Medication Errors and Reducing Interventions: A Mixed Study in a Teaching Hospital
-
Serajaddin Gray
,
Mohammad Effatpanah
,
Sara Salehi
,
Siamand Anvari Savojbalaghi
,
Leila Momeni
,
Roghayeh Abedi Gilavandani
,
Alireza Abbasi Chaleshtari
Abstract
Background: Given the special importance of preventing from medication, the present study aimed to investigate the determining Causes of Medication Errors (CMEs) and their Priorities for reducing interventions in a hospital.Methods: The present mixed, sequential and cross-sectional study was conducted in a teaching hospital (2016). For data collection, Fishbone Diagrams, interviews, note taking and checklists were used, and qualitative data were analyzed though the thematic approach. Moreover, the Maxqda Software v.14.0, Excel, Edraw Max v.9.0 were employed for data analysis and reporting.Results: Seventy-five CMEs were classified under two main themes (human and non-human) and four sub-themes (personal, network, organizational, and meta-organizational). Weakness of professionalism and low experience as the personal causes; Actions of pharmacy colleagues, physicians and other nurses as the network causes; Management of nurses and unit specialty as the organizational causes and the quality of academic education, drug features and macro policies of medication as meta-organizational causes were classified. Six causes were given priority for reducing interventions.Conclusion: In the short term, human factors should be considered with the aim of reducing medication errors. It is also recommended that teaching how to deal with nurses’ stress and psychological pressure (especially beginner nurse), resulting from critically ill patients and high workload, be paid special attention. Besides, it is suggested that professionalism be given priority to reduce personal neglects and to create safe environments for reporting personal neglects. In addition, more emphasis should be placed on the right route in the process of medication administration.
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34. Tang FI, Sheu SJ, Yu S, Wei IL, Chen CH. Nurses relate the contributing factors involved in medication errors. J Clin Nurs 2007;16(3):447-57.
35. Hajbaghery MA, Salsali M. A model for empowerment of nursing in Iran. BMC Health Serv Res 2005;5(1):24.
36. Hansen LB. Medication Errors. Am J Pharm Educ 2007;71(3):59.
37. Mirsaeid G, Javad S, Mirzaie M, Haghshenas E, Dargahi H. Human resources distribution among Tehran university of Medical Sciences Hospitals. Journal of Payavard Salamat 2014;7(5):432-446.
38. Dashti E, Rassouli M, Khanali Mojen L, Puorhoseingholi A, Shirinabady Farahani A. Patient-to-nurse staffing ratios and its outcomes on nurses and premature infants in NICUs. Quarterly Journal of Nursing Management 2015;4(2):39-48.
39. Berry L, Curry P. Nursing workload and patient care: Understanding the value of nurses, the effects of excessive workload, and how nurse-patient ratios and dynamic staffing models can help. Ottawa: Canadian Federation of Nurses Unions; 2013.
40. Vahey DC, Aiken LH, Sloane DM, Clarke SP, Vargas D. Nurse burnout and patient satisfaction. Med Care 2004;42(2 Suppl):II57-66.
41. Wang Hf, Jin Jf, Feng Xq, et al. Quality improvements in decreasing medication administration errors made by nursing staff in an academic medical center hospital: a trend analysis during the journey to Joint Commission International accreditation and in the post-accreditation era. Ther Clin Risk Manag 2015;11:393.
42. Penoyer DAA. Nurse staffing and patient outcomes in critical care: A concise review. Crit Care Med 2010;38(7):1521-8.
43. Biron AD, Lavoie-Tremblay M, Loiselle CG. Characteristics of work interruptions during medication administration. J Nurs Scholarsh 2009;41(4):330-6.
44. Woodrow R, Colbert B, Smith DM. Essentials of pharmacology for health occupations. Sixth ed. New York: Cengage Learning; 2010.
2. Taheri E, Norian M, Rasoli M, Kavoosi A. The study of type and amount of medication errors in neonatal intensive care units and neonatal units. Journal of Critical Care Nursing 2013;6(1):21-8.
