Medication Administration Errors

Medication Administration Errors
Name
Institution
Due Date
Medication Administration Errors
Introduction
In this study, patient safety problem is the Medication Administration Error (MAE), which ideally should be error-free. Medication administration involves preparation, giving, and documentation of medicines. The administration process is undertaken by nurses who ensure that the right dose of the right drug is actually given to the intended patient at the right schedule time using the right channel (Aronson, 2009). Those charged with the primary responsibility of administering medication are nurses (Hughes & Blegen, 2008). For instance, research by Shane (2015) shows that nurses spend approximately 40% of their work time on medication administration processes. Several health care organisations have adopted different models such as Total Quality Management (TQM), Six Sigma, Plan, and Do, Study, Act (PDSA) including other methods to attain quality improvement (Vickerie, 2017). The rationale behind the choice of the multiple model (PDSA and Kotter’s) approach for this study is because the methodology involved is applicable to healthcare systems and currently adopted by a number of countries such as Australia and the United Kingdom. The Kotter’s approach is a model that comprises the process of leading change that entails establishment of a sense of urgency, creation of a guiding coalition, and development of a change vision as well as incorporation of changes into the culture.
The patients, especially those in the Critical Care Units (CCU) environment, are highly vulnerable to medication administration errors. This is since there are many drugs given intravenously to the patient especially when under critical condition, making it almost impossible to either detect or correct existing errors by patients themselves. It is important to address this topic on Medication administration errors within the paediatric ward especially the Paediatric Intensive Care Unit (PICU) since such an environment seems complex and requires high cognitive knowledge for purposes of making the right decisions. Further, patients who are at critical conditions are considered highly susceptible to the various consequences of errors since there are no chances that they compensate for any additional damage due to low psychological activeness (Bedford & Roughead, 2010).
Intended Improvement
The nature of the situation as described and the speed of such change project, requires the adoption of a multiple approach using the PDSA (Plan, Do, Study, Act) cycle as well as the Kotter’s eight step change model of improvement for the purposes of guiding the change project (Berdot, 2013). The Kotter’s model in our case will help provide a list of eight reasons that are capable of identifying points of failure within the hospital change processes and at the same time proposes a process towards successful organisational change which include the preparation stage, action stage, and then grounding stage.
On the other hand, the PDSA is a cycle that operates on two parts, the first part is considered the thinking part that encompasses 3 key questions which entails the gathering of evidences as well as ideas that concerns required improvements in a project. In this case, the first question helps in the building of knowledge concerning the current practice and the second question provides the guidance needed to choose the right measures that checks the validity of the planned changes. Then the third question focuses on the intensive work towards improvement which links to the second part. The PDSA cycle is crucial since it helps the stakeholders to learn along the process and at the same time apply their knowledge on the successive changes as required. This change plan focuses on the reduction of medication administration errors through such interventions as education, check-ins on a daily basis, and counselling sessions (Bifftu, 2015). This project intends to provide necessary insight into the processes of medication administration errors and the problems associated with these errors within the paediatric intensive care unit (PICU) (Dalmolin, 2013). At the same time I will be providing intervention measures necessary for the improvement of safety amongst patients.
The change model
1 What are we attempting to accomplish?
Several impediments might be discovered in the current practice after the auditing exercise. These may include; first, the use of the wrong kind of medication that defies following any system that could help in identifying each medication within the recommended prescription, therefore, creating chances of nurses giving medication on what they are not aware of or have no knowledge of (Flynn, Llang, Dickson, Xie & Suh, 2012). Secondly, there may be lack of adequate reporting system capable of identifying incidents, and then there is also a lack of regular retrieval of medical data, whereby the medications that require the judgement of the nurses are grouped in a manner that can easily result into confusion. The record sheet used for medication administration might not, at times, incorporate the necessary information that relates to best practice.
How to identify that a change is an improvement
For the purposes of identifying with the change as an improvement, the data will reflect the type as well as the rate of medication error within the organisation. The data will be collected through observation, review of chart, form showing reports on medication error in the change project.
