educated and develop to care for the sick or disabledOne that serves as a nurturing or fostering influence or means(C.L.R James,2009 ) performanceing experience Work experience is the linking of a period of activity in a worksetting (whether paid or voluntary) to the programme of shoot,irrespective of whether the work experience is an total partof the progr amme of aim(Harveyet al,2002)Incident Any other incident in which tec is unsure some exposurepotential.1.3 SIGNIFICANCE OF THE STUDYMedication administration is a crucial part in nursing . Having a study concerning the incident of contri scarceing factors that lead to medication error is important as this study creates awareness well-nigh the medication error and it consequences will affect patients safety. Such prevention methods could be taken to reduce the cases of medication error in hospital setting. Through this study, the management team of the hospital may take a serious action to solve the problem arised. Besides that, the nurses may realize the consequence of medication administration process to overcome the factors that contribute to medication administration error.Further more than, nurses need to perform their duty in ethical manner and obey the correct modular procedures as guided by the ministry of health. The function beyond the limit of nursing practice acts or ones ability is to endanger clients life will govern the nurses open to malpractice suits such medication administration error. Therefore, it is crucial part for nurses to always be aware of entire the medication administration process in shape to maintain the safety of the patient.1.4 enquiry OBJECTIVE1.4.1 General ObjectiveThe general objective for this study is to provide reasons well-nigh incidence of factors that contribute to medication error among the nurses. This study also helps to determine the barrier towards medication error which can utilize as guidelines for the nurses to be more caution on certain location during administering medication in the hope of facilitating improvements to medication administration processes.1.4.2 Specific ObjectiveThe specific objectives of conducting this research are1) To identify the most factors which contribute to medication error2) To indicate the relationship between working experience with all the contributing factors which poten tially lead to medication error1.5 RESEARCH QUESTIONSWhat are the commonest factors that contributed to medication error perceived by nurses?Is in that location any relationship between working experience with all the contributing factors which potentially lead to medication error?1.6 ADVANTAGES OF RESEARCH1. This study able to provide reasons about factors that contribute to medication error among the nurses.2. This study helps to determine the barrier towards medication error which can used as guidelines for the nurses to be more caution on certain situation during serving medicationLITERATURE REVIEWIntroductionNurses are the group of health care providers who are closest to the patients. They have a major responsibility in administration of medication for patients, particularly in the wards. The issue of medication administration error (MAE) within the acute-care setting has long been the focus of research. Since nurses are intimately involved in the delivery of medications and the final person who occupy the link on medication administration, thus they are accountable for the responsibilities in medication error. It is important for nurses to understand the factors that contributed to medication administration errors in view of the fact that the burden of reporting medication error falls heavily on nurses.Prevalence of medication errorMedical errors harm an estimated 1.5 million people and kill several thousand all(prenominal) year in the United States of America (Joint Comission International ,2007).In Malaysia the Malaysian government does emphasize on the medication safety whereby the government encourages researchers to conduct research on medication safety (Institute for Health Systems Research ,2008). In view of the fact that the prevalance of medication administration error is increasing globally, the serious action should be taken to minize it from fleet.MedicationThe oxford Concise Medical Dictionary stated that, medication is a substance that is administered by mouth, applied to the body, or introduced into the body for the purpose of treatment (p.417).Medication AdministrationIn administration of medication, the nurses must follow several principles that have been set up to prevent medication administration error. While administering medication, the nurses should implement the hexad Rights to make sure the effectiveness of the drug effect and gain improvement in treating the disease. The six rights are involved before, during and after giving the medication. According to bennet (2008), the six rights of medication administration implys the following right medication, right dose, right client, right route, right time and right documentation. It is a must for the nurses to follow the standard protocol outlined for the implementation of medication administration.Medication administration errorAn article from joint comission international (2007) stated that errors are common