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Communication Issues Contributing to Medication Incidents

According to Bingham et al. (2020), effective acknowledgment of the feedback of the patients is a very essential step in nursing, as this feedback can help in providing information about the side effects of the medicine through effective non-verbal, verbal, or other means of communications. It is also necessary that a safe environment is maintained which ensures the hygiene and the safety of the patient. The registered nurses can play a major role in ensuring that the medication administrations are safe and this can be obtained with the help of – conducting regular follow-ups, frequent monitoring, and evaluation of the patients. The nurses are expected to engage in safe medicine or medical nursing practices. The following sections will discuss the medication administration, role of a registered nurse for patient safety in preparation, and during the transition of care. The following sections will also have an elaborated discussion about the ways to reduce medication errors and safe medication.

During Preparation and Medication Administrations

According to McKittrick et al. (2018), the medication should only be administered by the nurses who are involved in health care and it should never be prepared beforehand. The registered nurse (RN) should have complete information about the abbreviation used in prescriptions and entire safe handling information – spill disposal handling or correct local procedure. There should be no routine crushing of the medicines in the tablets as this act removes the protective effects of this coating of the medicine that will result in ineffective absorption of the medicine by the body and ineffective effects of the medicine. Before medication administrations, the patient’s identity should be confirmed twice and the RN should ask the patient about his/her name and date of birth for more clarity and safety. The nurses also assess the patient’s medical history and allergic information as well. The RN should ensure that the patient is well informed and aware of his/her medication procedure. If the patient is not comfortable with the medication then he/she might refuse it, therefore, consent is very important for the patient’s safety. This ensures that there is informed consent taken from the patient ensuring his/her safety. While administration of the medication, it should be ensured that the nurse has complete information about the procedure of the medication administration. For example, precautions associated with that medication, known adverse effects, normal dosage, therapeutic use, and any specific contraindications. According to Odberg et al. (2019), the RN should ensure that the medication should be administered within 30 minutes of the scheduled time and promptly documenting the medication information in records. Other safety considerations are as follows: if the patient is unable to move then he should be properly positioned for the medication administrations; the nurse should maintain a proper environment for proper medication administrations like inappropriate room temperature, insufficient lighting, high levels of noise, and few others; these environmental factors that can impact patient safety while medication administrations due to errors or other unexpected results. A safe medication administration can be ensured with the help of following rights of drug administrations, these are as follows: right dose – the patient should be check for the right dosage, age, size, and conditions; the right information and education; right drug – the patient should be check for the correct prescribed medication; right route – the patient should be check for the right route chosen; right time and frequency – the patient should be check for the medication time to ensure that the administration is in scheduled time always; right patient; frequent assessment and documentation – there should be frequent assessments and documentation about the deterioration or progress of the health of the patient (Sessions et al., 2020).

When Monitoring for Response

According to Rudolph et al. (2020), the role of RN is very important in monitoring the response in safe medication administration procedures. The RN should assess for the aftereffect of the medication like the patient’s vital signs should be examined as it is obvious that they may get impacted due to the after-effects of the medication. If the patient shows allergic symptoms like dry mouth, anxiety, itchiness, redness, skin texture changes, cough, or other, if these are found then alternatives should be used for patient-centered care. The patient should also be monitored for his/her cognitive, behavioral, and physical functions as well. The documentation of the patient’s reports should be frequent and regular. This ensures that there is effective communication among the patient with his/her feedback and also with the associated health professionals. This will ensure patient’s safety as the involvement of a multidisciplinary team and their effective communication will result in effective medication plans without conflicting elements. The nurse should ensure that there are effective monitoring, assessments, and evaluation of the patient’s health status to ensure safety. Hand hygiene should be properly maintained for eliminating the risk of infections. The patient’s doubts should be acknowledged and informed. The entire focus should on one patient during monitoring and the family members should also be involved in decision-making. According to Syyrilä et al. (2020), the patient should be provided with alerts or alarm systems so that there is effective monitoring whenever the patient needs assistance. With effective monitoring for a response, the unexpected results or issues can be recognized that might be related or unrelated to the main disease of the patient, and accordingly, the medication pan can be prepared for effective treatment. While monitoring for the response, not only vital various other factors should also be monitored which are as follows: heart rate, respiratory rate, cardiovascular activity, consciousness, blood pressure, blood glucose levels, oxygen delivery, temperature, pain score, and many others. These factors can get impacted by the effects of the medications; therefore, these should also be monitored for responses (Prydderch, 2019). Moreover, the patient should be educated and taught about the signs, symptoms, medication administration procedures, or other information related to his/her health condition so that he/she can self-monitor and safety can be maintained.

