Definition Of Medication Administration Errors

A medication administration error can be stated as any specific and un-manageable event which may arise due to wrong use of medicines or uses in patient harms. On the other hand, it can be stated that this error is primarily in control of medical staffs and healthcare professionals (AlBashtawy, 2020). In other words, it can be stated that medication administration errors occur in vicinity of medical professionals only. This error can also occur throughout the medication use system also. The FDA has stated various ways of preventing medication errors (StatesMcCall et al., 2019). However, these methods are only for helping the medical professionals and healthcare providers, administer the right drug to the specific patient. As per the statistical data obtained from FDA, it can be stated that more than 100,000 reports of errors in healthcare service delivery are related to FDA (Kane-Gill et al., 2017). The dose labels on the drug containers should be specifically mentioned in order to help the medical professionals in identifying the specific doses of the medicines, to be administered for the patient.

Medical errors have been found to be a serious public health issue and also cause deaths of patients (Giannetta et al., 2020). This factor has been found to be very challenging to uncover the consistent of error causes and to provide a specifically consistent viable solution which minimizes the recurrent event chances (Elliott Elliott et al., 2018). The part of solution is for maintaining the culture which works towards the safety challenges recognition and implementation of viable solutions rather than harbouring the culture of punishment, shame and blame. Errors of omission can be stated to occur mostly in post-surgical wards and in may times, several actions cannot be undertaken (Farnese et al., 2018). The fear of punishment has been found to make healthcare professionals reluctant to the reporting of errors. Clinicians have been found to equate errors as well as failures associated with breaching of public trust and with patient harming in-spite of their mandate of doing not harm (AlBashtawy, 2020).

Sometimes, it has been observed that post-surgical medication administration errors are not reported by the medical staffs. This is due to their fear of punishment and thus the activity goes unnoticed for a long period of time (Giannetta et al., 2020). In other words, it can be stated that since this is a serious issue, it needs to be dealt with strong hands in the surgical wards. Post-surgical wards have been found to be associated with patients, who are at a high risk of developing infections. The post-surgical infections have mainly been found to occur in patients who have undergone surgery in the last two days (AlBashtawy et al., 2020). Thus, to prevent these types of hospital developed infections, the administrations of medications can be significant. In other words, it can be said that the present research study will be focussed on decreasing the medication administration errors in the post-surgical sectors of a hospital (Elliott et al., 2018). The present research study will thus focus on finding the best way to reduce medication error in order to prevent higher number of post-surgical patients from suffering due to wrong medication error administration.  Medication Administration Errors In Post-Surgical Wards Discussion Paper

Prevention Of Medication Errors By FDA

A medication administration error is defined as any particular and avoidable incident that occurs as a result of improper pharmaceutical usage or use in patient harm. On the other hand, medical personnel and healthcare professionals are mostly responsible for this inaccuracy. To put it another way, pharmaceutical administration mistakes only happen in the presence of medical personnel. This mistake can occur anywhere in the pharmaceutical administration system (Hammoudi, Ismaile& Abu Yahya, 2018). The Food and Drug Administration (FDA) has listed many methods for reducing drug mistakes. These approaches, on the other hand, are exclusively intended to assist medical experts and healthcare providers in administering the appropriate medicine to a given patient. Medical staffs have been detected not reporting post-surgical drug delivery problems on occasion. Because they are afraid of being punished, their behaviour stays unreported for a long time. To put it another way, because this is a significant problem, it must be dealt with by strong hands in the surgical wards. Patients who are at a greater risk of infection have been found to be related with post-surgical wards (Di Simone et al., 2019). Patients who have had surgery within the prior two days are more likely to develop post-surgical infections (Di Simone et al., 2019). As a result, the prescription of drugs to prevent various forms of hospital-acquired infections might be considerable. Thus, it can be stated that there is an urgent need of a quality improvement or QI plan, in order to reduce or decrease medication administration errors in the post surgicalwards of a hospital.

