Literature_Review_on_Medication_Errors

Introduction Medication administration is a complex process involving a myriad of individuals in an increasingly fast-paced and fragmented health care environment. Medication errors have been identified as the most common type of error affecting the safety of patients and the most common single preventable cause of adverse events (National Medicines Information Centre 2001). Barker et al (2002) found that medication errors occur in approximately one out of every five doses in a typical hospital, with Scott (2002) reporting a 500% rise in drug errors over the previous decade. This led to approximately 1200 deaths in England and Wales in 2001 occurring as a result of drug errors alone. Drug errors have been found to occur in 49% of drug administration procedures (Taxis & Barber 2003a). However, administration is only one part of the medication management process, and such errors may occur as a consequence of errors in other aspects of the medication process such as selection, procurement, storage, prescribing, ordering and transcribing (Fijn et al 2002, The Joint Commission 2007). Attempts to document the nature of medication errors are evident in the literature (O_Shea 1999, Armitage & Knapman 2003, Lasseter & Warnick 2003, McBride-Henry & Foureur 2006, Fry & Dacey 2007a,b). Medication errors A medication error has been described as a “deviation from a physician order” (Mayo & Duncan 2004). An alternative definition is ‘a preventable mistake in prescribing or delivering medication to patients’ (Lasseter & Warnick 2003). National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP 2007) definition is. “A medication error is 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 labelling, packaging, and nomenclature; compounding; dispensing; distribution; administration; education; monitoring; and use.” The review Aim The aim of the review is to explore the empirical literature on medication errors to identify the factor that contribute to medication errors and the implications for nursing practice. Rationale Search Method The review was conducted using the following electronic databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Medline, Science Direct, InterNurse and British Nursing Index (BNI) databases were used to search the literature for this review. Search terms included medication errors, nurse/nurses/nursing (truncation was used to produce words with similar endings), medication errors, medication administration, medication rounds, drug and mathematical skills, medication management, reporting medication errors were used as well as a combination of terms. Initial search limitations included: the past five years, research only, peer reviewed, English only and UK and Ireland journals only. However, the introduction of these limitations often produced too few results, so it was considered necessary to broaden the search to get a wider perspective of the evidence on the topic. Since medication administration is a universal nursing task, with similar issues emerging in the literature from various countries, it was thought that some non-UK research could be transferable to the UK perspective. Research that is more than five years old has also been included where it was considered to be seminal or useful to provide a background to the discussion. Medication administration is a fundamental task widely undertaken by nurses, and is underpinned by legal and professional requirements (Griffith et al 2003, Nursing and Midwifery Council (NMC) 2007). Drug administration is predominately a nursing responsibility. In England and Wales, one in ten medication administrations results in error (National Patient Safety Agency (NPSA) 2007). NPSA (2007) statistics show that 59.3% of errors occur during the administration stage. Such errors must be a key concern for nurses, who are largely responsible for the administration of medications (O’Shea 1999, Anderson and Webster 2001). This has become particularly relevant in the past ten years as the ‘drug round’ has become more complex as a result of the increasing number of medications available and new routes of administration (Tang et al 2007). There is uncertainty and differences in interpretations among staff as to what constitutes a drug error, which obscures the evaluation of causes (Gladstone 1995, Baker 1997, Mayo & Duncan 2004). Results There are many viewpoints in the literature regarding the main causes of medication administration errors (Carlton and Blegen 2006). One major viewpoint that is evident in the literature is that the nurse is considered to be the key ‘faulty’ component in the medication process and much of the literature refers to nurses’ poor calculation competency, poor adherence to protocols, poor knowledge of medications and complacency as important causes (O’ Shea 1999, Preston 2004, Castledine 2005). This is regarded as a ‘person-centred’ approach to explaining errors (Reason 2000). The factors that contribute to medical errors are complex and multifaceted, but can generally be divided into Other contributing factors are also important. Some authors state that healthcare organisations should consider errors to be the result of a faulty system (Anderson and Webster 2001, Milliganand Dennis 2005). Under this ‘systems’ approach, a series of failures combine to cause an error. This is often referred to as the ‘Swiss Cheese Model’ of error (Reason 2000, Fry and Dacey 2007a), in which each failure is described as a ‘hole in the cheese’; an error occurs when these holes join up to form a channel. The systems approach takes into account underlying causal factors including distractions and time pressures. Other underlying system factors may include medical professionals’ poor handwriting (Mayo and Duncan 2004, Fry and Dacey 2007b) or similar medication packaging (Garnerin et al 2007), but these will not be discussed in detail as they are not within the scope of this article.