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Nursing

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Contents

Introduction................................................................................................................................2

Healthcare problem....................................................................................................................2

Possible causes of problem or issue...........................................................................................3

Recommendations......................................................................................................................4

Pros.........................................................................................................................................5

Con.........................................................................................................................................5

Conclusion..................................................................................................................................5

References..................................................................................................................................6
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Introduction
The national health system was started in the year 1948. It was launched from the dire

need for ideal healthcare service to be made available to all persons, regardless of

socioeconomic status. Except for some expenses incurred on prescriptions, dental, and optical

services, the United Kingdom health system remains open to the UK public for free. This

trend currently stands at more than 64.6 million people in the UK and 54.3 million people in

England alone. One of the significant issues which are being faced by various NHS in the UK

is the quality of the services provided. 

“Quality itself has been described as “the degree to which health services for people

and communities enhance the probability of desired health outcomes and are compatible with

current professional knowledge.” (Macias et al., 2017). Furthermore, it’s not unusual for

nurses to have patients confide in them and seek their counsel. They trust the nurse to keep

them safe. This is a big duty, and when things do not go as planned, or there are errors made,

the consequences on the patient and their family are that much harsher. Safely delivering

medicines is a basic skill acquired by a nurse. Although this understanding errors with the

administration of medicines occur globally and have lasting consequences on individuals

affected.

Healthcare problem
This is an issue that affects every medical practitioner who gives medicine to a

patient. Errors in the administration of medication may and can have serious consequences

for patients. These errors may range in severity from little to no effect to lifelong damage and

death. Thousands of individuals are impacted by pharmaceutical errors each year. There has

been considerable work to find methods of avoiding errors with drug delivery. In fact, this is

a subject of such extensive research that one might study it ad nauseam and yet not have a

clear notion as to the underlying cause or remedy.

Certainly, human errors, poorly worded instructions, inattentiveness and lack of

comprehension play a part in this issue. “Personal negligence, a high workload, and new

personnel were the three most frequent categories. The patient's medical history and

medications are also unknown, as are the prescriptions and instructions, which are often

complex, as well as the lack of adequate training. Other issues must be solved when

medicines are administered, advanced drug manufacturing without recheck, and newly

trained personnel."

Possible causes of problem or issue

have just one task at a time to focus on. It is crucial to be painstaking careful when

administering medications. It is imperative for a nurse to have completely understood what is

considered a medication administration error. A nurse should be able to identify an error and

then feel comfortable about reporting the error appropriately and without the fear of a

retaliatory response from their employer. This is not a subject that should be hushed and not

discussed. On the contrary, nurses should be proactive to institute ideas to reduce or eliminate

these occurrences. Nurses furthermore need to develop a clear way to identify an error. “As

of now, there is no official agreement on what constitutes a drug administration error.”

(Shawahna et al., 2016).

Medication errors are harmful and need to be avoided. As a nurse, one should

examine anything that could be a potential barrier to reporting an error. “Both failure to

disclose a error and failure to record a near-miss have the same themes: knowledge, fear, job

load, and justifying the error.” (Haw et al., 2014). If the nurse is scared into not reporting a

error, this problem will not be able to be addressed. Medical personal clearly understands that

unless one is able to honestly report errors, patient safety is compromised. Lack of

understanding, education and unclear packaging may play a role in this issue.
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The population of the patient that this safety issue affects includes anyone that is

prescribed or administered a medication. This includes neonates, paediatric, adolescent, adult,

and geriatric patients. The problem includes clinics, hospitals, and other inpatient units.

Errors with medication administration are a safety problem for pharmacists, nurses, mid-level

providers, and physicians. As noted above, medication errors are a global concern.

Recommendations
In order to develop options for a solution to this problem, one must first identify why

these errors occur. It would be very important to include the medical staff in this process and

gain their insight and rule out any biases. Using the Socratic Problem-Solving Approach, one

could thoroughly develop a plan of action. I appreciate that this method helps one to break

down a problem into smaller pieces in order to be evaluated for risk versus benefit. Once a

plan is in place, one could implement it with a clearly defined purpose (Petrozzello, 2017).