During Transitions of Care

According to the Australian Commission on Safety and Quality in Health care (2019), transitions of care include patient movements between hospitals, health care centers, homes, clinics, residential consultations, and various other care service delivery places. For safe medication with zero medication error during the transition of care, best possible medical history (BPMH) is prepared, it is compared with prescribed medication, if any discrepancies are found then they are resolved and documentation is updated. There should be proper and effective medication communication among health professionals. All these are the parts of medication reconciling and review during the transition of care. Moreover, in medication review, there is the optimization of medication use so that the outcomes of the patient’s health are improved. It is found that 62 % of the patients faced medication discrepancies during the transition of care, therefore, effectiveness, alertness, and accountability of the RN are required to ensure the patient’s safety with zero medication errors. According to the World Health Organization (2019), during the transition of care stages to avoid medication errors, there should be the development of strong partnerships among parents, family members, patients, and health professionals. For this, the RN should encourage the use of written communication, oral communication, self-management, empowering the patient, and supportive systems. During the reconciling step, the patient’s medication list should be identified and patient knowledge about his/her medication should be assessed and evaluated. Counseling and advice should be delivered to the patient for their safety while they are involved in using any medication or administration aids. Smooth transitions are delivered if the patient’s needs are met, and consistent and competent care is delivered by the health professionals.

Role of RN

According to Hammoudi et al. (2018), the nurse should have complete information about the following: minimizing clutter, verifying the medication, alert, or alarm systems, administrations verifications, performing follow-ups, tracking of medication errors, performing double checks, being proactive, involving the patient, educating the patient about look-alike and sound-alike drugs, designing effective warning, using barcodes in checking the right drug or medication, and few others. There should be involvement of another nurse or health professionals to perform follow-ups ensuring double-check security, medication reconciling procedures should be performed effectively and properly, legible documentation, proper shortage, and disposal of medication, following the policies and guidelines as per the institution’s medication policy. The RN can help in promoting safety in medication by encouraging the use of e-technologies like electronic medical records, My Health records, and others by the hospital staff or by the patient’s and their family members. These systems help in reducing medication errors (Wheeler et al., 2018). If there are any blood-related products or transfusions, then the RN should ensure adequate oversight until the completion of the procedure, and every blood-related product should be properly labeled and stored. The RN should also identify and manage the potential blood transfusion-related complication or reactions. It should be ensured that autonomy, justice, beneficence, and non-maleficent principles are maintained (Jarvill et al., 2018). The nurse should also ensure that the patient’s privacy and confidentiality are maintained during medication administration and related procedures, and the information is not shared with any third party.

References for Safe Medication Administration in Nursing

Australian Commission on Safety and Quality in Health care. (2019). Medication safety. Retrieved from: https://www.safetyandquality.gov.au/our-work/medication-safety

Bingham, G., Fossum, M., Hughes, L., Digby, R., & Bucknall, T. (2020). The pre‐medical emergency team response: Nurses' decision‐making escalating deterioration to treating teams using urgent review criteria. Journal of Advanced Nursing76(8), 2171-2181. https://doi.org/10.1111/jan.14433

Syyrilä, T., Vehviläinen‐Julkunen, K., & Härkänen, M. (2020). Communication issues contributing to medication incidents: Mixed‐method analysis of hospitals’ incident reports using indicator phrases based on literature. Journal of Clinical Nursing, 9(13-14), 2466-2481. https://doi.org/10.1111/jocn.15263 

Rudolph, C. W., Murphy, L. D., & Zacher, H. (2020). A systematic review and critique of research on “healthy leadership”. The Leadership Quarterly31(1), 101335. https://doi.org/10.1016/j.leaqua.2019.101335 

 McKittrick, R., & McKenzie, R. (2018). A narrative review and synthesis to inform health workforce preparation for the health care homes model in primary healthcare in Australia. Australian Journal of Primary Health24(4), 317-329. https://doi.org/10.1071/PY18045

Hammoudi, B. M., Ismaile, S., & Abu Yahya, O. (2018). Factors associated with medication administration errors and why nurses fail to report them. Journal of Caring Sciences32(3), 1038-1046. https://doi.org/10.1111/scs.12546

Jarvill, M., Jenkins, S., Akman, O., Astroth, K. S., Pohl, C., & Jacobs, P. J. (2018). Effect of simulation on nursing students' medication administration competence. Clinical Simulation in Nursing14, 3-7. https://doi.org/10.1016/j.ecns.2017.08.001

Odberg, K. R., Hansen, B. S., & Wangensteen, S. (2019). Medication administration in nursing homes: A qualitative study of the nurse role. Nursing Open6(2), 384-392. https://doi.org/10.1002/nop2.216

 Prydderch, S. (2019). Preparing pre-registration nurses to be ‘prescriber ready’: Aspirational or an achievable reality?. 8, 1-4. https://doi.org/10.1016/j.nedt.2019.03.009

Sessions, L., Nemeth, L. S., Catchpole, K., & Kelechi, T. (2020). Use of simulation-based learning to teach high-alert medication safety: A feasibility study. Clinical Simulation in Nursing47, 60-64. https://doi.org/10.1016/j.ecns.2020.06.013

Wheeler, A. J., Scahill, S., Hopcroft, D., & Stapleton, H. (2018). Reducing medication errors at transitions of care is everyone's business. Australian Prescriber41(3), 73–77. https://doi.org/10.18773/austprescr.2018.021

World Health Organization. (2019). Medication Safety in Transitions of Care. Retrieved from:https://www.who.int/patientsafety/medication-safety/TransitionOfCare.pdf?ua=1

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