As a staff nurse in a progressive care unit, this paper’s author works attentively to prevent medication administration errors (MAEs). In particular, careful monitoring and reflection of working processes are carried out. Subsequently, it was observed that there are often difficulties in administering the drugs to the patients at the appropriate time. The author noted several incidents, reported them to the nursing manager or compiled corresponding records in the Electronic Medical Administration Record (EMAR).
While the reported incidents did not have negative consequences, their recurrence carries significant risks. WTMAEs involve the administration of a drug an hour earlier or later than identified in the treatment plan (Martin et al., 2020). Many prescriptions require taking at certain hours to improve therapeutic impact and prevent side effects (Martin et al., 2020). Therefore, WTMAEs significantly influence patients and can delay treatment, harm, condition deterioration, and the need for additional treatment (Martin et al., 2020). Such consequences affect both patients and providers, creating an additional burden for medical staff. For these reasons, addressing the problem is critical to the progressive care unit.
The problem of errors in drug administration is widely discussed in the scientific literature. MAEs result from failures in one of the six rights of drug administration – the right medication, dose, time, patient, route, and documentation (Yousef et al., 2022). Therefore, for proper administration, nurses are supposed to ensure that all six mentioned aspects are maintained. In the incidents under investigation, a critical issue that did not go as intended is the difficulty in providing the correct timing of drug administration.
Studies and observations highlight several factors preventing drug administration at the right time. Raja et al. (2019) highlight the personnel shortage, lack of experience, difficulties in communication among staff, the incomprehensibility of prescribing writings, and ineffective distribution of workload. Furnish et al. (2021) also emphasize communication problems, lack of awareness of time-critical drugs, and no process optimization. Tsegaye et al. (2020) divide factors into groups – related to work, professionalism, and additional factors. Their study determined that time error is more common than other types and the key reasons are lack of training, poor communication, interruptions, and lack of guidelines (Tsegaye et al., 2020). The factors highlighted by the researchers are the most common causes of errors.
Considering the causes of the studied incidents, the author highlights several root causes that increase the likelihood of WTMAEs in the progressive care unit. First of all, the reasons are associated with the complexity of the condition of patients and the high workload. Another factor is regular interruptions, which disrupt the planned work schedule. Thus, the causes of incidents are associated with work-related and communication factors. While the severe condition of patients is an integral characteristic of the progressive care unit, the other two causes – workload and interruptions – can be controlled.
Considering the causes of WTMAEs, one may highlight several measures to prevent errors. According to Furnish et al.’s (2021) study, optimizing electronic records can improve the efficiency of workflows. In particular, the researchers propose to apply special marks for drugs, whose administration should take place only at a specific time so that employees pay special attention to them. The study by Westbrook et al. (2020) also confirms that using electronic systems for medicines contributes to a decrease in errors. With a high workload, process optimization is critical to prevent MAEs
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