3. Nikpeyma N, Gholamnejad H. Reasons for medication errors in nurses’ veiws. Advances in Nursing & Midwifery 2009;19(64):16-24.
4. Valizadeh F, Ghasemi S-F, Nagafi S-S, Delfan B, Mohsenzadeh A. Errors in medication orders and the nursing staff's reports in medical notes of children. Iran J Pediatr 2008;18(1):33-40.
5. Hanskamp-Sebregts M, Zegers M, Boeijen W, Westert GP, van Gurp PJ, Wollersheim H. Effects of auditing patient safety in hospital care: design of a mixed-method evaluation. BMC Health Serv Res 2013;13:226.
6. Mark BA, Belyea M. Nurse staffing and medication errors: Cross-sectional or longitudinal relationships? Res Nurs Health 2009;32(1):18-30.
7. Barton A. Patient safety and quality: An evidence-based handbook for nurses. Aorn J 2009;90(4):601-2.
8. Unver V, Tastan S, Akbayrak N. Medication errors: perspectives of newly graduated and experienced nurses. Int J Nurs Pract 2012;18(4):317-24.
9. Alvarez G, Coiera E. Interdisciplinary communication: an uncharted source of medical error? J Crit Care 2006;21(3):236-42;discussion 242.
10. Carayon P. Human factors in patient safety as an innovation. Appl Ergon 2010;41(5):657-65.
11. Alsulami Z, Conroy S, Choonara I. Medication errors in the Middle East countries: a systematic review of the literature. Eur J Clin Pharmacol 2013;69(4):995-1008.
12. Shahrokhi A, Ebrahimpour F, Ghodousi A. Factors effective on medication errors: A nursing view. J Res Pharm Pract 2013;2(1):18-23.
13. Raju TN, Suresh G, Higgins RD. Patient safety in the context of neonatal intensive care: research and educational opportunities. Pediatr Res 2011;70(1):109-15.
14. Musarezaie A, Momeni GGT, Zargham BA, Haj SE. Survey of the medication errors and refusal to report medication errors from the viewpoints of nurses in hospitals affiliated to Isfahan university of medical sciences, Iran. Health System Research 2013;9(1):76-85.
15. Garfield S, Reynolds M, Dermont L, Franklin BD. Measuring the severity of prescribing errors: a systematic review. Drug Saf 2013;36(12):1151-7.
16. Baghcheghi N, Koohestani HR. Nursing students’ errors in preparation and administration of intravenous drugs. Strides in Development of Medical Education 2008;5(1):43-49.
17. Darabi F, Amolaei K, Asarzadegan M, et al. Frequency of nursing and midwifery errors in referred cases to the Iranian Medical Council and Imam Reza Training Hospital in Kermanshah. Journal of Kermanshah University of Medical Sciences 2009;13(3):261-266.
18. Poland B, Krupa G, McCall D. Settings Health Promot Pract 2009;10(4):505-16.
19. Jalali R. qualitative research sampling. Journal of Qualitative Research in Health Sciences 2013;1(4):310-320.
20. Curtis S, Gesler W, Smith G, Washburn S. Approaches to sampling and case selection in qualitative research: examples in the geography of health. Soc Sci Med 2000;50(7):1001-14.
21. Polit DF, Beck CT. Essentials of nursing research: Appraising evidence for nursing practice. ninth ed. Lippincott Williams & Wilkins; 2010.
22. Ilie G, Ciocoiu CN. Application of fishbone diagram to determine the risk of an event with multiple causes. Management Research and Practice 2010;2(1):1-20.
23. Curran E. MRSA: monitoring quality. British Journal of Infection Control 2001;2(1):20-3.
24. Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol 2013;13(1):117.
25. Keers RN, Williams SD, Cooke J, Ashcroft DM. Causes of medication administration errors in hospitals: a systematic review of quantitative and qualitative evidence. Drug Saf 2013;36(11):1045-67.
26. Ritchie J, Lewis J, Nicholls CM, Ormston R, editors. Qualitative research practice: A guide for social science students and researchers. second ed. london: SAGE; 2013.
