Medication Administration Errors as a Result of Human Behavior

The general failure of healthcare institutions across the globe to ensure patient safety motivates the study by Parry, Barriball, and While (2015). The study notes that the issue of medication administration errors - the most prevalent cause of morbidity and mortality in the healthcare environment – has achieved priority status within the broader concern of patient safety. The study, however, notes that the rates of medication errors remain intolerably high despite the elevated attention the healthcare industry has given the issue. Parry, Barriball, and While (2015) investigate the cause of the healthcare problem. Their study focuses its investigation to Registered Nurses (RNs) because their role as the primary providers of care imposes on them considerable influence over patient safety. The research investigation pivots on the fact that professional nursing standards require RNs to be accountable for their acts of omissions or commission that may lead to medication administration errors. The research hence proposes that exploring medication administration errors as a consequence of human behavior rather than as isolated events could provide significant insight into the factors that contribute to the failure to ensure patient safety.

Reason for Selecting the Article

            A medication error nearly resulted in a fatal outcome for a patient when I was working as a volunteer in an emergency department. The patient was brought into the trauma room after experiencing anaphylaxis. They reported severe pain in their chest, limbs, and head before losing consciousness. Upon recovery, they reported an intense headache and nausea. Subsequent investigations on the patient’s health condition revealed that the symptoms were the consequence of an injection of epinephrine which the attending nurse had administered intravenously directly into the patient’s heart. Standard procedure, on the contrary, required that a patient experiencing an extreme allergic reaction receive an injection of the potent epinephrine to the thigh muscle – not the heart. The patient suffered minor but reversible damages to the heart as a result. Indeed, epinephrine should not be among the body of drugs that nurses are most likely to commit errors in its issuance. The incident activated my interest to understand why such was the case during my practical experience. The article by Parry, Barriball, and While (2015) seemed a reasonable choice that could provide answers to the curious case of the incorrect administration of epinephrine.

Pros and Cons of the Article

Pros

            The review adopts a perspective that is different from that of inherent to the existing body of research concerning the medication errors. Parry, Barriball, and While (2015) observe that research on the subject matter has consistently focused on the role of healthcare institutions. However, the excessive focus on institutions has limited opportunities for the examination of other potential factors that could explain the source of errors in the administration of medication. The study hence introduces a new approach with the incorporation of Bandura’s theory of reciprocal determinism as the organizing framework. The method presumes that the interplay between the environment, the person, and their behavior in the healthcare context ought to be considered as a factor necessary for understanding the source of medication errors. It is against this background that the researchers assert the article’s hypothesis that such errors are the consequence of the Registered Nurse behavior. The unique approach is the article’s primary strength since it precipitates a comprehensive investigation into a factor that stakeholders in the healthcare industry might have missed by relying on the inadequate current body of research on medication administration. 

Cons

            Parry, Barriball, and While (2015) admit to several limitations that diminish the reliability of their study.         Firstly, the review relies exclusively on research papers written in the English language. The implication is that the researchers fail to consider the findings of other non-English research publications that could have potentially influenced their conclusions and recommendations. Secondly, the study – in as much as it consults a worldwide collection of research – relies on research that conducted in countries with developed healthcare systems. It is possible that Parry, Barriball, and While’s (2015) address of the issue of medication administration errors could be least relevant or even irrelevant to countries with under-developed healthcare systems. Thirdly, the review relied on articles with varied definitions of the term “medication administration errors.” The lack of a standard operating definition of the term implies that the researchers might have been biased in the selection of the research they reviewed.

Results of Research

            The review examined 26 studies drawn from multiple countries with a predominant focus on Europe and North America to emphasize the global importance of concerns regarding medication errors. The study treated medication administration errors as an outcome of RN nursing behavior. The domains of the person and the environment were then used to process the research findings. Two themes – clinical activity and the type and disposition of the working environment were identified as the prevalent themes within the domain of the environment. Regarding clinical activity, the review found that workload, patient characteristics, and interruptions and distractions were the main contributors to medication administration errors. RN workload was found to be a significant factor since the articles under review shared the consensus the association between high patient-to-RN ratios and increased opportunities for the occurrence of medication administration errors.  It was also found that higher patient acuity and levels of care elevated the presence of errors. The study also observed that interruptions and distraction increase the chances of mistakes in the administration of intravenous medication. However, it was found that the RN staffing mix had a different effect on the occurrence of errors; hospitals with relatively less RNs staff experienced fewer incidences of medication administration errors.

The type and disposition of the working environment involved an investigation of two sub-themes – RN fatigue and the perceived quality of working life.  RN fatigue was shown to be a significant factor with the observation nurses who worked for more than 12.5 hours experienced fatigue levels that doubled the risk of committing medication administration errors.  Regarding the perceived quality of working life, it was shown that RN who were least satisfied with their work, showed low morale, and those who demonstrated high stress levels were most likely to commit errors.

Key Learning Points

            The key takeaway from the research is that RNs play a more vital role than the institutions they serve in enhancing patient safety outcomes. RNs are at the forefront in the provision of in their capacity as primary caregivers. They are, therefore, to best suited to promote patient safety especially with regard the provision of medication. Parry, Barriball, and While (2015) have indeed demonstrated that RNs, therefore, ought to be most accountable party in the whenever issues errors in the administration of medication occur.

Implications for Nursing Practice or Client Teaching

            The study’s findings have significant implications in the contexts of nursing practice and clinical teaching. In the context of nursing practice, it is essential to appreciate that RNs are best positioned to facilitate higher standards of patient safety. Therefore, it is imperative that hospital administrators consider implementing optimal patient-to-RN ratios and ideal working hours to reduce the workload and to create less demanding working environments that would diminish the chances for medication administration errors. RNs involved with the provision of direct care also ought to be more attentive when issuing intravenous medication.  Similarly, it would seem imperative that RNs at least enhance the levels of collaboration with clients to inform them of their role in helping nurses avoid errors.

References

Parry, A. M., Barriball, K. L., & While, A. E. (2015). Factors contributing to Registered Nurse medication administration error: A narrative review. International journal of nursing studies, 52(1), 403-420.