Improving Medication Safety

Abstract

Modern medical practice has many achievements. However, it is not immune to medical errors. What are the ways of minimization of medical errors and improve adherence to medical treatment? This is a research question of this paper. The research has a purpose of exploration of the variety of medical errors, which occur in physicians’ practice and identification of the methods of their prevention. This paper highlights the examples of the most common mistakes and points to the ways to eliminate or, at least, minimize their consequences. Based on the sources used, the author develops a strategy to increase the credibility of the medical treatment and describes the prospects of nursing in this context.

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Introduction

Annually, there are about 98,000 deaths due to medical errors in the US (Pham, 2012). The errors relate to making medical decisions despite the fact that the healthcare system pays attention to this issue. The medical errors top the list of errors that have led to the death of a patient (The American College of Obstetricians and Gynecologists, 2012). Regardless of the constant improvement of the health care system, medical errors continue to occur. To illustrate, the study, which involved 10 hospitals, took place in South Carolina. The results showed that 18.1% of hospitalized patients were harmed (Landrigan et al., 2010). The procedures occupied first place in the number of inflicted harm. The medications were in second place (Landrigan et al., 2010).

In medical practice, inevitable complications are likely to lead to a deterioration of a patient. However, there is harm inflicted because of the mistakes that could have been prevented. Focusing on the correction of these errors is the core of the provision of health services (Van Den Bos et al., 2011).

Medical errors are one of the criteria for evaluating the effectiveness of the healthcare system. Each additional error reduces the efficiency of the overall system. If the achievements of modern medicine are in the numerator, the medical errors are in the denominator. The result of this equation is the efficiency of the healthcare system. The higher the efficiency, the higher the level of Americans’ confidence in the medical treatment is. Therefore, to attract people to the medical treatment, it is necessary to increase the number of achievements or to reduce the number of medical errors and adverse effects of the existing system. The second way is the main objective of this paper.

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There are many ways to prevent medical errors, ranging from the strategy aimed at reduction of errors, adoption of the information technologies in health care to the prevention of the risk of errors (The American College of Obstetricians and Gynecologists, 2012). For instance, the professional associations of physicians, such as the American College of Obstetricians and Gynecologists (2012), ascertain that practicing obstetricians should be aware of these methods and use them while prescribing medications. This approach will ensure the safety of patients’ health and minimize litigation. Adherence to medical treatment is inversely proportional to the number of medical errors. It affects the prospects of nursing. Furthermore, the medicine must be safe to be a pledge of the future health of the nation.

Errors in Medical Practice

Undoubtedly, medical errors are directly related to safety. Of course, the assessment of the extent of this problem is unavoidable on the way to its solution. Van Den Bos et al. (2011) investigated the complaints of medical errors, which cause harm to the patients’ health and the ways to prevent them. The authors measured the cost of medical errors in their articles. On the results of calculations, they claimed that the costs of medical errors amounted to 17.1 billion dollars in 2008 (Van Den Bos et al., 2011). The most common mistakes were postoperative infection and post-laminectomy syndrome. The bedsores were ranked the third most common issue in this regard. In addition, the Wisconsin study investigated cases of medical injuries. According to the results, 1,000 hospitalizations had 133.3 cases of medical injuries. In these cases, the hospital suffered an 18.5% increase in expenses, and hospitalization increased by 14.6%.

Many studies indicate the various medical errors that occur for different reasons. To illustrate, these issues include the wrong dose of medication prescribed, failure to give the medicine (vendor error), or failure to take the medication (Institute of Medicine, 2007). The human factor has always contributed to this phenomenon. Hickner et al. (2010) designed the on-line reporting system, which gives an opportunity to report about every medication error and by-effects to the Web system. In the article discussing the operation of the system, they stated that the reasons for the error are:

  • noisy working conditions;
  • inattention;
  • fatigue;
  • irritability;
  • forgetfulness;
  • problems with associates;
  • personal stress among others (Hickner et al., 2010).

The significant source of medical errors is also the lack of understanding among physicians and patients, pharmacists, and nurses. Misunderstandings can be both verbal and written. At the same time, there are several types of medical errors. Some of them are associated with allergic contraindications, others with the wrong dosage of drugs. There are also errors associated with the incorrect dose of medication issued.

