A national, standard medication chart ensures that health professionals are familiar Medication management in health service organisations should also accord with . The date that the medicine order was written should be entered. .. NIMC Online Training Module (designed for all health professionals using the NIMC). Nurses are most involved at the medication administration phase, although they provide a vital among health care providers, drug information that is not accessible or up to date, Using the internet to deliver education on drug safety. But it can be difficult to keep taking medication over a long period of time, especially if you need several Cover of Informed Health Online.
Of the 3, doses observed, 19 percent contained at least one error. Nearly half of those errors were wrong-time errors. Other common types of errors included omission, wrong dose, and unauthorized unordered drug. In a much smaller study conducted in the Netherlands, Colen, Neef, and Schuring 88 found an MAE rate of 27 percent, with most of these wrong-time errors. The rate of MAEs without wrong time was approximately 7 percent, and most of those were omissions.
Information from these research studies forms a consistent picture of the most common types of MAEs. These are wrong time, omissions, and wrong dose including extra dose. Rates of error derived from direct observation studies ranged narrowly between 20 and 27 percent including wrong-time errors, and between 6 and 18 percent excluding wrong-time errors.
The alarming exception to this was the nearly 50 percent error rate in observation of intravenous medication in ICUs in Europe. Impact of Working Conditions on Medication Errors Medication safety for patients is dependent upon systems, process, and human factors, which can vary significantly across health care settings. A review of the literature found 34 studies that investigated some aspect of working conditions in relation to medication safety. Systems factors Systems factors that can influence medication administration include staffing levels and RN skill mix proportion of care given by RNsshift length, patient acuity, and organizational climate.
There were 13 articles presenting research findings and three literature reviews. Nurse staffing Medication administration is a key responsibility of nurses in many settings, and three studies assessed the relationship between nurse staffing, hours of nursing care in hospitals, RN skill mix, and medication errors. Two studies associated the total hours of care and the RN skill mix at a patient care unit to reported medication error rates in those units; one study used 42 units in a large Midwestern hospital 95 and the other used 39 units in 11 small hospitals.
In both studies the type of unit was controlled and the rate of reported medication errors declined as the RN skill mix increased up to an 87 percent mix. A third study of nurses in ICUs in 10 hospitals found an inverse relationship between rates of medication errors and staffing work hours per patient day in specific settings e. A little over 30 percent of the variance in medication error rates resulted from the variance in staffing work hours per patient day.
Three literature reviews, 303998 concluded that the direct evidence for a relationship between staffing and MAE rates was inconsistent. Workloads These findings are consistent with three studies and two literature reviews on the impact of heavy workloads, a component of nurse staffing, on errors. In one survey of nurses in 11 hospitals, both pediatric and adult nurses reported staffing ratios and the number of medications being administered as being the major reasons why medication errors occur.
Most of these errors involved nurses 64—76 percent and medication administration 59—68 percent. In all three sets of error reports, workload increases and insufficient staffing were noted to be causes of errors. The effect of heavy workloads and inadequate numbers of nurses can also be manifested as long workdays, providing patient care beyond the point of effective performance. In a national survey by Rogers and colleagues, 99 self-reported errors by nurses found that the likelihood of a medication error increased by three times once the nurse worked more than Among nurses working more than Other findings support the importance of adequate nurse staffing and understanding the impact of shift work in decreasing medication errors.
However, there were more errors with nurses working rotating shifts.
While it was not possible to determine the effect of organizational climate on violations, distress was positively associated with violations, while quality of working life, morale, and organizational climate had a negative association. The organizational climate was found to be linked with safety behavior. Higher overall safety climate was related to lower rates of medication errors and urinary tract infections.
Policies, procedures, and protocols Lack of appropriate policies, procedures, and protocols can impact medication safety, as seen in a few small studies. In a study of malpractice cases, medication errors were associated with lack of administration protocols and ineffective nurse supervision in delegating administration.
