NURSES VIEW ON DRUG ADMINISTRATION ERROR AND PATIENT SAFETY IN HEALTH FACILITIES IN THE CENTRAL REGION OF GHANA

ABSTRACT
Drug administration is a core responsibility of nurses. Medication error occurring during the drug administration process can be attributed to varied effects on patients’ safety, ranging from the errors going undetected to prolonged hospital stays, discomfort and death. It is relevant to identify the extent of drug administration error in the district hospitals in the Central region of Ghana. A quantitative, cross-sectional study was conducted among nurses nursing patients admitted to selected district hospital in the Central Region of Ghana. Primary data was gathered from 168 nurses using a pre-tested questionnaire and a review of incident books on the wards. Logistic regression was done to assess possible factors contributing to drug administration error. The majority of the respondents (61.9%) were below 29 years and had worked between one and four years (72.2%). Most common types of error committed include pre-administration error (mean=2.67) and administration technique error (mean=2.67).The majority of these errors occur during the night shift (65%). Lack of understanding of medication jargons (mean = 3.89), “feeling uncomfortable to wake patient up’ (mean = 3.78) and nurses eagerness to go home (mean = 3.67) were the most predisposing factors to drug administration error. Increasing internal environment constraints corresponds with increasing drug administration error commitment by a factor of 0.228. Lack of emphasis placed on medication error as a measure of quality of care and non-existence of channels for reporting drug administration error were the main barriers to reporting drug administration error.


CHAPTER ONE
INTRODUCTION
Background to the Study
The effect of medical errors on the safety and quality of patient care in health facilities cannot be overemphasized. Studies shows that, patient safety is one of the most pressing health care challenges in the world (Institute of Medicine (IOM), 1999). Patient’s safety is freedom from accidental injury while a patient is receiving care in the health facility (IOM, 1999). Patient safety encompasses a variety of patient care processes and outcomes, including the safe use of surgical equipment during procedures, medications, physical restraints, and prevention of harmful events, such as patient falls and suicide (Wakefield, Uden-Holman & Wakefield, 2005). Emmanuel, et al (2009) stated that the level of a patients’ safety in health facilities affects the recovery rate of clients. The Patient Safety Curriculum Guide Report (2011), explains that it is the responsibility of every healthcare provider to render the best medical services with minimal or no medical errors to patients.

Medications are therapeutic interventions envisioned to reduce patient suffering, promote healing and improve health and quality of life; however, all medications have potential adverse effects (Metsala & Vaherkoski, 2014). Among patient safety issues, medication safety has been considered a major indicator of health-care quality (Joint Commission on Accreditation of Healthcare Organizations, 2006). The use of medicines to address the health challenges of patients in the world has increased considerably(Avian, 2009). However, the increase in the use of medication is accompanied by medication error. Medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer (Williams, 2007).

Medication errors may occur in any phase of the medication use process (Mrayyan, Shishani, & Al-Faouri, 2007). The medication use process extends from procuring the medication by the procurement officers; selecting, transcribing and ordering of the medication by the doctors, preparing, dispensing and educating on the medication regimen by the pharmacy attendants; administering and monitoring on the effect of the medication by the nurse and the patient or the consumer who is receiving the medication. Some stages of errors comprise manufacturing, prescribing, transcribing, dispensing, administration of a medication and monitoring of its effects (Dabaghzadeha, et al, 2013).

Empirical evidence shows that medication error continues to place the patient in serious danger (Rozich, Haraden, & Resar, 2008). According to estimates by the IOM, patients who are admitted into hospitals experience approximately one medication error per day of their stay (Institute of Medicine, 2006). It has been estimated that between 10% and 18% of all reported medical errors can be attributed to unsafe medication use with varied effects, ranging from the errors going unnoticed to causing death and other disabilities to patient (Choo, Hutchinson & Bucknall, 2010).

The increase in the incidence of medication error may be due to the complex nature of the medication use process which extends from medication prescription, transcription, dispensing and the administration stage. It could also result from lack of professional competence or system failures (Ndosi & Newell, 2008). Increases in new products as well as advances in technology also increase the risk of medication error.

Globally, empirical evidence shows that researchers are concerned by the increased rate of medication error. A report from the IOM, (1999) stated that 7,000 deaths could be associated with medication errors annually in the United States. Similarly, Ammenwerth, et al (2008) estimated that nearly 100,000 individuals per year in the United States (US) die of preventable medication errors. Aside from death, poor patient safety practices are responsible for the increasing hospital admissions and cost, prolonged hospital stays, use of additional resources, extra cost of litigation, lowering patient satisfaction and undue discomfort (Montesi & Lechi, 2009). It is therefore important to promote safety in the medication process because of the significant consequences associated with medication error.

Medication error is particularly common in hospitalized patients, especially elderly people, critically ill, pediatric patients and those that require multiple forms of pharmacological therapies (Mirkuzie, Tesfahun and Zeleke ,2014). The above categorization places adult clients on admission at risk of medication error. A study by the US Food and Drug Administration (FDA) evaluated reports of fatal medication errors over five years’ records that almost half of the fatal medication errors occurred in people at the age of 60 years and above (Stoppler,2006). This indicates that older people are at greatest risk for medication errors because they often take multiple prescription medications (Stoppler, 2006).