27. Smith J, Firth J. Qualitative data analysis: the framework approach. Nurse Res 2011;18(2):52-62.
28. Dahlgren L, Emmelin M, Winkvist A. Qualitative methodology for international public health. second ed. Umeå Universitet: Umeå (Seweden); 2007.
29. Lawshe CH. A quantitative approach to content validity. Personnel Psychology 1975;28(4):563-75.
30. Nursing Best Pracice Guidelines Program [Internet]. Ontario: Registered Nurses’ Association of Ontario; 2007.Healthy Work Environments Best Practice Guidelines; Professionalism in Nursing; [cited 2020 Sep 25]. Available from: https://rnao.ca/bpg/guidelines/professionalism-nursing
31. Abolhassani N, Akbari Sari A, Rashidian A, Rastegarpanah M. The establishment of the Drug Naming Committee to restrict look-alike medication names in Iran: A qualitative study. Int J Risk Saf Med 2017;29(1-2):69-79.
32. Bahramnezhad F, Cheraghi MA. Realization of Clinical Guidelines in Providing Health Services. Journal of Hayat 2015;21(3):1-4.
33. Hofmann DA, Mark B. An investigation of the relationship between safety climate and medication errors as well as other nurse and patient outcomes. Personnel Psychology 2006;59(4):847-69.
34. Tang FI, Sheu SJ, Yu S, Wei IL, Chen CH. Nurses relate the contributing factors involved in medication errors. J Clin Nurs 2007;16(3):447-57.
35. Hajbaghery MA, Salsali M. A model for empowerment of nursing in Iran. BMC Health Serv Res 2005;5(1):24.
36. Hansen LB. Medication Errors. Am J Pharm Educ 2007;71(3):59.
37. Mirsaeid G, Javad S, Mirzaie M, Haghshenas E, Dargahi H. Human resources distribution among Tehran university of Medical Sciences Hospitals. Journal of Payavard Salamat 2014;7(5):432-446.
38. Dashti E, Rassouli M, Khanali Mojen L, Puorhoseingholi A, Shirinabady Farahani A. Patient-to-nurse staffing ratios and its outcomes on nurses and premature infants in NICUs. Quarterly Journal of Nursing Management 2015;4(2):39-48.
39. Berry L, Curry P. Nursing workload and patient care: Understanding the value of nurses, the effects of excessive workload, and how nurse-patient ratios and dynamic staffing models can help. Ottawa: Canadian Federation of Nurses Unions; 2013.
40. Vahey DC, Aiken LH, Sloane DM, Clarke SP, Vargas D. Nurse burnout and patient satisfaction. Med Care 2004;42(2 Suppl):II57-66.
41. Wang Hf, Jin Jf, Feng Xq, et al. Quality improvements in decreasing medication administration errors made by nursing staff in an academic medical center hospital: a trend analysis during the journey to Joint Commission International accreditation and in the post-accreditation era. Ther Clin Risk Manag 2015;11:393.
42. Penoyer DAA. Nurse staffing and patient outcomes in critical care: A concise review. Crit Care Med 2010;38(7):1521-8.
43. Biron AD, Lavoie-Tremblay M, Loiselle CG. Characteristics of work interruptions during medication administration. J Nurs Scholarsh 2009;41(4):330-6.
44. Woodrow R, Colbert B, Smith DM. Essentials of pharmacology for health occupations. Sixth ed. New York: Cengage Learning; 2010.
| Files | ||
| Issue | Vol 9, No 1 (Winter 2021) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jpc.v9i1.6030 | |
| Keywords | ||
| Health Priorities; Medication Errors; Nurse; Hospitals Teaching | ||
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How to Cite
1.
Gray S, Effatpanah M, Salehi S, Anvari Savojbalaghi S, Momeni L, Abedi Gilavandani R, Abbasi Chaleshtari A. Medication Errors and Reducing Interventions: A Mixed Study in a Teaching Hospital. J Pharm Care. 2021;9(1):3-12.