For example, a review of two studies in the literature found that medication errors did not necessarily decrease with two nurses administering medications e. Double-checking policies are commonly used as a strategy to ensure medication safety. When errors occurred under such policies, failure to double-check doses by both pediatric and adult nurses 58 and nurses in a Veterans Affairs VA hospital were reported.
However, research presented in two literature reviews offers somewhat conflicting information. In the first review of three studies, following double-checking policies did not necessarily prevent errors. Distractions and interruptions Factors such as distractions and interruptions, during the process of delivering care can have a significant impact on medication safety.
Nine studies, four with nationwide samples, and two literature reviews present information on the association between MAEs and distractions and interruptions. One survey of nurses in three hospitals in Taiwan found that they perceived distractions and interruptions as causes of errors. These finding are furthered by research concerning self-reported errors from a nationwide sample of nurses.
From a sample of 12 nurses in one hospital, one-third of progress notes were found to contain information about administered medications, yet only 30 percent of those progress notes included medication name, dose, and time of administration, and only 10 percent documented information about desired or adverse effects of medications.
Medication education, outcomes of administered medication, and assessment prior to administering were not documented in any progress note. Only half of withheld medications were documented. Communication Five studies and one literature review assessed the relationship between communication failures and medication errors.
A small observational study of 12 nurses found that they communicated with other nurses about information resources on medications, how to troubleshoot equipment problems, clarification in medication orders, changes in medication regimens, and patient assessment parameters when handing over patients.
Nurses also communicated with pharmacists about information on medication administration and organizing medications for patient discharge. Another direct observational study of medication administration found opportunities for errors associated with incomplete or illegible prescriptions. When patients were transferred from across units, 85 percent of nurses reported that medication orders were rewritten at transfer, 92 percent that medication orders were checked against electronic medical records, 62 percent that it was time consuming to clarify medication orders, 66 percent that the reasons for medication changes were made at transfer, and 20 percent that blanket orders are often written as transfer orders.
The suggested explanation was that the mediations RN must administer in long-term care are those with more complexity. Another survey of RNs in 11 hospitals found that pediatric and adult nurses reported numbers of medications being administered as a major reason on why medication errors occur.
In two ICU studies, infusion pump problems were involved in 6. Monitoring and assessing An essential component of the medication process related to the administration of medications is monitoring and assessing the patient by the nurse. Only two studies provided information in this area, offering scant evidence.
In the first, based on a small sample of nurses in one unit in one hospital, a qualitative analysis of observed medication administration found that participants monitored patients before, during, and after medication administration.
They also felt responsible for timing medication administration and providing as-needed e. In the second study, where ICU nurses were surveyed, no administration errors were found to be associated with inadequate monitoring or lack of patient information. These factors include characteristics of individual providers e.
Four major themes emerged in the review: Effects of fatigue and sleep loss Five studies assessed the association between fatigue and sleep loss with MAE errors. The first specifically investigated the effects of fatigue and sleep loss on errors using a national sample of nurses over a 2-week period. In this study, the rate of errors increased after working In one of these, a survey of 57 nurses, respondents reported that the majority of medication errors were attributable to fatigue.
A semistructured, qualitative interview of 40 hospital nurses prior to implementation of a bar-coding system explored the thinking processes of nurses associated with medication administration. The other study of nurses, using direct observation in a medical and surgical unit in Australia, found that participants used hypotheticodeductive reasoning to manage patient problems. Thought process can also be distorted by distractions and interruptions.
One study employed direct observation of medication administration to determine the effects of human factors on MAEs. During both the prescribing and administration of medications, the causes of errors were attributable to slips and memory lapses Another study using direct observation found causes associated with MAEs to include slips and memory lapses 40 percentrule violations 26 percentinfusion pump problems 12 percentand lack of drug knowledge 10 percent. In one study of 40 student nurses and 6 nurses using a computerized program to assess the impact of dyslexia found that the greater the tendency towards dyslexia, the poorer the potential cognitive ability to effectively provide the skills associated with effective drug administration.
Of these reported contributing factors, 78 percent were due to the inexperience of staff. Twenty-six studies and descriptions of quality improvement projects were identified. Strategies used included recommendations from a nationwide voluntary organization to improve safety, education of nurses and other providers in safe practices, and system change and technology.
