Role of a Nurse on Patient Medication Safety
Patient safety is an essential discipline in delivering quality services in the healthcare system. It aims at reducing errors, harm, and risks that occur during the provision of services to patients, which is done through continuous improvement and learning from previous errors. A safe environment reduces the length of hospitalization and overall increases patient satisfaction. Patient safety is achieved through accurate medication administration, evidence-based practice, and application of the nursing process. The role of a nurse is to avoid administration errors and recognize adverse effects related to pharmacologic therapy.
Pharmacological errors are one of the leading causes of avoidable harm and injury in the Health Care System. The cost associated with medication errors globally is estimated to be $42 billion annually (Donaldson et al., 2017). According to the Institute of Medicine (2006), 7,000 deaths occur yearly in the United States due to medication errors. Further, the IOM reports that most mistakes happen in the medication process from the prescription to drug administration. This has led to the National wide campaign by the Food and Drug Administration institute for safe medication practices, which aimed at reducing errors such as medical abbreviations that are unclear (Donaldson et al., 2017).
The Rights of Medication and Their Role in Patient Safety
Nurses play an essential role in patient safety when it comes to medication administration. A third of errors in patients’ medication happens in the drug preparation and administration phase, notably a nursing activity (Donaldson et al., 2017). To minimize those mistakes, nurses are taught to practice the seven rights of medication: right dose, right route, right time, right individual, right medication, right expiration date/effect, and right documentation. It is necessary to triple-check the drug to prevent medication errors. The research reported that most deaths occur due to medication errors linked to drug overdose and wrong drugs (Di Simone et al., 2018). The types of errors that violate the seven rights of medication include failing to verify the right patient, ignoring the safety alerts, and giving the medication the wrong route and technique. Ensuring every step is achieved is extremely important because you may have all six steps right, but it only takes 1 to do some severe damage to the patient. It is also essential to determine whether diagnostic tests have been ordered for completion before initiating or continuing therapy (Willihnganz et al., 2019).
Math and Calculations in Drugs Safety
All nurses should be knowledgeable about medication dosage calculations. It is an essential part when it comes to patient safety. Nurses should know how to calculate the dosages accurately by using dimensional analysis, including flow rates, oral dosages, and timed calculations. It is essential to understand various necessary measurements, such as grams to milligrams, understanding ratios, fractions, and converting decimals to fractions during the drug administration process (Kavanagh, 2017). For instance, in a fluid calculation, a nurse may have to calculate the fluid infusion rate in milliliters per hour. There may be circumstances where there is no infusion pump available, and knowing how to calculate gtt/min accurately will be necessary. When it comes to pediatric patients, doses need to be highly individualized; for children, it is usually based on weight, for example, micrograms, milligrams, or grams per kilogram of body weight (Willihnganz et al., 2019). These skills aim to promote accuracy, which is essential in medication error prevention.
Application of the Nursing Process to Ensure Safety
The nursing process is the foundation for nursing’s clinical practice (Willihnganz et al., 2019). It includes patient assessment, nursing diagnosis, planning, intervention, and evaluation. In this approach, nursing actions are based on problem-solving and critical thinking. The nurse critically assesses the patient to collect objective and subjective data. This process starts when the patient is admitted and continues until the patient is discharged (Willihnganz et al., 2019).
During this process, the nurse collects past medication history and existing allergies, which will help manage their conditions properly. The nursing diagnosis (NANDA-1) will help the nurse understand medication therapy goals, manage the existing problems, and prevent future complications (Kavanagh, 2017). The nursing process helps the nurse identify our patients’ safety risks by evaluating drug-to-drug interactions, accident overdosing risk, and drug-disease interventions. It also helps in noting the adverse effects of drugs and antidotes to counter the effects. Also, to evaluate if the patient knows the reasons for taking their medications. Through the Strategic approach, medication errors are prevented, thus enhancing patient safety.
Regulatory and Governing Bodies Role in the Safety of Patients
The Institute Of Medication (IOM)
In 2007, The IOM reported that over 1.5 million patients in America had been injured annually in American hospitals (Donaldson et al., 2017). The report came up with particular healthcare systems, funders, regulators, and providers to improve medication safety. The recommended measures included; electronic prescriptions and dispensation of medication, more research on medication error, and prevention. The IOM recommends specific nurses’ specific measures to ensure medication safety for patients (Donaldson et al., 2017). The recommendations include; establishing environmental safety for drug preparation and administration and documentation such as providing enough lighting. It also recommends, maintenance of a strict commitment culture to safety principles in the medication safety such as accurate math and communication in the drugs administration. Another recommendation was to promote patient caregivers’ involvement in the medication process and monitor for adverse effects, enhance communication and confidence between team members to question medication orders when in doubt, and that nurses should contribute to the implementation of accurate error reporting systems.
North Carolina Board of Nursing.
According to the NC Board of Nursing, nurses are responsible for the safe provision of care to the patients. The board provides medication administration teaching modules to help registered nurses teach the Unlicensed Assistant Personnel (UAP) on forms of medication, routes of medication, and all steps of the technical task of medication administration (Logic, 2020). For instance, the UAP’ s procedure of safe administration of buccal drugs state that; the nurse should put on clean gloves, help the patient in placing the buccal tablet between the cheek and gum, instruct the patient not to swallow and the medication to dissolve and remove and discard the gloves correctly. It also recommends that registered nurses and administrators participate in direct drug administration to patients, assign nursing functions to qualified personnel to monitor patients for adverse effects, and remain accountable to all personnel’s care (North Carolina Board of Nursing, 2014). The nurses should immediately report to the supervisor about the adverse effects and ask for assistance to cab the situation (Lewis & Horne, 2016). The RN and LPN should ensure accuracy in drug administration and nursing procedures, such as counting surgical equipment before and after the procedure and doing timeout before starting the procedures.
Quality and Safety Education for Nurses (QSEN)
QSEN encourages patient pharmacological safety and quality as essential values to guide health professional work. It further defined the values as competent for nursing students’ education. It advises nurses that medication administration is a system-process that needs collaboration with other team members to ensure safe and effective treatment of the patients QSEN also gives a medication administration map for students that guides them in recognizing objective, subjective assessment findings, and laboratory results, for them to administer or withdraw medications (“Medication administration map,” 2020). It also helps students create decision-making and clinical reasoning on administering or withdrawing common medications in acute care settings such as diuretics. For instance, it is common knowledge that nurses are supposed to administer medications via the seven rights of medication and fill the gap in patient assessment and pharmacy knowledge. So through the skills, a nurse may decide to administer a drug such as Lasix to a patient whose CXR has infiltrates, the input is greater than output. The patient has decreased weight of 1kg since admission, has a congestive cough and short breath with a respiration rate of 20, heart rate of 84, and a negative orthostatic pressure blood pressure (“Medication administration map,” 2020). The nurse should practice critical thinking in administering or withdrawing medications by giving reasons and evidence for their decisions. They should also follow principles for basic medications V9 (Quality and Safety Education for Nurses, 2020). As part of the process, the nurse must consider National guidelines, laws, ethics, and cultural determinants of patients before medication administration.
The nurse plays a vital role in patient medication safety and error prevention. Nurses can prevent potential harm before it reaches the patients. This can be done by using the nursing process, adhering to the seven rights of medication administration, and following the National Patient Safety Goals guidelines. Also, educating the patient about the medication and documenting correctly, evaluate patients for potential adverse effects, and report errors immediately for urgent interventions.