PDF The specialized role of nursing in the care and education of people with diabetes has been in existence for more than 30 years. Diabetes education carried out by nurses has moved beyond the hospital bedside into a variety of health care settings. Among the disciplines involved in diabetes education, nursing has played a pivotal role in the diabetes team management concept.
Author Information Ronda G. Medication errors were estimated to account for more than 7, deaths annually. With the growing reliance on medication therapy as the primary intervention for most illnesses, patients receiving medication interventions are exposed to potential harm as well as benefits.
Harm from medications can arise from unintended consequences as well as medication error wrong medication, wrong time, wrong dose, etc. With inadequate nursing education about patient safety and quality, excessive workloads, staffing inadequacies, fatigue, illegible provider handwriting, flawed dispensing systems, and problems with the labeling of drugs, nurses are continually challenged to ensure that their patients receive the right medication at the right time.
The purpose of this chapter is to review the research regarding medication safety in relation to nursing care. We will show that while we have an adequate and consistent knowledge base of medication error reporting and distribution across phases of the medication process, the knowledge base to inform interventions is very weak.
Defining Medication Errors Shared definitions of several key terms are important to understanding this chapter. Any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer.
Such events may be related to professional practice, health care products, procedures, and systems, including prescribing; order communication; product labeling, packaging, and nomenclature; compounding; dispensing; distribution; administration; education; monitoring; and use. Medications with similar names or similar packaging Medications that are not commonly used or prescribed Commonly used medications to which many patients are allergic e.
Misreading medication names that look similar is a common mistake.
These look-alike medication names may also sound alike and can lead to errors associated with verbal prescriptions. This list is available at www.
Medication errors occur in all settings 5 and may or may not cause an adverse drug event ADE. Medications with complex dosing regimens and those given in specialty areas e. Most of the common types of errors resulting in patient death involved the wrong dose The causes of these deaths were categorized as oral and written miscommunication, name confusion e.
Adverse Drug Events and Adverse Drug Reactions Adverse drug events are defined as injuries that result from medication use, although the causality of this relationship may not be proven.
These warnings are intended to be the strongest labeling requirement for drugs or drug products that can have serious adverse reactions or potential safety hazards, especially those that may result in death or serious injury.
The authors concluded that BBWs did not prevent the inappropriate use of high-risk medications. The researchers found that 3. About one in four of these adverse events were judged to be attributable to negligence, and 58 percent were judged to be preventable.
It is difficult to reduce or eliminate medication errors when information on their prevalence is absent, inaccurate, or contradictory.
Bates 20 put forth the notion that for every medication error that harms a patient, there aremostly undetected, errors that do not. Most medication errors cause no patient harm or remain undetected by the clinician. Rates of medication errors vary, depending on the detection method used.
For example, among hospitalized patients, studies have shown that errors may be occurring as frequently as one per patient per day. The impact was less in male patients, younger patients, and patients with less severe illnesses and in certain diagnosis-related groups.
Without an infrastructure to capture and assess all medication errors and near misses, the real number is not known. These rates could be expected to be higher once patient safety organizations begin to collect nationwide errors and health care clinicians become more comfortable and skilled in recognizing and reporting all medication errors.
The concern raised in To Err Is Human 1 about the potential prevalence and impact of ADEs—2 out of every hospitalized patients—was just the beginning of our understanding of the potential magnitude of the rates of medication errors. Yet, despite numerous research findings, we cannot estimate the actual rates because they vary by site, organization, and clinician; because not all medication errors are detected; and because not all detected errors are reported.
Error-Prone Processes There are five stages of the medication process: Some of the most noted and early work on medication safety found hospitalized patients suffer preventable injury or even death as a result of ADEs associated with errors made during the prescribing, dispensing, and administering of medications to patients, 1227—29 although the rates of error in the stages of the medication process vary.
A few studies have indicated that one of every three medication errors could be attributed to either a lack of knowledge about the medication or a lack of knowledge about the patient.
In this stage, the wrong drug, dose, or route can be ordered, as can drugs to which the patient has known allergies. Workload, knowledge about the prescribed drug, and attitude of the prescriber—especially if there is a low perceived importance of prescribing compared with other responsibilities—are significantly associated with ADEs.
Similar results have been found in mandatory adverse event reporting systems. An analysis of reports associated with significant harm or death reported to the State of New York noted that, when the error occurred during the prescribing stage, written prescriptions accounted for 74 percent of the errors, and verbal orders accounted for 15 percent.
One investigation of the occurrence of ADRs in outpatient veterans found no difference in ADR events between physicians and nurse practitioners.
Transcribing, dispensing, and delivering In some settings, medication orders are transcribed, dispensed, and then delivered for nurse administration.walls. To date, the most effective way to improve patient outcomes and reduce readmissions to the hospital is by Sometimes the patients medications stay the same, yet the dosing regimen changes post-discharge, and A recent study has shown that about 50% of patients cannot recall discharge orders; of these.
Clozapine is the most effective antipsychotic based on the U.S. Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE)4 and the UK Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study (CUtLASS).5 In regards to the significant blood draws and monitoring that is continuously required, clozapine can be a challenging.
The patient interview is the primary way of obtaining comprehensive information about the patient in order to provide effective patient-centered care, and the medica- adverse reactions, allergies, or issues with medication cost the patient .
task and determine whether it is cost effective to have interns or pharmacists in this role. Another case study evaluated students in a hospital in Ohio specifically tasked with obtaining admission medication data in an emergency department.
While the service was successful, the hospital was unable to. In this context, the objective of this study was to determine whether different physicians are associated with different patient compliance results.
In this study patient compliance was measured using a different approach, involving pharmacy refill records. Study Quality Management Final Exam flashcards from Michaela S. on What would be the most cost effective and appropriate data collection time frame? The UM Committee has asked for a retrospective study done to determine the number of patients treated for cystic fibrosis who are discharged home with a referral to be seen .