QI plans in nursing have been found to be associated with a specific framework, which guides the improvement process for any part of the work, whose quality needs to be increased. In other words, it can be said that CQI or the Continuous Quality Improvement is a CQI or a quality management process which encourages various healthcare teams for continuously asking questions on what is being done and how can it be done better (Elliott et al., 2018). The quality improvement plan has been given below –

The main reason behind the needed change is associated with the fact that medication administration errors have increased since 2015 (Pevnick et al., 2018). A research study from 2020, has reported that the nurses in Ethiopia, were associated with medication administration error prevention. However, despite their intentions, 70% of the nurses have reported of medication administration errors in the post-surgical wards (Senders, 2018). Medical staffs have been detected not reporting post-surgical drug delivery problems on occasion. Because they are afraid of being punished, their behaviour stays unreported for a long time. To put it another way, because this is a significant problem, it must be dealt with by strong hands in the surgical wards. Patients who are at a greater risk of infection have been found to be related with post-surgical wards. Patients who have had surgery within the prior two days are more likely to develop post-surgical infections. As a result, the prescription of drugs to prevent various forms of hospital-acquired infections might be considerable (Perotti et al., 2020).A major driver for the quality improvement plan will be the hiked medication administration errors in the post surgical wards. Thus, it can be said that the necessity to introduce a quality improvement plan is needed for the post-surgical ward in the hospital.

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Incidence Of Unreported Medication Administration Errors In Post-Surgical Wards

Decrease in medication administration errors in the selected post-surgical department is needed. In other words, there is a hiked percentage of medication errors which have been found to occur in the post-surgical departments (Shahid,Rappon& Berta, 2019). These sectors of the hospital have been found to deal with the most delicate and compromised patients of all. Moreover, it can be said that the patients, belonging to the post-surgical wards are already associated with various surgical techniques which leads to blood loss and finally the immune system is compromised (Rutledge, Retrofit& Ostrowski, 2018). This condition exposes the patients towards various nosocomial infection agents or pathogens which come via the air of facilities of the hospital. Thus, the requirement of medication administration reduction is a must. For example, nurse and medical staff literacy levels should be improved. Tshiamo et al., (2016) has shown that education has a major role to play in the prevention of medication errors. They have highlighted the fact that medication error prevention education and knowledge are to be implemented in order to prevent future medication errors in the post surgical wards. On a condition where the nurses have high levels of knowledge about medication errors, they will be less vulnerable to committing medication errors in the post surgical wards. Based on the above statements, it has been stated in the research study, in Botswana, nurses are already exposed to multiple types of medication error prevention education. Both acute and primary care settings were found to be associated with taking part in prescription transcription, dispensing and administration of medication. Therefore, it can be said that taking part in pre-service nursing education should ensure that the students are already equipped with skills and knowledge on the management of medication and prevention of errors in medication as well as prepare them for safer practice (Tshiamo et al., 2016). Another research study has shown that high workforce also leads to medication errors in post surgical wards. This is because of the fact that when a nurse has to manage multiple patients at a time, medication error in a patient is bound to occur (Kane-Gill et al., 2017). Similarly, when a nurse has less knowledge about the dosage range of a medication, medication administration oriented errors are bound to occur (Lyons et al., 2018). Based on the above statement, it has been observed that nurses commit medication errors due to their low literacy and knowledge levels on drugs and their doses (Hammoudi, Ismaile & Abu Yahya, 2018). Therefore, it can be stated that this type of change is needed in order to reduce the medication administration errors in the selected post surgical department.

As per the recent statistics, 70% of the errors associated with the medication of post surgical patients are administration related (Giannetta et al., 2019). Thus, this percentage needs to be reduced to the maximum value possible. A research article from The Harvard Gazetter has proved that adverse drug reactions occur in the second operation. Five percent of the patients experience drug administration based adverse events. The research study comprised of 275 operations and found that a third of the errors resulted in the development of an adverse drug event which caused harm to the patient. Another research from this organisation has proved that one in twenty perioperative medication administrations did result in the adverse drug based medication error event (Harvard Gazetter, 2022). According to an article of Mozes, (2015), medication errors or adverse events of drug was specifically documented in 124 out of 277 surgeries. One ninety three medication errors were observed out of 3675 medication administrations according to another Harvard research (Mozes, 2015). The researcher has shown that 80% of the events associated with medication errors were preventable (Mozes, 2015). Another research has proved that every 3^rd surgery out of 277 operations in MGH or Massachusetts General Hospital found, resulted in post surgical infections due to medication errors (HealthManagement). Therefore, the cumulative percentages of medication errors in post surgical wards were found to be moderate (5% to 30%). Therefore, the aim of this QI proposal will be to reduce the percentages of medication errors in post surgical wards, from the percentages as given above.