as medications are procured, prescribed, disp ensed, administered, and monitored but, they occur most frequently during the prescribing and administering actions. Since, the parts of administering process are bound to nurses job, so that they are responsible for their action and conduct. Mayo et al (2004) found that some medication errors are not reported because nurses are afraid of the reaction they will receive from the Nurse Manager. Hence, the real incident of medication error that occurred cannot be measurable since the nurses do not take responsibility to report the incident. Medication usage is a multidisciplinary process, which begins with the doctors prescription, is followed by the review and provision of medications by a pharmacist, and ends with the set and administration of the medication to the patient by a nurse. Inadvertent errors or accidents are encountered if there is a breakdown at any stage in this process, which leads to overwhelming consequences for the patient and for the career of the healthcare profe ssional (Gladstone 1995). The impact of medication errors can be devastating to the confidence and self-esteem of the healthcare professional. Consequently, healthcare professionals are unwilling and indisposed to report any medication error unless there is an obvious harm to the patient.Factors that contribute to medication errorNurses need to prioritize of import responsibilities for safe patient care. In this hectic and stressful environment, serious medication errors are appearing portentously as a basis for successful malpractice cases against nurses (Lilley et. al, 2005). correct medication process and system analysis approach are the essential link in the prevention of medication errors from occurring in health care setting. Asim and Nagy ( 2007) in their study showed that there were statistically substantial differences in responses across the participants years of experience and the current clinical working area about the medication error to occurred. Research done by Fu et al.(2007) showed that medical wards and intensive critical units are the commonest areas for medication error.Knowledge and practiceHenry (2005) revealed that, most of the types of medication administration errors occurring are due to omission of dose, wrong doses. The other study done by Fu et al. (2007) showed the wrong dose is at the highest to occur. Undeniable to say that, most of the errors can occur when the nursing duty during medication administration is not taken naughtily. In addition, medication error can occur due to nurse attitude who do not check whether the right patient received the right medication. Medication administration error can occur when the nurse failed to check the patients arm peal with the patients medication administration record or calling the patient by name to make sure the right patient receiving the medication. According to (Nancy et.al 2003 Ulanimo et al, 2007) through their observations that had been done, they found that nurses were fail ing to compare the patients wristband with the medication administration record before giving the medication to the respected patient.Whats more, spelling errors and the sympatheticities amongst the appearance different medication can cause confusing to the nurses. Unfamiliarity with drug medication such as new drug name with similar drug packing can cause medication administration error Fu et al (2007). The potential for medication errors will increase and leads to injury to the patient. Cases reported by FDA-Food and drug administration (2008) medication errors associated with Flomax and Volmax, ranitidine and Zyrtec caused patient to suffer. For that reasons, unfamiliarity with the medication can cause the medication error to occur.Besides drug administration, there are other factors that lead to medication errors fetching place such as interruptions while administering the medication. In the research done by Pape et al.( 2005) ,it mentioned that conversations with other staff members and visitors or multi-tasking that occurs during medication preparation and administration can result in errors. Thus, the normal procedures for checking the six rights are easily neglected. So that, reducing unnecessary conversation and other distractions is an important aspect in administering medication safely to patients.Personal issuesAbandon the six essential rights of administering the medication, are latent conditions evidenced to be a part of factors that contribute to medication error. Personal factors mentioned in connection with prescribing errors included physical and mental well being, skills, and knowledge. However, there are few associated factors that contributed to medication error to happen among nurses. The factors are time pressures, fatigue or exhaustion a part of nurses (Mayo et al Ulanimo et al, 2007). determine by Nick Barber et al (2002), 18 interviewees reported that they had felt tired, hungry, or unwell, and that these factors might have contrib uted to the error. A considerable percentage of reported that they omitted to give medication or gave at the wrong time, and also indicated that other nurses gave incorrect medication or wrong administered treatments practice issues which were related to the