In health facilities, the drug administration process is the last stage of the medication use process. The process involves: obtaining medication in a ready-to-use form, counting or calculating, labelling, storing and preparing in some way. It also involves checking for allergies; giving the right medication to the right patient, in the right dose, via the right route, at the right time; and documenting and monitoring of patient for effects of the drug (World Health Organisation (WHO), 2011). In the same vein, the Nursing and Midwifery Council (NMC) in the UK argues that the drug administration process is not a robotic task that should be performed by strictly following the prescriber’s orders but demands that the nurse thinks through and exercises professional judgement as well (NMC, 2007). There is potential for a drug administration error to occur with each dose of medication due to the complex nature of the medication administration process. It is therefore imperative that drug administration errors are detected and reported by nurses (Ferner, Ferner, & McDowell, 2009). A study by Anderson and Townsen, 2010 (as cited in Jo, Marquard, Clarke, & Henneman,2013) expounds that approximately 38% of medication errors occur during medication administration process and are termed drug administration error.

Drug administration error is any discrepancy between the drug therapy received by the patient and that intended by the prescriber (Chua, Tea & Rahman, 2009). About 71.5% of medication errors are due to nurse administration and 16.4% result from the prescribing stages (Westbrook and Woods, (2009) & Redley and Botti, 2012). A recent systematic review of drug administration error prevalence in healthcare settings found that nursing administration error is the most common type of medication error in health facilities, reporting an estimated median of 19.1 % of total opportunities for error in hospitals (Keers, Williams, & Cooke, 2013).

Many policies and guidelines have been devised to help prevent drug administration error from occurring. Most nurses are familiar with the five rights of medication administration: the right patient, drug, dose, route and time (Eisenhauer, Hurley, and Dolan, 2007).These medication rights are designed to ensure patient safety and prevent harm (Malcolm, Yisi, 2010). However, quality in medication administration is not simply a matter of adhering to these five rights (Cox, 2000).

Just like medication error classification, different types of drug administration error can occur owing to the stage of the drug administration process at which an error occurs. For instance, Seki & Yamazaki (2009) describe that error of omission can occur when a drug is prescribed but was not administered by the nurse to the patient. Wrong patient error occurs when a different medication is administered to the patient other than the one prescribed. Drug administration error can also occur during any shift (morning, afternoon and night shifts). Likewise, various classifications of medication like antibiotics, intravenous infusions, diuretics, anti-diabetes, anti-hypertensive medications and analgesics can be involved in drug administration error (Ferner et al., 2009).

A study by Clifton-Koppel (2008) shows that nurses can reduce drug administration error and improve patient safety by implementing important changes to their individual practice. These changes include reporting medication errors, reducing distractions, independent implementation of safe medication double checks before medication administration, and promoting a safety culture (Handler et al., 2008). It appears that nurses are not reporting drug administration error when they occur. Meanwhile, error reporting is important in reducing drug administration error. Informal reporting and documentation of drug administration errors can prevent healthcare authorities from knowing the rates of specific types of medication errors that occur (Garner, 2012). It will also prevent the authorities from understanding the underlying cause of drug administration error and from appropriately prioritizing the opportunities to correct and prevent the errors, both within and across facilities.

Drug administration errors are less likely to be prevented than prescription and dispensing errors because it occurs in the last stage of the medication use process and result in direct harm to the patient (Van den Bemt, Robertz, De Jong, Van Roon, & Leufkens, 2007).

Statement of the Problem
The increase in the use of drugs has also brought about an increase in associated medication errors (Avian,2009). A study of anonymous errors reported via a national, confidential medication error-reporting program in the US across 496 emergency departments recorded a total of 13,932 medication errors over a 4-year time span (Pham, et al, 2011). This value translates to an error rate of 78 reports per 100,000 patient visits. The groups most frequently responsible for these errors were nurses (54%) and the most common errors that occurred were in the drug administration phase (36%) (Pham, et al., 2011).

Likewise, Dabaghzadeh, et al (2013), in a study on medication errors in a large teaching hospital in Tehran (US) showed that 19% of drug administrations contained at least one error. The most recorded errors were made by nurses (44.5%), most commonly during the drug administrating stage (63.6%). Most of these drug administration errors were responsible for one-third of medication errors leading to poor patient recovery, death, decreased client satisfaction, and other forms of harm to patients (Westbrook & Woods 2009; Redley & Botti, 2012). Similarly, Alsulami et al. (2013) in systematic review study on medication errors in the Middle East countries revealed that the most frequent types of reported medication incidents errors were drug administration related errors.

The case is not different in Africa. A prospective observational study carried out in Ethiopia revealed that a total of 196 (89.9 %) administration errors were identified from 218 observations made over a period of 13 days (Feleke & Girma, 2010). This indicated that at least 15 administrative errors were committed each day in the hospital.

Studies by Ahado, (2007) and Degley (2013) in Ghana using questionnaires and an observational method recorded 32.9% and 49% administration errors respectively. These findings suggested that drug administration error also occurs in Ghanaian hospitals but little is known about the frequency of these drug administration errors. WHO (2009) also estimated that the risk of patient harm as a result of medication error may be greater in Ghana, due to inadequate infrastructure facilities, technological advancement, and skilled human resources in hospitals.

According to Barker, et al, (2002), identifying errors is fundamental to error prevention. Thus, for a hospital to be able to minimize drug administration error, it is important to explore the various factors that contribute to drug administration error in the facility. The questions that remain unanswered are what types of drug administration error occur in health facilities in Ghana, what contributes to those errors and how do these medication errors compromise in-patient safety? These questions remain unanswered in the two empirical studies on medication errors carried out in Ghana.

Likewise, it was revealed that some studies were done on drug administration error in specialty wards (theatre, emergency department, psychiatric and intensive care unit), but little has been done among the general adult, medical and surgical ward which was the focus of the researcher. To address this gap in literature, the study aimed to profile drug administration errors and explore nurses’ perception on the effects of drug administration error on patient safety in the health facilities in Central Ghana.

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Item Type: Ghanaian Postgraduate Material  |  Attribute: 136 pages  |  Chapters: 1-5
Format: MS Word  |  Price: GH50  |  Delivery: Within 30Mins.
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