Medication Errors Leadership Project

Medication Errors Leadership Project

Abstract 150

Improving medication safety has been the primary goal of the healthcare system, especially in nursing home facilities. However, medication errors continue to cripple the provision of quality care and calling for close attention to how the issue can be addressed to promote patient safety and improve the quality of practices within healthcare institutions.  This paper thus set out to discuss the problem of medication errors and how it affects the nurses and medical institutions, along with my plan determining the right course of action that should be taken in a nursing home, where I work as a vent unit nurse, to reduce the prevalence of medical errors. The identified solution is the implementation of electronic health records (EHR) in the healthcare institution. This will be achieved by creating a training program that will teach the nurse practitioners in the nursing home on the effect of medical errors, the significance of incorporating the EHR system, and how to use it in reducing care. The paper will thus review recent scholarly articles and develop a training program that will help in reducing medical errors in a hospital setting.

Part I

The healthcare industry has continually made advances in clinical therapeutics, and the results have been major enhancements in health for the patient population with various diseases. Still, these benefits are continuously crippled by increased risks. One of the risks that have been affecting the delivery of quality care to the patients is medication errors. In the United States alone, there are always approximately 100,000 cases reported to the US Food and Drug Administration (FDA) associated with medication error from the point of care (FDA, 2019). It then highlights the fact that this remains to be one of the factors that increase the cost of care, affecting the patient population, and also the ethics of nursing care aimed at delivering quality and efficient care. Unlike the common misconception, medical errors does not only occur at the point of prescription, but can instead occur at any point of the medication-use system like when prescribing drugs to the patients, at the point of offering information into a computer system, during the preparation or dispensation of a drug, or when the drug is being administered to the patient. In other words, medication errors can occur in any department and at any point of care. As a vent unit nurse in a nursing home, I have witnessed cases of the medication error that occur in various points of care, and it is currently the leading issue affecting the delivery of quality care. The medication errors commonly encountered in this home care are either knowledge-based, rule-based, memory-based, or action-based, and are either errors of commission or omission. This then prompts the need to determine the underlying causes of this prevailing issue, how it is affecting not only the nursing home institutions but care facilities in general, the impact on the patients, and the healthcare system as well.

The term medication error has always been identified commonly as the failure to prescribe the right medication to the patients. Though the definition aligns with what medication error entails, it leaves out a significant portion of what the problem involves. It is because of this that the term medication error has always be found to be confusing. FDA (2019) defined medication error as “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer.” The given definition highlights that medication error, therefore, is any event in the process of medication that is either inappropriate or harmful and that under the control of either the care provider, the patients, or consumers in general. According to Gorgich et al. (2015), a medication error is either an error of omission or commission that occurs at any step along the pathway of offering medication where a clinician is prescribing the medication and ends with the patients receiving the medication leading to adverse drug events. Bailey et al. (2016) defined adverse drug events as the harm the patients experience because of exposure to a medication. The definition given by Gorgich et al. (2015) encompasses the key terms often associated with a medication error, and these are omission and commission. The definition of error offered by the Institute of Medicine (IOM) is that it is what occurs when one fails to finish a planned action as required, which leads to the error of execution or the utilization of the wrong plan in achieving a particular aim, thus leading to an error of planning (Wittich et al., 2014). It then points to the fact that there are two instances where medication errors can occur, and these are when a healthcare provider deviates from the standard course of the plan for offering medication or when the medical practitioner uses the wrong approach in providing medication to the patient. Therefore, before determining the best approach to addressing medication issue in a healthcare institution, it is vital to have a clear understanding of what medication error is about and how is often experienced in the process of care.

Nursing homes remain to be one of the institutions affected by medication errors, and this is because of the patient population in these facilities. As a vent unit nurse, my primary role entails offering care to the elderly, and the disabled, and the encounter of medication errors has mainly been from the end of the nursing staff who are responsible for medication administration more than any other healthcare professional in the institution. Given the population that we serve in the ventilation unit, it only translates to the fact that medication errors can and often have adverse impacts on the patient population. Some of the commonly encountered medication errors found both in the vent unit and other care departments in the nursing home where I serve include crushing medicine that should not be split, inadequate fluids with medication, improper administration of medication, leaving patients to take the drugs without close administration, overdosing or underdosing the patients, and negligent medication errors. Some of the negligent medication errors in the nursing home include administering an incorrect medical product, incorrect time or rate of medication administration, improper administration technique, incorrect patient documentation, error with lab work, or following the wrong med pass route. As evident, medication errors in the nursing home are not only limited to the vent unit care, but it is an institutional issue that needs an objective approach to how medication errors are addressed in the healthcare system.