Eight types of strategies were successfully used, including documentation of allergies, nonpunitive reporting, and standardizing medication administration times. Effective leadership and appropriateness of intervention were associated with successful change implementation.
The converse was associated with failure, as were unclear aims, poorly designed interventions, lack of focus on underlying system failures, unclear measures, too much focus on data collection, involvement from only some stakeholders, opposition from physicians and nurses, and conflicting time demands for team members.
The findings were limited by the lack of an analysis of the relationship between established safety policies and practices and the success of implementing new strategies, as well as the relationship between the implementation and the occurrence of ADEs.
Of the recommended practices, there was high adoption of standardized labeling and storage of medications For-profit hospitals were more likely than not-for-profit hospitals to have unit-dose medication distribution systems There were greater distractions affecting medication administration in large hospitals. Hospitals with — beds were more likely to report using pharmacists to review and approve nonemergency orders prior to dispensing; and, One randomized controlled study used an interactive CD-ROM education program to improve the use of safe medication practices and decrease the rate of MAEs.
There were too few actual medication errors to analyze pre-post differences. Another approach used an 11 module Web-based educational strategy to improve drug safety with a small sample of nurses. After using these modules, rates of nonintravenous MAEs decreased from 6. Rates of errors in intravenous drug administration did not decline as expected. Dennison reported the results of a medication safety training program for nurses. Knowledge scores improved in this pre-post test study, but there was no significant change in safety climate scores, labeling of intravenous infusion setups, or the number of self-reported errors.
Attempts to improve basic and continuing education in medication safety have been reported, but they have not assessed the impact on actual error rates. In a small pilot study, a problem-based learning approach was found to enable students to use findings from topic-specific research to develop and apply solutions for clinical problems.
Papastrat and Wallace proposed using problem-based learning and a systems approach to teach students how to prevent medication errors and suggested content, but their approach was not compared to other teaching methods. Simulations could be used to prepare nurses to recognize and manage medication errors when and if they occur. System change Several attempts to change the system have been tested. Some of the strategies addressed the thoroughness of error reporting, some the processes and events surrounding medication administration, and some focused directly on reducing errors.
Using a hospitalwide performance improvement project that emphasized system factors, not individual blame, error reporting increased from a rate of These included removing 90 to 95 percent of potassium chloride ampoules from the bedside; developing preprinted labels for five common drug infusions; removing four-channel infusion pumps the unit and replacing them with double-channel infusion pumps with a simple interface design; standardizing administration of drugs given by bolus dose using a syringe pump; decreasing missed doses of immunosupression drugs for transplant patients from 25 percent to 9 percent by incorporating them into the main drug chart; implementing standardized prefilter and heparin-lock central venous catheters and heparin infusions into ICU protocol; redesigning drug infusion administration practices throughout the hospital; eliminating burettes for IV drug infusion; preparing standardized drug infusions for 36 drugs; and providing Intranet-based up-to-date drug information.
A time study and focus groups were used to compare nurse efficiency during medication administration using either medication carts with unit doses or a locked wall-mounted cupboard in each patient room. Time saved by not having to search for missing medications saved 0.
The Five Rights of Medication Administration
Pharmacists spent an additional 0. Nurses reported more contact time with patients when using room cupboards and fewer interruptions by colleagues during medication preparation and administration.
Two small experimental studies attempted to reduce distractions that frequently interrupt nurses during medication administration and thereby introduce the potential for error. The signage in the first study was a vest that the nurse administering medication wore; in the second it was a sign above the preparation area.
Direct observation of the number and types of distractions provided the outcome measures in the first study; a questionnaire completed by each nurse administering medications provided the measure of distractions for the second.
In both studies, the number of distractions was significantly reduced. Medication error rates were not captured. One randomized controlled trial compared the use of a dedicated nurse for medication administration to nurses providing comprehensive care, including administering medications, to their patients in two hospitals.