It would seem unreasonable to try to make a one-size-fits-all model for safe

medication administrations because of the variances in different healthcare settings. A strong

start would be, “The "7 rights" of medication administration are taught to nurses to guarantee

safe medication preparation and delivery.” (Smeulers et al., 2015). Additionally, the right

reason and documentation further protect the patients. If at all possible, having a double-

check system, though time-consuming, could further reduce the incidence of errors. Efforts

have been made by many safety organizations to reduce the frequency of these events.

“This agency recommends that a QI implementation team be composed of hospital

leadership, clinical specialists in the intervention being implemented, QI-trained people, and

important staff from impacted regions.” (Macias et al., 2017). This team would be able to

assist the staff with the transition to a new protocol. Due to the high volume of research on

this subject matter, it would be important to perform careful research prior to deciding which
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methods will be used. This will avoid repeating errors and give one the opportunity to choose

methods that have proven to be effective.

Pros
1. The improvement in quality will increase the healthcare service quality.

Con
1. It will take significant time and incur a greater cost.

2. Some of the staff of the hospital will be reluctant to undergo the changes.

Conclusion
In conclusion, medication errors are a serious problem within the healthcare system.

Nurses, being at the forefront of this issue, need to collaborate with their peers to seek out

solutions. Using tools such as the Socratic Problem-Solving Approach, one is able to

carefully perform research to come up with a workable solution to avoid this issue and

protect the many patients who are negatively affected. From performing research, it is

apparent that there is no perfect solution to this issue. Going back to the basics and including

the seven rights provides a virtual safety net. Nurses must follow their instinct and have a

second nurse double-check anything that does not seem right prior to the administration of

medication. Appropriate training of employees and policies to prevent adverse events will

further provide patients with the safest care possible.

Every medical professional who administers medication to a patient is affected by this

problem. For patients, drug delivery errors may and will have severe repercussions. Some of

these errors may have little or no impact at all, while others may result in permanent harm or

death. Each year, pharmaceutical errors have an effect on thousands of people. Finding ways

to prevent medication distribution errors has taken a lot of time and effort. Although this is a

topic that has been the subject of considerable investigation, there is still no clear

understanding of its underlying origin or cure. Human error, poorly written instructions,

inattention, and a lack of understanding all play a role in this problem, no doubt. Most
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complaints were due to a combination of personal carelessness, a heavy workload, and new

staffing. Medical history and medicines are often unknown, as are prescriptions and

instructions, which are sometimes complicated.

Medicine administration, sophisticated medication production without rechecks, and

freshly educated staff are all problems that must be resolved. Errors in medication are

dangerous and should be avoided at all costs. One's job as a nurse is to identify any obstacles

to reporting a error. There are common features in both failures to report a error and failing to

record a near-miss. We cannot solve this issue if the nurse is frightened into not reporting an

error. It is well understood by medical personnel that patient safety is endangered if errors are

not reported honestly. Education, lack of knowledge, and confusing packaging may all be

contributing factors.
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References
Haw C, Stubbs J & Dickens G (2014) Barriers to the reporting of medication

administration errors and near misses: an interview study of nurses at a

psychiatric hospital. Journal of Psychiatric and Mental Health Nursing 21, 797–

805. Retrieved from https://doi.org/10.1111/jpm.12143

Macias, C. G., Loveless, J. N., Jackson, A. N., & Srinivasan, S. (2017). Delivering value

through evidence-based practice. Clinical Pediatric Emergency Medicine, 18(2),

89-97. doi:http://dx.doi.org.library.capella.edu/10.1016/j.cpem.2017.05.002

Nute, C. (2014). Reducing medication errors. Nursing Standard (Royal College of

Nursing (Great Britain) : 1987), 29(12), 45-51. doi:10.7748/ns.29.12.45.e9191

Shawahna, R. , Masri, D. , Al‐Gharabeh, R. , Deek, R. , Al‐Thayba, L. and Halaweh, M.

(2016), Medication administration errors from a nursing viewpoint: a formal

consensus of definition and scenarios using a Delphi technique. J Clin Nurs, 25: 412-

423. doi:10.1111/jocn.13062

Smeulers M, Verweij L, Maaskant JM, et al. Quality Indicators for Safe Medication

Preparation and Administration: A Systematic Review. Pappalardo F, ed. PLoS

ONE. 2015;10(4):e0122695. doi:10.1371/journal.pone.0122695.