Nanji et al. (2011) explored the errors of computerized prescribing systems in their research. The authors considered that the errors in medical prescriptions are based on the underlying causes. They are unclear prescriptions or misinterpretation of the prescriptions. The difficulty lies in the fact that the new medicines appear from time to time and improper names reducing are added to the promiscuity writing and missing components. This is due to the fact that new medicines are often similar to the old ones in writing and pronunciation. This situation complicates the interpretation of medical prescriptions. What is more, computer systems, which generate the recipes, are not immune to mistakes.

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In addition, medical errors and medical trauma are different fundamentally. Medical injury is a broader concept than an error. This notion covers causing harm to a patient because of the negligence, carelessness, or misunderstandings among the hospital staff as well as based on unavoidable complications (Van Den Bos et al., 2011). These include complications after the surgical operations that do not depend on the actions committed by the doctors, unforeseen allergic reactions, and relapses. The consequences of medical injury may range from the softest ones to death. Medical error is an unfavorable outcome that could have been prevented with proper management. Medical errors may cause injury to health or may not (Van Den Bos et al., 2011).

Van Den Bos et al. (2011) in the article “The $17.1 Billion Problem” identified the factors, which contribute to the spread of medical errors. They divided them into three groups:

  • “human problems,” such as poor compliance with regulations and rules during procedures;
  • “patient issues,” including incorrect assessment of the patient or one’s identification, as well as not properly collected history;
  • inadequate provisions in the rules and regulations relating to the procedures.

Similarly, Stahel et al. (2010) conducted research, where they tried to identify the frequency, original causes, and consequences of the surgery errors in Colorado, such as wrong-patient and wrong-site procedures. The study showed that such mistakes occur quite frequently. The errors included:

  • foreign objects left in the body after surgery;
  • injuries during the patient’s stay at the hospital, such as falling;
  • urinary tract infections caused by the catheter;
  • improperly managed coronary bypass surgery, which became the cause of inflammation in the lung.

The most common surgical errors occurred in Colorado in 2008 and their probability. It is obvious that the most frequent surgery errors proceeding from the table’s data are pressure sores, post-procedural infection, and accidental puncture or laceration during a procedure.

The most common types of medical errors, from incorrectly interpreted recipes to the surgical mistakes, were discussed above. In any case, it is important to identify the problem before solving it. This process helps to understand the problem’s nature, its sources, and work out the adequate ways of prevention.

 

Strategies for Improving the Medical Safety

Institute for Safe Medication Practices (2011) considers that the basis for the increase of safety in medical practice is a perfect knowledge of the medication and treatments prescribed to patients. Several ways to achieve this goal can be regarded, including:

  • complete information about the previously prescribed medication to the patient at the time of prescribing;
  • full awareness of the patient’s condition, one’s the diagnosis and the indications for treatment;
  • the account of the factors that may affect the efficacy of the treatment, such as body weight, metabolism, kidneys condition, or pregnancy;
  • predicting the interactions between the prescribed drugs and medicines that the patient was taking before, including those which have not been discharged;
  • forecasting drug interactions with other treatments, for instance, surgery;
  • be especially careful when writing prescriptions for medicines that carry a high risk of dangerous consequences if used incorrectly, such as oxytocin and warfarin.
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To ensure safety when prescribing, The American College of Obstetricians and Gynecologists (2012) advises to pay attention to the following:

  1. Medical prescriptions must be legible and include the name of the drug, dose, method, and time of administration, age, and weight of a patient.
  2. It is necessary to prescribe the dosage clear, especially if there are zeros in numbers after the decimal point.
  3. Using only standard normalized cuts while avoid using abbreviations, developed by the Joint Commission, entitled “Do Not Use” is another strategy.
  4. It is important to state the reasons for the administration of the drug in the recipe. This circumstance will help to prevent the issuance of incorrect medication that can be similar in spelling or pronunciation.
  5. Verbal orders of medicines should be taken only in cases where written recipes are not possible. At the same time, the one who fulfills the order must repeat the name of the prescription to the customer because many drugs have a similar pronunciation.