Various strategies have so far been put in place to reduce medication errors, but so far, not many have been effective. One of the approaches that have been taken by the healthcare system to reduce medication errors has been implementing the policy of reporting the incidences of errors. Yung et al. (2016) reported that most of the healthcare institutions have implemented the approach of reporting occurrences of medication errors. However, this so far has not been effective as the nursing practitioners are sometimes afraid of the pending consequences associated with reporting a mistake to the management. According to Hung et al. (2015), under-reporting of medication errors is common around the United States, and only about 4-50% of the errors are ever reported to the administration. At the same time, Hayes et al. (2015) explained that the strategy of reducing medication errors is hampered by the lack of accurate information offered by the nursing practitioners regarding the incidence. O’Mahony et al. (2016) argued that the most effective approach that has been proposed by many nursing homes to reduce medication errors is double-checking medication before administering it to the patients. However, this is still limited to the aspect of human error as when a nursing practitioner is either tired or pressed with time; it is highly likely that they will not have ample time to crosscheck the medication processes for every patient. It is thus essential to consider an option that will reduce the cases before they happen, and that will benefit the nursing practitioners, patients, and the hospital.

The consequences of medication errors can be felt on three levels; on the profession of nursing, the patients, and the healthcare institutions. Today, in the American healthcare system has implemented the pay-for-performance system. This is a payment model that gives financial bonuses to hospitals and individuals that meet particular performance measures, and that reduces the cost of care. It then translates to the fact that the profession of nursing is hurt gravely when there is a high number of medication errors as this translates to the fact that, based on the system, they will be denied incentives that are supposed to motivate them in delivering quality care (Robertson & Long, 2018). The other effect on the nursing profession is the fact that the affected patient and their family upon realizing there was a medication error in the procedure of care may decide to pursue a personal injury lawsuit against the nurses for negligence. In turn, this will affect the nurse’s professional career and even can lead to the revoking of their licenses, and from a broad perspective, this affects the number of workforce in the nursing profession, which is already a grave issue in the American healthcare system (Robertson & Long, 2018). The common impacts of medical errors on the patients are injury and death. The Institute of Medicine identified that there are about 98,000 deaths that occur in America every year as a result of medical errors (Makary & Daniel, 2016). At the same time, medical errors are known to be the leading cause of nosocomial infections that continue to increase the length of stay and cost of care among patients (Makary & Daniel, 2016). These infections can worsen the already existing conditions or lead to the development of new illnesses that will cripple the patients’ health and well-being. Lastly, medication errors also cripple the functioning of healthcare institutions. Affected patients and their families can also pursue a lawsuit against the healthcare provider, and this could mean that the hospital could face serious legal counsel and even settlement costs that can be very costly for the institution. Medication errors also increase the waste of medical resources as this will lead to the extension of the length of stay in hospitals and reducing the levels of output or even loss of clients willing to receive care from the institution.

Part II (534)

Implementing Electronic Health Records

Electronic health records (EHR) can be defined as the systematized collection of the patient information that is stored in digital format maintained by the provider over a given period and may entail all the essential administrative, clinical data relevant to an individual’s care (Yanamadala et al., 2016). EHR serves the purpose of enhancing quality, safety, efficiency, and reducing health disparities by presenting the medical providers with accurate health and treatment records of the patients to avoid wrong administration of care. In turn, meaningful use of EHR will help the nursing professionals reduce medication errors in their daily practice while enhancing patient care and experience.

