Considering Options and Solutions
It is critical to consider a nurse’s patient assignment, workflow, the electronic medical record, and the storage of high-alert medications when considering potential strategies or solutions to reduce medication errors. All of these factors aid in identifying whether the problem stems from the system or from the prep and administration process. Common problems related to medication errors include inconsistent IV tubing setups and connections, unopened clamps during infusion, and a lack of understanding or knowledge of the electronic medical record’s verification process (Schmidt et al., 2017). Management also needs to continuously review and if necessary update the policies and procedures behind high-alert medication preparation and administration thus, ensuring patient safety.
Another option worth considering is to examine the standard process currently implemented by using the “three C’s”. The “Three C’s” stand for connection, clamps and confirming pump settings (Schmidt et al., 2017) Improving this process could include verbalizing the steps in order to confirm the steps are being taken. This process does not add any extra time to a medication pass and can assist in ensuring medications are being properly delivered to the patient. Altering the acknowledgement step in the electronic medical record is an additional option to think about. One nurse could confirm orders instead of two and in doing this, she or he would relieve the second nurse from having to contend with yet another interruption while attempting to prepare and administer his or her own med pass.
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Insulin and IV potassium chloride are two examples of commonly used, high-alert medications associated with many medication errors. Potassium vials should either be removed from care units and replaced with premixed potassium provided by the pharmacy, or IV potassium chloride should be placed in a specific locked section of the unit, to help prevent medication errors with these two medications (Mancha et al.). To prevent label confusion with insulin, it is important to reduce the number of hospital presentations (Mancha et al.).
Implementation for change must start with management collecting feedback from staff regarding the current medication administration process. This will help shine light on problem areas that need improvement. To ensure that employees are adequately trained on the policies and procedures underpinning the administration of high-alert medications, management can also help by offering monthly educational opportunities. Hospitals should look into streamlining EMR’s so that information is in a tidy, orderly, and accessible location. This could eliminate the need for nurses to recognize and confirm administration on three different screens. Additionally, a streamlined process could increase speed, efficacy and comprehension for new graduates and traveling nurses
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