The responsibilities of the nurse
as manager and coordinator of client care are many. Nurses are caregivers primarily of the body,
but must address the mind and soul of the patient. During this pharmacy class,
the emphasis was the role of the nurse related to safe medication
practices.
Medications
errors are, “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).
Because medication errors are so prevalent, the nurse must manage and
coordinate her client care to ensure medication administration safety. Stress
reduction is a way in which the nurse can ensure safer delivery practice. Stress
can be reduced by use of electronic medical records, ensuring a proper work
environment, and ensuring multi-disciplinary communication. Finally, the nurse
as patient advocate must advocate for herself.
Ensuring
that stressors are limited is key to reducing medication delivery errors. The
Health Information Technology for Economic and Clinical Health Act (HITECH)
calls for the use of technology in helping to reduce errors (Kaushal &
Barron, 2011). The HITECH act, has been mandated by the federal government and
those hospitals that are not in compliance by a certain date will lose some of
their federal reimbursements. The dual
purpose of this act is to 1) aid in continuity of care and 2) reduce medical
errors. The reduction in medical errors
is realized because technology reduces human error and takes the need for
memorization, list making and
transcription out of the medication delivery equation.
Medication
errors are an enormous source of stress for nurses. Most nurses live in fear of
accidentally committing a med error. Almost all nurses who have been at this
career for a while can recall stories of near misses as well as sentinel events
related to medication errors that they’ve either heard about in their hospital
or witnessed themselves. One of the most widely used systems to help reduce
medication errors has been the implementation of automated dispensing cabinets
(ADCs). By 2007 94% of hospitals had adopted
ADCs (Mandrack, 2012). Although ADC’s are useful, nurses and their management
need to advocate for excellent design principles when it comes to good systems.
A good starting point in creating
adequate systems is using the CPOE Process Design Principles (ASHP Guidelines,
2011). The basic principles of the ASHP guidelines are: "Standardization,
Simplification, Communication, Reporting mechanisms, Redundancy, Memory
avoidance, Forced functions, and Access to clinical information", (2011).
The ideal of having access for clinical information is crucial as shown in a
comparative study of 2 electronic prescribing systems by Kaushal, Barron and
Abramson (2011). It was the access to information, tech support and amount of
training that made the most difference in error. The difference in error
reduction was 4 fold (Kaushal, Barron & Abramson, 2011).
Hospitals
are notoriously loud and action-packed places with a lot of chatter and
disruptions. A second valuable way to decrease stress is to ensure that
electronic dispense cabinets as well as computerized medication administration
record access are located in areas that are well lit and away from possible
distraction and interruption.
A
culture of teamwork and communication must be perpetuated in hospitals.
Teamwork allows for the perception that questioning medication orders can be
done at all levels whether it be a resident questioning an attending, a
pharmacist questioning an order, or a nurse questioning a prescription. Management should promote the idea that all
members of the team are valuable and that the goal is to improve patient care
rather than to stop work flow. Improving the perception that nurses are
professionals and advocates for evidenced based practice will go far to improve
the acceptance of nurses’ voices as part of the medical team.
Finally,
the reduction of stressors must start with the nurse. Adequate rest, diet, exercise and healthy
interpersonal relationships all add up to a nurse that is better equipped to
deliver safe medication administration without the interpersonal stressors that
often lead to errors.
References
ASHP Guidelines on Pharmacy Planning for Implementation of
Computerized Provider Order-Entry
Systems in Hospitals and Health Systems. (2011). American Journal of Health-System Pharmacy,
68(6), e9-e31. doi:10.2146/sp100011e
Kaushal, R., Barron, Y., & Abramson, E. L. (2011). The
comparative effectiveness of 2 electronic
prescribing systems. American Journal Of Managed Care, 17SP88- SP94.
Mandrack, M., Cohen, M. R.,
Featherling, J., Gellner, L., Judd, K., Kienle, P. C., & Vanderveen, T.
(2012). Nursing best practices
using automated dispensing cabinets:
Nurses' key role in improving
medication safety. MEDSURG Nursing, 21(3), 134-144.
National Medicines Information Centre, N.M.I. (2001). Medication errors. Medication Errors,
7(3).