Medication errors on the end of the healthcare providers in nursing homes are primarily caused by illegible handwriting, administering drugs that have names that are almost similar, inadequate therapeutic training, inadequate patient knowledge, poor communication medication between practitioners, along with physical and emotional issues (Ferrah et al., 2016). One of the benefits of EHR is the fact that they present the care practitioners with accurate patient records regarding their conditions and the right medication that should be prescribed to avoid misinformation of relying on human faculties of thinking. EHR should always be available at the point of care also to enhance interdisciplinary communication that improves teamwork and collaboration between care providers (Campanella et al., 2015). In turn, this means that proper implementation of the EHR will also reduce the burden of care often experienced by healthcare providers and that often leads to burnout and increased risk of causing medical errors.

EHRs prove to be the most efficient approach to addressing medication errors as they occur in the selected healthcare institution and, more particularly, in the vent unit of the nursing home. According to Birkhead et al. (2015), EHR systems are efficient in reducing errors at the point of care because of the various features that not only alert the clinicians about patients’ medication, bit also allow them to access patients’ medical information, care information from reliable sources, and communicate between each other as well as with patient population. Therefore, given the presented scenarios that lead to medication errors in the nursing home, implementation of the EHRs would ensure that nurses have a point of referral before administering medication to the patients, alert nurses when it is time to offer medication, provide accurate patient information, and even become a platform for sharing information between nurses and the patients. In turn, this would ensure that medication errors are prevented across the care spectrum.

Goals To Reduce Medical Errors

Short-term goal:

Train nurses on the adversities of medical errors and significance of EHR

Long-term goal:

Integrate the use of EHR in medical practice and patient care

Objective measurement:

Increased quality of care and customer satisfaction

Subjective measurement:

Decreased occurrences of medical errors in care and medication practice

The goals of implementing EHR in care practice are attributed to the various benefits of using the system in care, mainly in enhancing the quality and safety of healthcare. Various studies have already substantiated that the integration of EHR in nursing care enhances the accuracy of knowledge of care among nurses. Aligning with the qualitative short-term training nurses on the dangers of medication errors and the significance of EHR in practice aligns with the principle of nurses that indicate the significance of continuous learning among care providers to become aware of addressing challenges that arise in care and how to address them effectively. The long-term quantitative goal of incorporating the use of EHR in the nursing home would seek to reduce the occurrences of medication errors by at least 80% by the end of the next year. Studies already show that understanding the tools and the available options in the EHR systems can help in reducing medical errors by about 50% through increased information of personalized patient care and knowledge of enhancing the quality of care (Gellert et al., 2017). Therefore, the ultimate long-term goal of the training course is to equip nurses with the knowledge on the significance of EHR implementation in daily care and how to utilize the systems in reducing medication errors thus enhancing interdepartmental collaboration and quality of care.

The key resources required to accomplish the goals are the technology itself and the health informatics. Health informatics are individuals with qualifications in the field of medicine, information technology, and science, and information technology. These are a group of professionals who are familiar with the functioning of the EHR system and thus will be tasked to train the nurse practitioners on how to use the EHR system. I will utilize my knowledge of medical errors and work along with healthcare informatics with the skill to create a program of teaching the nurse practitioners through the training course. The training will utilize published materials and videos that will offer knowledge on how to use EHR in reducing medication errors.

The main challenge that I anticipate in accomplishing the goals is the resistance from the staff as not everyone would be open to the idea of implementing technology in the institution. At the same time, there might be a chance that some nurse practitioners may be doubtful about the efficacy of the EHR in addressing the issue of medication errors. In this case, I will need to work together with the team of health informatics in building acceptance and positivity regarding the change in the entire body of the staff. This will entail first communicating the issue that has been crippling the institution’s objective of offering quality care, then presenting them with the best viable solution, which is the integration of EHR, backed with significant data, and lastly, assuring them that this change will threaten no one’s job.

Part III

The desired plan that will be used in reducing medical errors in the institution will entail two key steps, and these are educating the staff on the significance of the desired change, and implementing the change. The objective of the training course is to equip the nurse practitioners with current evidence-based knowledge regarding the impact and threat of medical errors to the nursing profession, patients, and the institution as a whole. The training process will use the knowledge and skills of professionals, published materials on the topic of medical errors, videos, and experience from nurse leaders who advocate for the need to implement EHR in reducing medical errors. At the end of the training course, the nursing practitioners should possess adequate knowledge on how they can make use of the gained knowledge, both at personal and institutional levels, to reduce cases of medical errors by utilizing the provided technology in accessing the patients’ data and care information to improve care.

