Reducing the Risks of Medication Administration
A recent survey carried out by Newcross Healthcare highlighted some issues faced by nurses when administrating medication to clients. The main contributing factors increasing risks include; communication breakdown, interruptions, high workload and failures in documentation.
Medication errors can happen anytime during prescribing, dispensing, administering and ongoing monitoring and can be defined as “a failure in the treatment process that leads to, or has the potential to lead to, harm to the patient” (Ferner & Aronson))
The majority of errors made by nurses are when administering medication, and as the survey shows there can be many contributing factors. Human factors need to be taken into consideration but also organisational and environmental factors. Reflection and learning identify that many causes of medication errors are multifactorial.
Causative factors fall under three headings; Personal, Organisational and Environmental.
The nurse's personal resources including stress and fatigue can affect their ability to complete the task. Some personal factors nurses can influence themselves i.e. ensuring proper rest when not at work and being aware of stresses outside work that could affect their concentration. Personal factors are influenced by work, for example, a busy shift with no breaks leads to the nurse being tired hungry and thirsty, all of these may affect the level of concentration. Knowledge, understanding and a lack of experience are also contributing factors to drug errors.
The findings of the Newcross survey show that one of the biggest issues is interruptions during drug administration. Such interruptions come in a variety of forms and nurses are often expected to manage of tasks simultaneously and the support of colleagues to limit these interruptions.
The culture an organisation can also effect interruptions. Acknowledgement from the Managers that interruptions can cause problems and supporting staff in avoiding this can create a better environment. Adopting policies such as using tabards to highlight someone doing the drug round or providing areas for drug administration where the nurse can concentrate on this one task may help reduce errors. Good leadership should empower the nurse to be able to deal with the interruptions and nurses should use clinical judgement in responding to important or urgent interruptions.
Simple environmental factors such as lighting, noise level, and storage facilities, the use of drug trollies and accessibility all play a role in effective medication administration. An inadequate environment contributes to medication errors by causing stress, distractions and increasing the workload. Clear processes for storage and ordering of drugs can avoid medications being omitted and supports the nurse during her medication round as searching for drugs increases the time taken to complete the task and may again add to the nurse's stress. Nice guidelines recommend that care homes give protected time to nurses for ordering and checking medicines into the home.
Newcross Encourages an open and honest process
Newcross encourages an open and honest process for dealing with drug administration errors and is actively supporting nurses and encouraging learning from all errors. We recognise the need for ongoing learning and encouraging nurses to complete a medication competency testing their knowledge and supporting any identified learning. Nurses are encouraged to discuss any issues with their local branch but can also speak to nurses within the clinical governance team. It is important to understand the factors that can contribute to medication errors and for nurses working in all areas to understand how some of these factors can be avoided or improved to help support them when carrying out medication administration.
[Written by Alex Alen, edited and infographics created by Matt Olney]