NRSG 314 Unit 2 – Individual Project
Medication errors are the number one patient safety issue at most medical facilities.
You are a member of the risk management team at a medical facility. You have been assigned to develop a professional paper that will assist nurse managers in reducing the number of errors made by new employees concerning medication. Your paper should include all of the following:
- Discuss the most frequent cause and incidence rate of medication errors at a medical facility.
- Incorporate the continuous quality improvement (CQI) process into the identification, implementation, and measure of the plan to reduce the medication errors.
- Discuss the rationale for reducing the errors.
- Give at least 2 actions that the nurse should take to assist with the reduction of errors.
- Cite at least 3 scholarly sources. Two of the sources must be recent (within the past 5 years), and the third source must come from an Institute of Medicine (IOM) report that is related to medication errors.
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A primary concern in health care is patient safety; it can be addressed in many ways, and those who need around-the-clock care have found that bedside report (BSR) helps ease their mind. Medication errors, unfortunately, happen too often, putting patients’ safety at risk. In a unit that used to work, we had a near-miss incident with a chemotherapy infusion. The chemo drug was hanging but was left clamped, causing the medication not to infuse. On another occasion, the provider ordered a normal saline bolus for a diabetic patient with a blood sugar of > 400, the nurse administered D5W instead. These incidents happened within a week of each other.
The implementation of BSR was applied and enforced in the unit. Sherwood and Barnsteiner (2021) describe how this process happens. First, the oncoming RN is introduced by the leaving RN. Both RNs go over critical issues like checking IV lines, type of medication being infused, fall prevention equipment, and goals for the day. In the hospital where I work, besides the leaving and oncoming RNs, a physician, a pharmacist, and a social worker are part of the rounding team. BSR has helped reduce the number of medication errors because it increases the accuracy of care and reduces the amount of time spent trying to figure out or fix an easily avoidable mistake (McAllen et al., 2018).
Even though BSR has helped decrease the number of medication errors, they are still happening. Besides the implementation of BSR, a detailed log with the number of medication errors, the nature of the errors, and the adverse effect the medication error inflected on the affected patient would help increase the nurses’ awareness. Another tool that could be added to the BSR is auditing. By auditing one -another’s work, there is a less likely chance of having medication errors. Audits can help evaluate and analyze the effectiveness of the future changes that would be required to decrease the nurse error in medication faults.
McAllen, E. R., Stephens, K., Biearman, B. S., Kerr, K., & Whiteman, K. (2018). Moving shift
report to the bedside: An evidence-based quality improvement project. Online Journal of
Issues in Nursing, 23(2), 1. https://doi.org/10.3912/OJIN.Vol23No23PPT22
Sherwood, G., & Barnsteiner, J. (2021). Quality and Safety in Nursing (3rd ed., pp.119). Wiley Global Research (STMS).
Working in the emergency department we see a range of patients from pregnant mothers in labor to the sick and dying. The learning in the emergency department is awe inspiring and ever changing although that does come with its struggles. Being a facility that has new medical residents we see many new physicians come in to learn emergency medicine and to be able to do their patient care as smooth as possible.
In one instance I myself was a float nurse who was assisting with nursing tasks, break relief for my fellow coworkers and all around resource for the department. We received a patient that was having an allergic reaction to pine nuts that was hidden in the cookies that he was given. Upon presentation the emergency department we rapidly bedded the patient and proceeded with general procedures as one would expect. Cardiac monitor, vital signs, establishing an IV, fluids primed and have medications ready preemptively until the physicians are there for the actual orders. Understandably, epinephrine given intramuscularly remains the mainstay of treatment for this condition also additionally other second-line therapies such as H1 or h2 blockers and steroids. (Cheng, 2011).
As soon as the resident came in I was able to tell her the background of the patient and that I have already pulled the medications and have everything established I asked what the resident would like for medications she proceeded to tell me for a verbal order read back, 50 mg Benadryl IV, 150 mg Solu-medrol IV, and 0.4 mg epinephrine IV. I questioned the order about the epinephrine IV and received push back from the resident with her quoting “it’s alright it’s just a small dose”. I proceeded to ask the resident if they would like the epinephrine around route, possibly IM and was revoked. I prepared the medications, with no intention of giving the epinephrine IV, to have ready at bedside after the supervising physician was at bedside.
Once the supervising physician walked in I asked the resident to repeat the orders. The resident was corrected by the physician, the patient was treated as well as discharged later that day. As Sherwood goes on to say that discussions of near misses usually do not generate the defensive reactions (Sherwood, Barnsteiner 2021) this was an episode in which I was placed in a position in which it was. The resident responded in a defensive way and had a thought process of explaining to me that “it’s just a small dose”.
After my encounter with the residents in my department the education team increased their rounding and actually brought up encouraging nurses to speak up about not only medication errors, but about advocating for patients and appropriate medications but to speak up to residents. As Sherwood & Barnseiner go on to explain facilitating and harboring a culture of safety we should not let our egos get in the way of patient care when in critical situations, or ever.
Cheng A. (2011). Emergency treatment of anaphylaxis in infants and children. Paediatrics & child health, 16(1), 35–40.
Sherwood, G., & Barnsteiner, J. (2021). Quality and Safety in Nursing (3rd Edition). Wiley Global Research (STMS). https://coloradotech.vitalsource.com/books/9781119684459