The Need To Reduce Medication Administration Errors In Post-Surgical Wards

The stakeholders of a surgical care include hospital administration, surgeons, OR nurses, patients and medical staffs. The medication administration errors have been found mainly to be associated with the nurses and medical staffs (Pevnick et al., 2018). This is because of the fact that they are associated with medication administration and the administered medications are dependent on the medical staffs as well as the nurses only. In other words, it can be stated that the stakeholders responsible for bringing the change will be led by nurses and medical staffs. However, it can be said that the hospital administration also has a major role to play here. They have to permit the usage of every process that is targeted to the decrease in medication errors (AlBashtawy et al., 2020). They also have to support the use of various theoretical and practical techniques as training methods for the nurses and medical staffs associated with the medication process. The stakeholders responsible for the change can also be stated to belong to the class of drivers associated with the quality proposal.

As per the evidences, nurse literacy rates, less knowledge of dosage ranges, workforce, problems with medicine storage as well as supply and the problems with various equipments associated with wards. These changes are needed because of the fact that they will be directly associated with the reduction of medication administration errors inside the surgical ward, in patients after the surgical process has been completed (Mira, 2019). The strategies for the implementation of these changes have been given in the following section.

A small, local and low financial cost based strategic plan will be devised in order to bring about the change of reducing medication errors in the post surgical wards (Shahid, Rappon& Berta, 2019). For the change strategy, only newly qualified nurses will be considered. This is because of the fact that they are inexperienced and are more prone to committing medication errors, at higher rates than the already working staff nurses. The change strategy will be included with the normal training process of the newly qualified nurses so that extra resources are not needed for this new strategy training process. The types of strategies will include presentation and specific group activities associated with medication doses and administration trainings. Therefore, it can be said that the overall financial effect on the employer will be less since only newly qualified nurses are subjected to the training process and no new or extra resources are utilised in the process.

According to Musharyanti et al., (2019), it can be said that nursing students mostly commit medication errors. They are also known as newly qualified nurses and are in the student phase only. There are some major factors which contribute to the cause of medication errors by nurses. These factors are lack of knowledge, proper supervision, skills and appropriate role models while clinical rotations leads to the occurrence of medication errors by the students or nursing. In other words, it can be said that the nurses play a major role in the administration of selected drugs to a patient. Thus, the nurses have been selected as the primary targets of the quality improvement technique. The nurses have been found to play a major role in the medication administration errors and thus the above stated types of training techniques can be stated to be the best methods. These types of medication administration errors have been reported in another research study also (Farnese et al., 2018). Thus, the strategies for change implementation can be stated to be justified.

QI Plan In Nursing

The main percentage of change that can be expected from the implementation of the above stated quality improvement plan can be stated to be 15% (Hammoudi, Ismaile& Abu Yahya, 2018). This means that the percentage is expected to be reduced to 5% in a year. This is because of the fact that a major decrease in medication administration errors can be expected if the training processes are followed. The same percentage of medication error reduction was observed in another research study, where the effects of medication administration trainings on medication administration error reduction was analyzed (Lyons et al., 2018). A regression analysis has shown that as the impact of medication administration trainings increase, the medication administration errors were found to decrease (Rutledge, Retrosi& Ostrowski, 2018). So, the two above stated variables can be stated to have inverse relationship between each other.

The sustainability policies are specific measures which are associated with the achievement of desired goals of a quality improvement plan. As per the NHS policy information, the policy known as the Patient Safety Alert (Stage Three: Directive: Improving medication error incident reporting and learning). The policy was implemented in March 2014 (Morton et al., 2018). This policy was implemented by the NHS in order to reduce or remove the medication administration errors from any of the existing wards in a hospital sector (Perotti et al., 2019). The policy is also associated with the reporting of every medication error which occurs in the post surgical departments. The quality of a process is associated with the sustainability of the process also. Higher the quality of a process, higher will be the sustainability of the process.