The investigators found the error rates to be The rate of MAEs was not significantly different between control and experimental groups. Involving patients in the administration of medications while in the hospital is another system strategy that has been assessed.
With this intervention, hospitalized patients have the responsibility for administering their own medication under the supervision of nursing staff.
A literature review reported on 12 studies that described and evaluated a patient self-administration program. Given the body of the reviewed literature, it appeared as though patients and families make as many or more MAEs than do health care providers.
System change with technology Another rapid-cycle implementation project over 6 months used continuous quality improvement data before and after implementing a modular, computerized, integrated infusion system.
Nurses responded to 12 percent of the infusion error warnings by altering the setting and averting errors. The nature of the 88 percent of warnings not responded to was not discussed. Risk scores associated with heparin infusion rates decreased almost fourfold. Almost all nurses used the new software correctly.
Two studies focused on documentation of medication administration. One study introduced a charting system with decision support and used a quasi-experimental design to determine the effects. Staff in the study unit received an educational intervention about error avoidance through real-time bedside charting, followed by 12 weeks of monitoring and performance feedback.
After the 12 weeks, medication charting rates increased from 59 percent to 72 percent in the intervention group. Reported medication errors and documentation of medication administration were reviewed, medication administration policies were developed, and focus changed to the potential causes of errors.
Documentation errors decreased over the 3 years of the study, and reported error rates increased by 0. Bar-coded medication administration BCMA is promoted as the most effective way to reduce administration errors and is being implemented widely.
Conceptually this technology should catch nearly all errors, but rigorous evaluation of the impact of technology on error rates has lagged behind implementation. Many studies reporting analysis of the impact of BCMA have used data collected by the system only after implementation. Three other studies of the impact of BCMA on administration errors reported very large reductions: Direct observation of medication administration, a resource- and time-intensive approach to data collection, is the only way to gather unbiased data to evaluate the impact of BCMA on medication administration errors.
Three studies have used direct observation; however, each evaluated the implementation of a different set of technology.
Medication Administration Safety - Patient Safety and Quality - NCBI Bookshelf
Franklin and colleagues reported a decline in MAE rates from 8. The system included BCMA, computerized order entry, automated dispensing, and electronic medication administration record. Prescription errors also declined from 3. But it may make sense to risk some side effects, if the benefits outweigh the harm, especially if the medication can keep a more serious condition from progressing.
Acute health problems often improve on their own, and diseases can go away without treatment. But doing nothing may also result in a health problem developing into a serious condition. It makes sense to talk with your doctor about any fears and worries and ask them for more information so you can decide together.
How to keep track of your medication? But even just one drug can be a hassle: Special containers that show at a glance which tablets have to be taken when are available from pharmacies. These drug dispensers have small compartments for each day to organize your medication for an entire week at once - for example by putting one tablet of drug A into the compartments for morning, noon and evening, and two tablets of drug B into the compartments for evening.
Ideally you should also write down which medications you need to take when and at what dosage. You can use a form or a simple notebook to list all of the medications. Those products can also interact with medication. You can put together your medication list on your own or get some help from someone else. Since Octoberpeople with statutory health insurance in Germany are under certain conditions entitled to have their doctor put together a concise medication plan for them.
These conditions are met if the following apply: You need three or more prescription drugs. The drugs are systemic, meaning they work throughout the body. The drugs are prescribed to be taken for at least four weeks. The medication schedule includes both the prescribed medications and all other medicine.
It is has a standard design and includes personal details such as your name and birthday, as well as the following information: Name of the medicine: Active ingredient and trade name Dosage and dosage form, for example: Keep refrigerated Reason for using the drug, for example: High blood pressure, pain, or iron deficiency What can you do to remember to take the medication?
It may help to combine your medication with daily routines. Putting a reminder note or the package of medicine next to your toothbrush could help you remember to take your medicine if you always have to take it at the same time you brush your teeth. Putting notes on the refrigerator door or somewhere else that you frequently pass by is another good way of reminding yourself.
If you organize your day using a calendar on your phone, you can set it to remind you with a notification, a ring tone or vibration.