2 Possible changes that could result in an improvement
In this case, it will be a necessity to discontinue the application and use of any wrong prescription, therefore, implementing a system of safe medication administration for the purposes of ensuring safety on medication and compliance with Health Information and Quality Authority (HIQA) standards. Thus, the new practice should incorporate individual supply of resident’s medication in their original packs whereby the medication label includes all details of the recipient, the designing and implementation of the medication incident report (Wang et al., 2016).
Plan stage
This stage entails the aspects of clarifying the objective of the test, including predictions on future happenings and reasons behind such including the development of a possible plan that can test the change. This stage has similarities with the fifth step of Kotter’s change model, which suggests the need for empowering stakeholders within an organisation towards action on the vision (Smith, 2011).
3 Performance/Do stage
At this stage, there is the aspect of carrying out the scheduled plan, which also includes documentation of problems and unprecedented observations and data analysis. This relates so well to Kotter’s sixth step which suggests the need of planning for short-term performance that is visibly capable of triggering the change as well as acknowledging the level of work done by the stakeholders (Smith, 2011).
4 Study stage
This stage relates to Kotter’s seventh step that helps in consolidation of improvements for the purposes of enabling more change. Data was collected based on the agreed objective for testing change. This was done through a review of the chart, a report from the form showing medication error, and the ultimate observation at the end of change project implementation period.
5 Action Stage
This stage involves refining of the intended change based on the procedures of the test. The stage involves institutionalising new approaches, whereby a lot of effort is involved in addressing the problems through redesigning of the handover. Thus, the nurses are required to counter check the clarity in the medication administration records while taking over duties from other nurses for the purposes of ensuring that medications are signed and thorough explanations provided (Johnson et al., 2011).
Context and planning the Intervention
This study will engage all the medical staff at the hospital that includes; doctors, pharmacists, managers, consultants, and nurses working at the PICU. The study will be undertaken across the paediatric intensive care unit that is within a specialist children’s hospital. The hospital cares for children and teenagers up to 16 years of age from all kinds of specialties that include neurology, trauma, burns, infections, cardiac surgery, and oncology. The unit provides one of the largest known PICU and has all forms of therapy that include hemofiltration, cardiac extracorporeal membrane oxygenation and care for level 4 intensive care for children. The nursing workforce comprises of approximately 160 nurses, these include wards manager, nurse managers, nurse consultants, advanced nurse practitioners, senior research nurse, clinical educators, an audit nurse as well as specialist capable of running the PICU course (Hayes et al., 2014).
There are close to ten PICU team members that include consultant intensivists, pharmacists as well as three specialist physiotherapists. There are also a team of doctors approximately 18 on six months rotation that include paediatrics and anaesthetics. All the health care providers as outlined that includes the private, public and voluntary are required to register with HIQA for permission to undertake any health-related duty. The persons in charge at every stage should comply with the Health Act provisions that involve the change in practices, systems, and structure of the hospital environment. In this case, structure refers to environmental conditions under which care is provided, the process entails the different activities the encompass health care such as treatment, diagnosis, prevention as well as patient education (Hughes and Blegen, 2008).
Major stakeholders, opinion leaders and clinical champions and how they would be expected to facilitate or impede the adoption of the plan
In the adoption plan the chief medical officer will help in setting the direction of the organization including guiding the quality improvement as proposed by this plan. Nurses and doctor participants will be required to help identify the internal and external distractions that are common on PICU that affects the whole team. At some point they will be required to exercise control over the common distractions around PICU. The nurses will be required to avoid the aspect on noncompliance with the protocols, specifically in the case that involves two nurses working independently during medication administration.
Measuring best practice
The study will utilise the mixed methods approach to answer the objectives. Both the qualitative and the quantitative methods will be utilised, and these will involve the use of interviews, focus groups, observations of the process of medication administration and the content analysis of the available reflective learning equipment. The use of interviews and discussion groups was very necessary in the collection of primary data. In this case, the quantitative research does not provide an answer for some of the complex questions on facts, measured behaviours, causes, and effects. On the ot...