The quality drivers have been found to play a major role in the healthcare process and include the families and patients, governmental regulations and professional organisations as well as facility leadership and payers. Free services are a major driver of every change in a healthcare service (Roumeliotis et al., 2019). In other words, it can be said that once a service is free of cost, it is expected to be well availed by all. The participation of nurses and their motive in reducing the medication administration errors are the major driving factors of the project. Since, if active collaboration from every nurse of a hospital service is not received, the quality improvement proposal (Inge et al., 2019), cannot be implemented. On the other hand, the drivers of QI proposals are the organisational as well as the governmental policies itself. The drivers of QI proposal have been found to be one of the best medication administration error reduction policies, which have been described above (Sinha & Welch., 2012). According to Sinha & Welch, (2012), it can be said that there are many financial, social and patient centred factors which play a major role in QI proposal implementation. For this QI proposal, financial factors play a major role in the success of the process. This is because of the fact that very less or no extra financial charges are to be bared by the employer. Thus, finance is one of the major drivers of this QI plan.  These policies have been found to play a major role in driving the new QI plan for medication administration reduction. On the other hand, the payers play a major role in providing monetary support for the implementation of a quality improvement technique. In other words, it can be said that the major drivers of the QI proposal are directly associated with the implementation and running of the quality improvement technique (Kane-Gil et al., 2017). However, it can be said that the active participation of nurses and medical staffs may not always be expected due to the heavy workforce in surgical wards. Medication Administration Errors In Post-Surgical Wards Discussion Paper This factor can be stated to be a major barrier to the drivers of the quality improvement plans (Elliott et al., 2018). In other words, it can be concluded that every QI technique is associated with some major barriers, which needs to be overruled in order to perform a successful implementation of QI project.

External Factors Affecting Medication Errors In Post-Surgical Wards

Answer – Critical analysis of the leadership as well as the change management approaches for planned implementation of the quality improvement proposal

A drug administration error is any specific and preventable event that happens as a result of inappropriate pharmaceutical use or use that causes patient harm. Medical workers and healthcare professionals, on the other hand, are mostly to blame for this error. To put it another way, problems in pharmaceutical administration only occur when medical staff are present. This error can happen at any point in the pharmacological administration process. Many approaches for decreasing medication errors have been mentioned by the Food and Drug Administration (FDA) (Senders, 2018). These methods, on the other hand, are only designed to aid medical professionals and healthcare providers in providing the proper medicine to a patient.Medical mistakes have been identified as a severe public health hazard that also results in patient mortality. This element has been proven to be extremely difficult to find consistent mistake causes and propose a precisely consistent viable remedy that reduces the likelihood of recurring events. Maintaining a culture that works toward recognising and implementing feasible solutions to safety concerns, rather than harbouring a culture of retribution, guilt, and blame, is a component of the answer. Omission errors are particularly common in post-surgical wards, and in many cases, multiple acts are not possible (Farnese et al., 2018). Healthcare staff have been observed to be hesitant to disclose errors due to fear of penalty.Patients who are at a greater risk of infection have been found to be related with post-surgical wards. Patients who have had surgery within the prior two days are more likely to develop post-surgical infections. As a result, the prescription of drugs to prevent various forms of hospital-acquired infections might be considerable (Marsh et al., 2018). To put it another way, the current quality improvement proposal will be focused on reducing medicine delivery mistakes at a hospital’s post-surgical departments. As a result, the current research project will concentrate on determining the optimum method for reducing medication errors in order to avoid a greater number of post-surgical patients from suffering as a result of incorrect drug administration.

The theory of transformational leadership has been found given by James Macgregor Burns (Givens, 2008). This name is famous for coning the term transformational leadership. The theory was found to be given by previous researchers also, but was not described, as done by Burns. According to a research study, Transformation leadership is one of the best styles of leadership, for bringing a change in a work process (reduction of medication errors in post surgical wards) (Van Cott, 2018). This is because of the fact that this leadership style allows the leader to make decisions on a collaborative manner, where the employees (nurses) are also consulted for the decision. The leadership style also motivates the employees in order to participate in the change management plan. The style of leadership also empowers the employees in order to work for the reduction of medication errors in post surgical wards. The theory was found to distinguish transformational leader as a leader who describes the qualities and behaviours, which a leader can develop.

