Safety Quality Pertaining to Medication Administration in a Health Care Setting
Elements of a successful quality improvement initiative
Quality improvement is replicated in good quality practices and performance. Population health is made through decreasing cost, increasing experience, using efficient and effective equipment to attain safety. There has been a blast in the initiatives aimed at improving health care provision. Having considered successful quality improvement programs, common elements emerge (qpm_tech_admin, 2019). The features stem from a thorough comprehension of the problem setting of attainable and realistic goals while ensuring the aims are clear for the distinction of the progress. Identification of the problem forms a start and target for an initiative. There is a need to address concerns of patients, like medication errors. The goals target betterment of cost and Investment. The element of aims is a breakdown approach for the goal. Measures that require one to fathom baseline and the actual clear. Analytics to validate the steps through smooth data sharing. Therefore, in quality improvement initiatives, there is a need to consider how effectiveness will be measured.
The complex healthcare system is faced with considerable challenges in creating and maintaining a safe environment. It is considered problematic because of the difference in providers’ education and experience, insurance, patient mix-up, and unpredictability. Nurses are forming the most considerable portion of healthcare promotion; no professionals do so through effective interventions to improve quality and planning safety. People are harmed or die due to medical errors. As described by IOM, patient safety is being free from accidental injury during the reception of care. Some dispensation mechanisms to improve the administration of include wall-mounted cupboards inside patient rooms to lessen disruptions in the preparation and issuance of medications. In administering IV medicine, safety can be ensured through computerized integration of the infusion system (Muroi, Shen, & Angosta, 2017). The inclusion of allergy status in the administration of medicines is essential is it helps alleviate errors. Thus drug safety education increases the safety of patients.
Factors that lead to Patient safety risks
Several factors pose a risk to the safety of patients during the administration of medication. Medications with similar packaging or similar names referred to as sound-alike and look-alike medicines pose the challenge of medication errors arising from verbal prescriptions (Sessions, Nemeth, Catchpole, & Kelechi, 2019). Medications that are not prescribed commonly pose the challenge of knowledge gaps. Common drugs to which patients are allergic, like opiates, need monitoring. Other medicines require routine monitoring to establish and maintain non-toxic therapeutic levels like lithium. However, some side effects and adverse reactions go undetected.
Latent conditions pose a challenge to the standard protocol—decisions made by managers affecting organizational turnover influence the outcome of the medication. The environment is also vital in terms of error-producing conditions. Interruptions and distractions in the medication process pose a significant risk. This could be in the clouding of patient transfer and confirmation of details. Patients, more often than not, share names. There is a need to avoid moving medication different from the laid-out method. Nurses need to be mindful of distractions caused by phones. Active failure can also be taken as a cause for medication errors, such as a lapse in memory or attention. Limited physician time could result in poorly coordinated care. System factors operate in a way that makes it hard for one to concentrate on one patient’s requirements.
Nurses are the largest workforce in the health care sector. Being the center of the system, they apply their know-how and experience for the diversified patient needs. On average, nurses spend most of their time administering medications. They are the last in the chain of drugs, offering the final layer of defense against error. With an important role and place in the healthcare system, nurses have to ever be on the Lookout (Tso, n.d.). Due completion of each step in the practice of medication administration is paramount. It is essential to ensure that allergy check is completed diligently by confirming the patient from the medical record.
Home care offers support to the critically ill via nursing home homes. Nurses play a central role in nursing home (Toivo, Airaksinen, Dimitrow, Savela, Pelkonen, Kiuru, Suominen, Uunimäki, Kivelä, Leikola, & Puustinen, 2019). Physician’s hardly allocated enough time for patients in nursing homes. Patients should be educated on ways of self-management. Nurses help in the reduction of cost by advocating against unnecessary medications.
Patient safety is a shared role. Nurses, Nurse-educators, patients, administration, government, accrediting agencies all take part in this role. Society takes an active part in patient safety by offering improved communication. Patients are no longer passive in the reception of their care. There is a need to know their rights, have Knowledge of available medication options, and everything related to them to make informed decisions. Nurse educators need to be competent to develop a structure that applies critical thinking. The administration of health centers needs to develop safety procedures. Physicians need to monitor the medications provided. Legislative set rules act and regulations on the use of medicines. The nursing Association creates awareness of changes, supports medication systems proven safe, and collects data on such improvements. Accrediting agencies promote adequate communication to ensure the use of high alert medication procedures that are safe.
A resident, 80 years old, returns to a nursing home from the hospital after a right hip fracture. ORIF had been done. Before the fall, Angie resided at home for one week before sustaining a right hip fracture. Her known history of congestive cardiac failure had frequent exacerbations. Vital signs on being admitted were a heart rate of 84, respiratory rate of 19, and blood pressure of 135/78. The hospital transfer form had an order for Lasix and other new medications. Lasix had had also been part of Angie’s medication list at the nursing home before transferred to the hospital. The new medical administration record included rewritten previous orders and new orders. However, the old MAR had not been removed from her file. Nurse one took a look at the new notes and interpreted the New Order on Lasix as transcription duplication and thereby yellowed it out. The process of checking the new order was interrupted by a phone call and was not completed.
Nurse 2, upon completion of the check on the orders, noticed the presence of the old MAR, which she consequently removed. Communication of completion of the task was promptly made to Nurse 1. Nurse 1 then gave medications, noted Lasix has been yellowed out, and interpreted it appropriately for discontinuation. The nurse gave medication for three consecutive days, and the Lasix removed from the medication cart and sent back to the pharmacy. Three days later, Angie had a 4 lb. increase in her weight. This was noted on her chat and necessitated a call for her physician. No New Order was given. On the fourth day, Angie developed difficulty in breathing, pitting edema. a BP of 185/110, HR of 119, and RR of 29. Assessment of lungs revealed moisture and crackles throughout the lung. The physician on call arrived and asked for her to be transferred to the hospital. Angie went into cardiac arrest waiting for the ambulance and unfortunately could not be resuscitated. Angie’s demise could have been stopped.
The healthcare sector works towards creating a safe environment for patients. Despite being complex and marred with many risk factors, quality improvement measures are being applied by stakeholders. Therefore, nurses, the heart of the healthcare sector, have a core role in safety improvement plans to ensure they are effective.
- Muroi, M., Shen, J. J., & Angosta, A. (2017). Association of medication errors with drug classifications, clinical units, and consequence of errors: Are they related? Applied Nursing Research: ANR, 33, 180–185. https://doi.org/10.1016/j.apnr.2016.12.002
- qpm_tech_admin. (2019, December 11). 5 key components of quality improvement in healthcare. Qualityze.Com. https://www.qualityze.com/5-key-components-of-quality-improvement-in-healthcare/
- Sessions, L. C., Nemeth, L. S., Catchpole, K., & Kelechi, T. J. (2019). Nurses’ perceptions of high-alert medication administration safety: A qualitative descriptive study. Journal of Advanced Nursing, 75(12), 3654–3667. https://doi.org/10.1111/jan.14173
- Toivo, T., Airaksinen, M., Dimitrow, M., Savela, E., Pelkonen, K., Kiuru, V., Suominen, T., Uunimäki, M., Kivelä, S.-L., Leikola, S., & Puustinen, J. (2019). Enhanced coordination of care to reduce medication risks in older home care clients in primary care: a randomized controlled trial. BMC Geriatrics, 19(1), 332. https://doi.org/10.1186/s12877-019-1353-2
- Tso, V. (n.d.). Increasing patient safety during medication administration. Usfca.Edu. Retrieved March 16, 2021, from https://repository.usfca.edu/cgi/viewcontent.cgi?article=1709&context=capstone