nursing shortage and causing moral distress (Marj.T Mrayyam,2011).Healy and McKay (2000) also found workload to be most significantly correlated with pique disturbance. However, Payne (2001) did not find a significant relationship between workload and burnout, although aims of burnout in her study were lower than in related studies. The reasons for this variation are unclear, but seem likely to include differences of stress hardiness (Simoni Paterson 1997), of coping mechanisms (Payne 2001), of age and experience (McNeese-Smith 2000) or of the level of social support in the workplace (Ceslowitz 1989, Morano 1993, Healy McKay 2000). hospital setting and workloadThe terms hectic, hassly, and busier than average were used to d escribe workload. Sometimes, workloads made nurses change their usual practice to try and save time From the study, it was shown that, it is not solitary(prenominal) the practice itself that contribute to medication administration error but other external factors can also contributed to medication errors such understaffing, inexperience nurses, design deficiencies, and deficient equipment while administering the medication( Carlton Bleggen, 2006). Nurses and workload is one of the major factors that should be considered .Most of the hospitals are lacking of nurses and this small issues will lead to big impact of nurses practice. Stordeur et al. (2001) attempted to rank stressors in order of severity of impact, the main ones being ranked as High workload, Conflict with other nurses/physicians, experiencing a lack of clarity about tasks/goals, a walk nurse who closely monitors the performance of staff in order to detect mistakes and to take corrective action.Lack of staffStaffing issues were also mentioned and included inadequate staffing, the make of new or locum staff, and attending to another doctors patient. Providing cover for absent colleagues not only increased workload but also meant that care was being given for patients the doctor did not know. Several doctors drew the distinction between those patients whom they had admitted and knew throughout their stay, and those whom they had to take over for only part of their treatment.The most commonly used unit-level workload measure is the nurse-patient ratio( Pronovost PJ et al (2000). The nurse-patient ratio can be used to compare units and their patient outcomes in relation to nursing staffing. Previous research provides strong evidence that high nursing workloads at the unit level have a negative impact on patient outcomes (Olson V et al, 2004). Hospital nurse staffing is a matter of major concern because of the effects it can have on patient safety and choice of care. Nursing-sensitive outcomes ar e one indicator of quality of care and may be defined as variable patient or family caregiver state, condition, or perception responsive to nursing intervention (Needleman et al, 2003)Briefly, medication administration error should be avoided because direct results of the error can cause harm to the patient as well as increased health care costs. Moreover, indirect results include harm to nurses in terms of professional and personal status, confidence, and practice. Thus, to maintain the professionalism in delivering of care to the patient, medication administration process should take seriously among the nurses. In a 1999 study conducted by the Institute of Medicine, entitled To Err Is Human Building a Safer Health System, It is estimated that medication errors cause over 7,000 deaths annually.This chapter will explain on the research methodology of the study consist of research design, population, warning, setting and info-collection instrument.2.1 Research designResearch design is an overall plan for conducting study on order to answer the research questions (Polit et al 2001 67). The research designs signify the steps which will be used in conducting the research. According to Burns and orchard (2001223) , research design is a guideline for the research process in order to achieve the intended result which will be the reflection of reality. Polit (1999155) state that the research design will includes the most important decisions in research methodology that researcher makes in conducting the study.This study used cross-sectional quantitative non-experimental correlational statistics study using assisted-administered questionnaire to reveal the question incident of contributing factors that lead to medication error.2.2 Population and samplingPopulation is an entire group of people that is concerned to the researcher as define by Brink (1996132-133).Burns and Grove (2001366,810) define population as the whole set of exclusives who meet the sampling crit eria. A sample taken from population and it will include in the study which representing research population, if random sampling procedures has been adhere to. Random sampling would give every individual in the whole population the same and unbiased chance of combat-ready in the study.Simple random sampling will be used in this study. The respondents are consisting of Registered Nurses in Hospital Tengku Ampuan Rahimah, Klang (HTAR) .The sample will be taken randomly from several discipline in HTAR.In order to get significant result, a sample size calculation formula