The problem associated with the present scenario has been found to be the medication error among the post surgical patients across the healthcare services in the selected country. Since, medication administration errors, were found to be very high, it can be said that a leadership support is needed in order to reduce the same (Senders et al., 2018). Transformational leadership can be stated to be the best strategy for this scenario. This is because of the fact that the previous strategies of punishment and laws as well as guidelines were not effective in controlling the prevalence of medication administration errors in post surgical wards.

The leader associated with the change needed in the healthcare organisation follows the transformational leadership theory (Givens, 2008). The transformational leader is well known for causing major changes in an organisation. The empowerment as well as development of employees in the organisation are the core features of transformational leadership (AlBastawy, 2020). Since, it has been observed that the teaching and training of the staffs are an effective stage of the change management plan, transformational leadership can be stated to be the best theory, which can be followed for this organisation (Giannetta et al., 2020). Nurse Managers have been found to play a major role in the implementation of transformational leadership in post surgical wards, for the reduction of medication errors.

The researchers can specifically study how various leadership strategies of nurse managers can have a direct effect on the error rates. However, it has been observed that the decreased medication administration errors rates are mainly associated with the transformational leadership. This leadership style can be stated to be the best strategy for controlling medication administration errors in the post surgical wards (AlBashtawy, 2020). As per information obtained from the previous research studies, it can be said that transformational leadership can also utilised EMR or electronic medical records for accessing the medicine names and dosage values, before they can administer. This is a specific example for the fact that transformational leadership, on the line to bring a reduction in medication errors in a surgical ward. Transformational leadership has been found to be associated with the relationship between the knowledge of nurses and training levels associated with medication errors (Rodziewicz, Houseman & Hipskind, 2018). The researchers have been found to identify the training deficiency and the education, provided to nursing preceptors, were found to be effective in reducing medication errors in the postsurgical wards. Previous research studies have been found to show that the nurses are mainly responsible for performing medication errors, due to lower literacy rates.

Since, the change management plan has been found to be associated with training all the healthcare staffs, responsible administration medicines in the post-surgical wards. In other words, it can be said that medication administration has been first targeted to be reduced, by the implementation of a quality improvement plan. Since, this process will improve the quality of care in post-surgical wards, it can be stated that the transformational leadership will be effective in reducing medication errors (Rodziewicz, Houseman &Hipskind, 2018). The transformational leadership will keep the nurses and healthcare staffs motivated as well at a higher literacy level, where they will have less changes in compromising the quality of care delivered in the post-surgical wards. Since the staffs will be provided training, in order to reduce medication errors, it can be stated that the use of transformational leadership will be perfect.

The change management model which has to be followed for this QI plan is Lewin’s Change Management Model. This is a specific and comprehensive change model, which aims at understanding why change occurs and what can be done to deliver change in a smooth way. According to the change management model, there are three stages – Unfreeze, Change and Refreeze. In the first stage, the already existing processes will be cut down and dismantled (Hussain et al., 2018). For this QI proposal, the way in which the newly qualified nurses were trained will be changed and therefore will be subjected to alterations. Then, the alterations in the training process will be implemented as discussed before. However, it is not always the fact that the change will be accepted by the existing employees. Thus, transformational leadership has a major role to play here. By this leadership style, a leader will empower and motivate the employees to participant in and accept the change. However, there are two major factors which play a key role in bringing out change in an organisation by using Lewin’s Change Management Model – Time and Communication (Thomson et al., 2016). Since, the QI proposal is small and local with minimal financial cost requirement, time and communication should never be an issue in this case. Finally, in the last stage, that is after the changes are taking place, the whole process will take a new shape where the employees will embrace a new way of working and lead to a reduction of medication error in the post surgical wards.

