Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Prevalence, Risk Factors, Consequences and Strategies for Reducing Medication Errors in Australian Hospitals: A Literature Review

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Prevalence, Risk Factors, Consequences and Strategies for Reducing Medication Errors in Australian Hospitals: A Literature Review

Article excerpt

INTRODUCTION

In the clinical setting, all too frequent errors in the administration of medications are a persistent problem. As registered nurses have the responsibility of the final contact with the medication prior to administration, they are often held accountable for subsequent adverse events. Administering a medication is the nursing task that carries the highest risk, and the consequences of an error can be devastating for the patient and the nurse (Anderson & Webster 2001).

As well as being a high risk task for nurses, it is also worth considering that in Australia it has been reported that about 59 percent of the population are currently taking prescription medication (Joanna Briggs Institute 2006). So although the probability of a single adverse drug event occurring is relatively low, the likelihood of such an event occurring remains a significant issue due to the high proportion of people taking medications (Australian Commission on Safety and Quality in Healthcare [ACSQH] 2004).

This paper will examine the issue of medication errors in an Australian clinical context. It will describe the prevalence, risk factors and adverse events relating to medication errors. Many health facilities have implemented strategies to reduce the number of medication errors. A discussion of the key aspects of these strategies is provided, focussing on nursing priorities.

BACKGROUND

An adverse drug event is defined as an incident which actually caused harm or injury to a patient, and can result from an adverse reaction to a medication or a medication error (ACSQH 2001; Lisby, Nielson & Mainz 2005). A medication error is any potentially avoidable event which may involve inappropriate use of medications (such as carelessness or negligence), causing actual or potential harm to a patient (National Coordinating Council for Medication Error Reporting and Prevention [NCC MERP] 2007; Meadows 2003). It can occur as a failure to accurately complete an intended action relating to preparation or administration of a medication, or a complete omission of a necessary action. A medication error has four distinctive characteristics: it follows a correctable problem in medication therapy; given the situation, the error was relatively foreseeable; the cause of the error was identifiable; and the cause of the error was controllable without sacrificing the essential benefits of therapy for patient safety (Helper & Segal 2003).

Patient safety can be defined as the avoidance or reduction of actual or potential harm to a patient in a health care environment (ACSQH 2004). Medication errors jeopardise the wellbeing and safety of patients, therefore it is an important consideration in the current context. According to Fogarty and McKeon (2006), medication errors are a leading cause of patient harm.The goal of every health care organisation is the continual improvement of systems to prevent patient harm, and the monitoring of medication errors and potential errors is a large component of such improvement (NCC MERP 2002). Health care facilities need to monitor medication errors and investigate causes to identify strategies for improvement of medication practices, ensuring maximal patient safety. In developing appropriate monitoring systems, it is important to recognise that blaming and punishing individuals for making errors does not resolve the underlying cause of the error. The analysis of the information and data received from reporting and subsequent actions has the potential to increase patient safety.

Previous literature on adverse outcomes of medication therapy promotes the idea that adverse events are unavoidable. Such events were an expected price to pay 'for the inestimable benefits' of modern medication therapy (Barr 1955: 1453). More recently, Hyman and Silver (2005: 56) suggest that the high rate of error in health care is 'predictable' and inevitable given human involvement. Kalra (2004: 1043) reiterates the more commonly accepted understanding that a limited amount of error is unavoidable in any task, and that 'human fallibility' in health care should be accepted. …

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