has been used to determine the size of the sample for this study.Inclusion criteria for respondents areRegistered Nurse with Malaysia Nursing Board regard Malay and English language and generally healthy. gather in working experience at least 1 year.The participants are involves in direct patient care.Have an experience in administering the medicationExclusion criteria areaUnregistered nurses with Malaysia Nursing Boar dHave working experience less than 1 yearDo not have an experience in administering medication2.3 Research settingThe study setting will be conducted in HTAR. The unit chosen is medical ward, surgical ward, Intensive Care Unit, Obstetrics and gynecology ward, Pediatrics ward, Emergency Department and orthopedic ward. HTAR is chosen because affordable cost and time constrain for me.2.4 Study period info collectionFebruary to April 2011Data Processing/ analysing and writing upApril to May 2011Grantt Chart (refer to appendix )First phaseScreening for initial data from hospital record (secondary Data) in Hospital Tengku Ampuan RahimahIdentify the discipline units to be studySecond phasePilot study done to confirm feasibleness of the studyCollection and analyzed the questionnaireThird phaseObtain consent from subjectThe data are collected by using questionnaire in order to obtain the breeding regarding the studyFourth phaseAnalyze the data collection and writing up2.5 Data collectionDem psey and Dempsey (2000195) define questionnaires is a paper and pencil data collection instrument filled in by the respondents for the purpose of the research study. Characteristics of questionnaires had been listed out by Gillham (2000 5-8) as belowA questionnaire is less expensive than interview. A lot of sample can be taken within short period of time. Questionnaires can reduce cost of using call up and travels thus it is also feasible to be used by researchers who have full time jobs.Questionnaires are an easy way to get more information within a limited period of time.Respondents able to complete the questionnaires at their own time without pressure.Anonymity can be guaranteed. Reassuring the respondents that no one will know any feedback from them. This aspect was deemed to be very important in this study as the respondents could be reassured that they could state their honest opinions about factors might contribute to medication error without fear that employer would take ac tion to them if their knowledge level is low. The research contents will display out numbers, facts and figures .No name calling should be mentioned not even the researcher nor did the supervisor know who provided which answers for specific questions.No different questionnaires are distributed all questionnaires are standardizedto limit the bias.2.5.1 festering of questionnairesThe development of questionnaires was based on the literature review (Chapter 2) and other research instrument used in similar studies. The questionnaire is compiled and discussed by researcher and supervisor. Changes suggested were implemented. Most of the ever-changing pertaining to rephrasing specific items so that each items had only issues to address rather than multiple issues. There is part of questionnaires that had been corrected and combined from previous study to vouch the objective of study answer.2.5.2 Pilot StudyPilot study was done to determine feasibility of the instrument .This shows a tria l administration of newly substantial questionnaires in order to identify the potential -problem encountered by participant. Brink and Wood (1998259 373) explained that pre-testing enabled the researcher to interact with the participant similar but they were exclude from the real respondents participating in actual study. These ensure the researcher to predict what would happen to the main study regards to participation.Pilot study was conducted with five staff nurses with year of experience more than 1 at the same hospital but different target unit which they will not selected to participate in the actual study. No probable problems were encountered during the completion of the questionnaires.2.5.3 Structure of the questionnairesThe questionnaire is conducted in Malay/English language and is assisted-administered questionnaire. The questionnaires will be distributed to the nurses in the unit by the researcher. The researcher needs to explain about the objectives, target populatio n and significance of the study. Some of the respondents will answer the questions by themselves and some of them need assistance while answering the questionnaires. The data obtained will be statistically analyzed using SPSS software. An effective strategy for nurses will be formulated based on the findings. The questionnaire is distributed to the whole chosen unit consist of 30 registered nurses in HTAR.The questions based on a structured questionnaire that composed of three parts.