The barriers of a process have been found to be associated with the non-clinical measures and also the focus on external accountability. Perception of barriers to QI by health professionals have been found to be the most significant cons of systems. QI was specifically described as the avoidance of quality degradation apart from the improvement of quality. The same has been found to include the funding lacking, staff training lacking and lack of management as well as support and lack of leadership also (Lyons et al., 2018). Poor communication has been found to be associated with the resistance to change as well as lack of data systems as well as infrastructure analytics. The main issue with the present state of problem in the healthcare service in the post-surgical wards is convincing people that there is a major problem and also getting the collection as well as monitoring systems in the right way. Since the leadership associated with this QI plan, is mainly related to staff training in order to reduce medication administration errors. In other words, it can be said that the QI plan, is successful only when the barriers will be removed. Transformational leadership is the best leadership style, which is associated with the increase in cooperation and collaboration among the employees (Marsh et al., 2018). The QI plan comprises of staff training in the post-surgical medication departments. The transformational leadership will be beneficial for the quality improvement plan since it will allow the increase of cooperation as well as collaboration in the department in order to reduce medication administration errors. In other words, it can be said that the change management plan will be beneficial for the improvement in staff knowledge as well as practical applicability, so that they are not committing same mistakes in future.

The enablers of the QI plan have many sections, starting from the hospital infrastructure and ending at the perspectives of healthcare providers, in reducing medication errors. The enablers of QI project will include the evaluation of the patients also – the level to which medication errors have been reduced. Both patient feedback and performance measurement will be the enablers of the current QI project for medication administration error reduction (AlBashtawy,2020). These enablers will be beneficial for the successful running of the quality improvement plan. In other words, it can be said that the quality improvement project will be associated with numerous problems, measures, goals and aim also. The regular evaluation of the nurses as well the patients will show whether the QI plan was beneficial in the reduction of medication administration errors or not. The largest enablers are associated with the proactive participation of nurses and other medication staffs in the post-surgical wards. In other words, it can be said that, the QI plan will help in the improvement of care quality and will also lead to the decrease in medication errors. This decrease in medication administration errors will lead to a direct improvement in quality of the patient care, provided by the healthcare service.

Part 9: ReferencesAlBashtawy, M. (2020). Barriers to reporting medication errors among nurses: A review paper. EC Psychology and Psychiatry, 9, 02-06.https://www.researchgate.net/profile/Mohammad_Suliman2/publication/343050087_Barriers_to_Reporting_Medication_Errors_among_Nurses_A_Review_Paper/links/5f135bb392851c1eff1c2cfc/Barriers-to-Reporting-Medication-Errors-among-Nurses-A-Review-Paper.pdf

Di Simone, E., Giannetta, N., Auddino, F., Cicotto, A., Grilli, D., & Di Muzio, M. (2018). Medication errors in the emergency department: knowledge, attitude, behavior, and training needs of nurses. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine, 22(5), 346.

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Elliott, R. A., Camacho, E., Jankovic, D., Sculpher, M. J., &Faria, R. (2021). Economic analysis of the prevalence and clinical and economic burden of medication error in England. BMJ Quality & Safety, 30(2), 96-105.

https://pubmed.ncbi.nlm.nih.gov/32527980/

Elliott, R., Camacho, E., Campbell, F., Jankovic, D., St James, M. M., Kaltenthaler, E., … &Faria, R. (2018). Prevalence and economic burden of medication errors in the NHS in England. Rapid evidence synthesis and economic analysis of the prevalence and burden of medication error in the UK.

https://pubmed.ncbi.nlm.nih.gov/32527980/

Farnese, M. L., Zaghini, F., Caruso, R., Fida, R., Romagnoli, M., & Sili, A. (2018). Managing care errors in the wards: The contribution of authentic leadership and error management culture. Leadership & Organization Development Journal.

https://pubmed.ncbi.nlm.nih.gov/32432782/

Giannetta, N., Dionisi, S., Cassar, M., Trapani, J., Renzi, E., Di Simone, E., & Di Muzio, M. (2020). Measuring knowledge, attitudes and behaviour of nurses in medication management: cross-cultural comparisons in Italy and Malta.  Medication Administration Errors In Post-Surgical Wards Discussion Paper