The implementation of the plan will be based on the framework of the regular training that occurs in a classroom setting where the medical staff will be students, and the team of healthcare informatics will be the educators, while I serve as the coordinator. The lessons will be held four times a week and twice a day to accommodate the shifts of the nurses at the nursing home so that everyone can manage to participate in the course training. Besides, materials will be published online on the nursing home website, where medical practitioners can review either before or after the lessons to help them get acquainted better with the training objectives. The first part of the lesson will entail covering what medical errors are and engaging the practitioners to give their opinion on what they believe are the issues associated with medical errors along with their personal experience with it. The session will then take a short-break before introducing the informatics who will introduce the concept of EHR and explain its significance in nursing today. In the next lesson, the informatics will train the staff on how to use the technology in enhancing the quality of practice and use it in different departments across the institution. This will be an extensive lesson that will cover two days to ensure that every staff is well equipped with the knowledge on how to use EHR to avoid system-based errors in care. The last lesson will be to allow the practitioners to ask questions and the team of teachers to address any issue that might hinder or slow down the implementation of EHR systems in the institution to reduce care.

Change is a process that is not always welcomed with everyone across the institution, and this is because it can be a threat to others, while others might be slow in general to accept change. It is thus essential to ensure that these factors are accommodated to facilitate smooth transitioning into the new practice of care. Managing change involves handling the complexity of the process since it is a combination of people and technological solutions (Pomare et al., 2019). Bringing change thus demands that the manager challenge the existing barriers and inspire a spirit of persevering and commitment to the objectives.

Leadership Style

Leadership style plays a vital role in determining the attitude of the team in accepting and committing. However, not every leadership style fits the criteria of managing change effectively, and therefore, the style that I will use in the change process is a transformational leadership style. Transformational leadership is concerned with developing cohesiveness among the team members to ensure that everyone is committed and is supporting each other towards the common vision (Sfantou et al., 2017). To apply this effectively, I will need to take training in advance on how to become an effective transformational leader with the capacity to inspire and motivate the team of workers without micromanagement. The individuals taking part in the course would be the nurse leaders in every department, and they must also take part in the training process and brainstorm on ideas of motivating and creating incentives that will increase commitment and inspire the team to embrace the desired change. The primary advantage of this leadership style is that it allows the leaders to take a leading role in implementing change, and this will encourage the team to get on board on the change process by personalizing it and bringing the desired results. By communicating the significance of the change and the potential benefit, the team members all agreed on the need to implement EHR as this would add financial incentives through the pay-for-performance model, and reduce the workload experienced by every nurse.

Part IV

The project is still in its primal stages of implementation, and so far, it has been approved by the manager of the institution and the acceptance of healthcare informatics to participate in the project and see it succeed. The outcomes, therefore, as previously mentioned in the objectives, will be evident after one year. However, there will be a monthly consolidation on the progress made regarding the integration of EHR in care and its effectiveness in reducing medical errors. The monthly review will allow me to get insight into areas that we can make changes so that they accommodate any unforeseen deficiency or barrier to the proper application of the new system. The project so far has been time-consuming in planning and getting the right team in order that will see it to its fruition. There was a need to get approval from medical care institutions that govern the care practices to allow the training to take place. There was also training for the leadership approach that would help me implement the project successfully, and this took a month. It is anticipated that the outcome of the program will improve the knowledge of the nursing team and add skills on how to mitigate medication errors while improving the quality of care. The patients will benefit from the outcome through increased satisfaction from proper quality care. The institution, on the other hand, will benefit through effective management of resources that will lead to cutting down the cost of care.

Conclusion

Medication errors remain to be one of the leading causes of death in America, and this is an issue that affects the healthcare system and the patient population. Technology, nonetheless, has proven to be an effective tool in improving the quality of care. It is thus essential to find avenues of integrating technology into the practice of care so that it can help nurses overcome challenges that often lead to medication errors. Already the system of EHR has been supported by various studies to be effective in reducing errors associated with quality care and thus it is time for a healthcare institution to take an active role in integrating EHR into care practice with proper training and guidance to help nurses in applying it in their daily responsibilities that will enhance the quality of care and patient satisfaction.