(refer to the appendix) incite 1 that consists of demographic data year of working experiencePart 2 Question consists of six incident of contributing factors which potentially lead to medication error.Factor 1 This section using closed -ended question (dichotomous question) direct towards the knowledge regarding the process for medication administration. This questionnaire change from study that had done by Raja Lexshimi R.G et al (2009).Factor 2-6 This section is questions regarding factors contribut ion to medication error edited from the result of study done by Fu et. al (2007) which categorized into five categories which using Likert scale. The respondents are asked to indicate how much the declarative statements given from each menage will influence to contribute to medication error.Personal neglect sonorous workloadUnfamiliarity with medicationNew staffComplicated order2.6 Data AnalysisTo identify the level of knowledge among nurses towards serving medication .It is also to identify the most incident of contributing factors which lead to medication error. A significant value of 0.05 was used to test for significance for all statistical tests. The chi square analysis was performed to determine the association between incident of contributing factors and the years of experience. The data collected will be analyzed using Statistical Package for Social Science (SPSS) version 18. 0.2.7 Research shiftingDependent VariableIn this study, the dependent variable is years of experie nceIndependent VariableIn this study, the independent variables are the 6 incident of contributing factors Knowledge, Personal send packing, Heavy Workload, Unfamiliar Medication,Newly staff and Complicated order.2.8 Validity and VariableAccording to Polit and Hungler (1999418), validity is the degree to which an instrument measures what it is designed to measure. The content of the questionnaire is adapted from the previous check up on and study that had been done. Moreover the questionnaire used will be reviewed by a philosophy doctors (PhD).2.9 Ethical considerationPermission from HTAR will be obtained from hospital post to conduct this research. Each participants who involve in this study will be given inform consent. Furthermore, before distributing the questionnaire, each participant will be explained about the purpose of the study and consent form was given to the participants. They are free to agree or decline their participation in the study at any time. All information obtained from the participants will be kept confidential. The participants took 15 to 30 minutes to answer the questionnaire and the researcher collected it back after finished answering. Polit and Hungler (1999 131-134) revealed that researcher therefore need to exercise care that the rights of individuals and institution are safeguarded.Administer medication is an everyday activity in nursing practice and nurses should have bounteous knowledge in order to perform this important job. The finding of these study shows that nurses knowledge in serving medication is sufficient. Most of the f=29 (96.7%) registered nurses able to answer the questionnaire correctly automatically make knowledge as low incident that will contribute to medication error. Reflected from the result, King (2004) and Coombs et al have similar result which reported the same. Nurses have the knowledge but the knowledge is limited especially on drugs administration. 43.3% did not know the frequent recommended site for heparin injections is at the abdomen (Caffrey, 2003).Nurses should improved their knowledge and highlight on different route of administer medication. Gerry Helen (2003) reported that time-span of experience and level of professional education was linked with level of knowledge in the administration of medications. Having extra educational qualifications among nurses were found to have contributed to a improved knowledge of medications.However in this study, 26.7% nurses practice wrongly which they did not check the patients ID band prior administering medication. It is also surprise 23.3% nurses violate the practice by administering medication prepared by other nurses. Benners and others (2002) agree source of errors include delivering too much medication, missed doses wrong route and wrong medication deliver due to misidentification of client.Mattan (1998) revealed that administering medicine effectively was a aspect of practice but it lacked quality, which is due to poor kno wledge in pharmacology and practice. Manias et al. (2004) indicated that nurses infatuated the necessary knowledge and skills in medication administration such as monitoring effects of medication, assessing and evaluating patients condition prior to medication administration. In many cases drug errors arise as a result of nurses failure to follow policy (Keill and Johnson, 1993).2) Personal NeglectFrom the data analyse, 18 (60%) nurses show personal neglect is in the low incident contribute to medication error. Nevertheless 4(13.3%) nurses indicate in the middle of administering drug, there was interruptions by others. A new study shows that interrupting nurses while theyre nursing to patients medication needs increases the likelihood of error. As the number of distractions increases, so do the number of errors and the try to patient safety. According to the study reported in the April 26, 2010 issues of theArchives of Internal Medicine, four interruptions in the route of a single drug administration threefold the likelihood that the patient would experience a major mishap. 26.7% nurses indicate that personal neglect as a medium indicator of medication error.3)