Medication errors are a significant cause of mortality and morbidity for patients. For this reason, all efforts must be made to reduce the incidence of medication errors. Annually, medication errors injure 1.5 million Americans and result in direct and indirect costs of $3.5 billion dollars (Anderson, 2010, p. 23). Unfortunately, for some patients, the medication error is fatal. These numbers are staggering in their danger. Patients deserve better than this from health care providers and health care systems. The first rule of medicine is “First, do no harm.” Obviously, health care is harming patients through poorly designed systems.
Systems need to be constantly reassessed to determine if they are effective at preventing medication errors. Currently, this long term care facility utilizes a paper system to verify medications for patients. However, studies have indicated that this is not the most efficient and effective method to prevent a patient from receiving an improper medication or dose. This facility”s system needs to be upgraded to a computerized system that includes barcodes. As health care providers, it is our duty and obligation to ensure the patients receive the best possible and the safest care we can provide.
Studies have clearly indicated that a bar-code safety system for medication administration clearly can positively impact the safety of administration. One study was conducted in a 300 bed hospital facility. The development of the program included input from nurses, nursing administration, pharmacy representatives and information technologists. The results were quite impressive. Over the course of the study, the incidence of medication errors for patients dropped by eighty percent (Foote & Coleman, 2008, p. 207). If this program could be utilized at all facilities in the United States, 1.2 million medication errors could be prevented. This would result in a possible savings of $2.8 billion annually. Due to these impressive numbers, it is reckless to not consider implementing a bar-code system for safe medication administration. While there is obviously a financial reason to do so, more importantly, there is a moral one. Our patients deserve to receive safe and quality medical care. They are in our care at the most vulnerable times in their lives. For this reason, we need to do everything possible to ensure that they are not harmed further during their stays in health care settings.
There are other methods that also should be considered for implementation. Real-time charting at the bedside also helped to reduce the risk of a medication error. A “quasi-experimental” study that focused on real-time charting clearly indicated that this methodology improves both medication administration and the overall quality of nursing notes and documentation. Improved documentation may help to alleviate other forms of medical errors as well. While the study did not focus on this, it is likely that better documentation and note-taking would improve the care and possibly the outcomes for the patient in numerous ways. For this reason, real-time documentation at the patient”s bedside also needs to be considered as an addition to system changes made by the facility (Nelson, Evans, Samore, & Gardner, 2005, p. 390).
While not all residents at a long-term care facility are older adults, they do represent the majority of the population. Due to this reality, it remains even more important to ensure a safe medication administration system. Older adults tend to receive a multitude of medications, a practice called polypharmacy. It is only understandable that a patient who receives five medications is at increased risk for a medication error. The medications may have negative interactions with each other. Additionally, as a health care provider is required to dose these medications at different times during the day, human error comes into play. Multiple doses of multiple medications create a situation where a health care provider would be at increased risk to make a mistake. An Australian study found that 86% of all individuals over the age of 65 are on at least one prescription medication. Additionally, 83% of all individuals over the age of 85 are on at least two medications. This study did not focus on specifically adults who are in long term care. It makes sense that individuals who utilize long term care do so as a result of poorer quality health. They are therefore more likely to be on medications. Additionally, the Australian study showed that 2-3% of all hospital administrations are the result of a medication error (Hodgkinson, Koch, Nay, & Nichols, 2006, p. 2).
Long term care facilities have been shown to have high percentages of medication errors. One study conducted in the Netherlands showed a shocking rate of 21.8% of medication errors in a long term care facility. Many of the errors were the result of improper administration, particularly crushing pills that cannot be crushed. This is particularly dangerous because many pills that cannot be crushed are extended release medications. The quick release of a calcium channel blocker, for instance, may be fatal. Since many of these errors resulted from improper administration, a computerized system that gives clear directions concerning the source of errors, such as non-crushable pill, could help alleviate these (van den Bemt, Idzihya, Robertz, Kormeling, & Pels, 2009, p. 486).
There are a number of new strategies that should be implemented to improve the safety of medication administration. As a long term care facility, the staff should work together to ensure that the patients receive the best possible care, and for a long time. By all means, the current paper verification system is substandard in its preventive abilities. For this reason, newer methods, such as bar coding, clear computerized instructions and real-time bedside charting need to be considered. All stakeholders need to have input into designing an appropriate and effective medication administration system. Together, these stakeholders can likely develop a safer method than the one currently being utilized.
- Anderson, P. (2010, March). Medication errors: don”t let them happen to you. American Nurse Today, 23-28.
- Foote, S. O., & Coleman, J. R. (2008). Medication administration: The implementation process of bar-coding for medication administration to enhance medication safety. Nursing Economics, 26(3), 207-10.
- Nelson, N. C., Evans, R. S., Samore, M. H., & Gardner, R. M. (2005). Detection and prevention of medication errors using real-time bedside nurse charting. Journal of the American Medical Informatics Association, 12(4), 390-7.
- Van den Bemt, P., Idzihya, JC., Robertz, H., Kormelink, DG., & Pels, N. ( 2009). Medication administration errors in nursing homes using an automated medication dispensing system. J Am Med Inform Assoc, 16(4): 486″492.