A significant factor in making mistakes is the distraction of the surgeons during the operation and nurses during the preparation or administration of the drug. All the necessary measures should be taken to prevent the diversion of the attention of the hospital staff from their tasks. For example, such an objective can be achieved through the creation of “no distraction” zones or “not disturb” areas. Wearing special colored vests during the procedure can be an important sign for the colleagues warning not to distract and not to interrupt the work of employees. In other words, it is necessary to create the conditions under which the nurses will be fully focused on the preparation and administration of the medications (The American College of Obstetricians and Gynecologists, 2012).

To provide medication safety, the Institute of Medicine (2007) recommended some actions to a prescriber in different cases.

The strategies for improving medical safety must be followed precisely and unequivocally to be effective. The human factor will always occur in medical practice, but these strategies will minimize the risk of harm caused by medical errors. The methods for improving the medical safety listed above will increase medication adherence and trust in nurses and other hospital staff.

Technological Methods for Improving the Medical Safety

Organizations involved in patient safety are trying to improve the prescribing and dispensing of the medicines and have already achieved considerable success. These approaches include automatic and non-automatic technologies that help to prevent medical errors. Currently, many technical aids help to avoid errors due to human factors. Such strategies are computerized order drawing, electronic prescriptions, automated medication dispensing cabinets, barcoding of drugs in combination with an electronic record of the order, and the intravenous infusion technology intravenous infusion (The American College of Obstetricians and Gynecologists, 2012). To illustrate, for obstetricians, who are directly involved in the appointment of medical treatment, there are two main strategies to prevent errors by technical means. They are computerized physician order entry and electronic prescription.

Computerized physician order entry in the electronic system designed for ordering medications, laboratory, and diagnostic tests. This system also has a function of clinical decision support. This circumstance means that the system is able to give advice on the appointment of a medication after the physician will enter the necessary data. The system intends to reunite the patient data, the base of medical knowledge, and the logic machine in order to provide the necessary advice on the treatment (The American College of Obstetricians and Gynecologists, 2012).

This technology will help to avoid errors, which could be caused by human factors, such as inattention, fatigue, confusion, and forgetfulness among other issues. However, computerized systems do not provide a 100% guarantee of the absence of errors. Based on the results of the study by Nanji et al. (2011), the authors claimed that about 10% of prescriptions written with the help of computerized systems had, at least, one error. One-third of them carried a potential threat to the health of the patient. Therefore, it is clear that computer systems should be further improved and updated.

Electronic prescription is an unmistakable, legible, and exact recipe developed by a physician, which is sent directly to the pharmacist (Centers for Medicare and Medicaid Services, 2012). Computerized physician order entry systems and other similar systems often include electronic prescriptions. This technique of the precept drafting solves the problem of the illegible handwriting, incorrect reductions, or illegible dosage of the medication. A very useful feature is the direct delivery of the prescription to the pharmacist and checking its correctness by the verification system. This attribute will reduce the pharmacist’s calls to the physician associated with the specification of the recipe.

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Recommendations on Improving the Medical Practice

Health providers should be familiar with the methods described above to provide medication safety. They ought to combine the strategies with the computerized technologies properly. However, the strategies should not be always unaltered and need to be developed abreast of the times as there can be the lapses in their content. They should be regularly checked for relevance because the health care develops, new medicines, procedures, and technologies appear, and new safety standards and updates are always needed. The same recommendation is relevant for the computerized systems. The database should be checked and double-checked. Every detected error in the electronic systems must be addressed immediately.

Moreover, the data and the prescription generating algorithms should be regularly updated. In addition, it is important that the hospital staff was always fresh and rested since the physical and psychological condition of the personnel may be the cause of mechanical errors, including forgetfulness and distraction, to list a few. For this purpose, the hospital administration should make up an adequate schedule for the staff to prevent work-related overloading.

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In addition, the restrooms and psychological relaxation rooms should be created. Summarizing the recommendation for improving the medical safety, it can be stated that the strategies and computerized technologies should be not only implemented but also enhanced and regularly updated. The improving methods must be supported at all levels of the hospital staff.

Conclusion

Medical errors contribute to an increase in the drawbacks of the health system. Concurrently, they reduce the adherence of the Americans to medical treatment. The strategies suggested in this paper will help to prevent or, at least, minimize the errors. This circumstance would increase medication adherence, improve the validation of the health care system, and provide optimistic nursing perspectives. If the induced strategies are implemented into the medical practice, the Americans’ trust in the health providers will increase with the safety level, and the prestige of nurses will rise to a higher level.

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