Assignment Task
Executive Summary
Background: Medication errors have significant adverse on patient safety; some of the issues associated with medication errors are physical and psychological impairment. Even though only a small proportion of drug errors have the potential to cause serious harm, omitted doses of certain medication have a severe consequence.
Aim: The project aimed to reduce medication omission errors by 100% over forty-two days on two inpatient units in a mental health Hospital.
Method: A pre-test-post-test method was used for this project; the method is widely used in evaluating change in practice before and after the implementation of an intervention.
Main findings: The audit results showed a significant reduction in omitted medication doses during the period of the project.
Conclusion: Increasing Registered Nurse, Enrolled Nurse and Student Nurse awareness of medication errors can reduce medication omission errors and improve patient safety.
Background
Medication errors adversely impact on patient safety and can result in physical and psychological harm (Webster & Anderson, 2002). Medication omitted dose is prescribed medication that is not given to the patient before their next dose is due and medication are omitted without no reason specified on the NIMC (Latimer et al 2017; Baqir et al 2015). Although medication errors result in harm, omitted doses of certain medication have serious consequences. Statistics from the NSW Patient Safety between the years July 2019 – December 2019 placed medication errors as the fourth most reported incident in IIMS (New South Wales MoH, 2019). In Australia, studies demonstrate an omission rate of up to 11% (Latimer, 2011), similar to UK data with rates reported up to 15.6% of medications are omitted (Graudins et al., 2015).
The project was conducted on two units in a mental health hospital, with a total number of twenty-four acute adult and adolescent patients. Both units share the same office and medication room, and both utilised paper National Inpatient Medication Chart (NIMC).
Medication on both units is administered during four different day times: morning, lunchtime, evening, and night-time by the Registered Nurses (RN), Enrolled Nurse (EN) and Student Nurses (SN).
Two different interventions were implemented after the baseline audit. The interventions were educational in-service (Appendix 6) which covered topics on the five rights of medication administration and visual prompts were put up in the medication room, nursing staff station (Appendix 5) and on the medication charts folder (Appendix 4). The interventions were targeted at RN, EN and SN as they are the ones who administer medication, and most likely to cause medication errors, (Clifton-Koeppel, 2008).
The project aimed to reduce medication omission errors by 100% in forty-two days with the overall goal of improving patient safety through raising awareness and its significance to patient safety. The timeline for the project is illustrated in (Appendix 1). A pretest-posttest method was used for the project, and it is widely used in evaluating change in practice before and after the implementation of an intervention (Knapp, 2016). A collection tool (Appendix 2 and 3) which was specifically designed according to the six rights of medication dispensing medication (Australian Commission on Safety and Quality in Health Care , 2019) was used to collect the data, and this was in turn, exported to Excel Microsoft Office.
Main findings
Pre-intervention data was collected from 24 National inpatient medication charts (NIMC), and this was done twice, the first pre-intervention audit was for the week commencing the 01/09/20 and the second pre-intervention audit was for the week commencing the 14/09/20 this gave the patient audited NIMC a total of 48 and a combined prescribed doses of 442 during the targeted period. Of the total pre-intervention audited doses 16.05% (n=71) were omitted: mornings (n = 42); afternoons (n = 15); evenings (n = 6) and finally nights (n = 2) (Appendix 3). After the intervention, the same process was applied to the same NIMC to get the post-intervention figures, and this was completed for the weeks commencing 21/09/20 and 05/10/20. The post-intervention results reflected a significant improvement in the reduction of omitted doses, a reduction of 94.40% (n = 67). The reduction across all prescribed times improved as follows: mornings 93.75% (n = 45); afternoons 93.30% (n = 14); evenings 100% (n = 6) and finally nights 100% (n = 6). The collated data were analysed using an online calculator from Social Science Statistics, with paired t-test used to test post- intervention effectiveness and the results were as follows, the value of t was -3.81257; the value of p was .00089. The result was significant at p < 0>
Discussion
This project consisted of three different stages, the first stage was the pre-intervention audit of the National inpatient medication charts (NIMC), this was followed by the intervention implementation stage which consisted of educational in-service sessions and development of visual aids and the finally the post-intervention audit of the NIMC. During the pre- intervention medication errors were recorded as high in the morning, several reasons might have contributed to the high numbers. Majority of the doses prescribed to the patients were in the morning on both units, and this is the time when both two units experience high activities. Having several activities going on during medication times can lead to distractions which might lead to medication errors such as omitted dose. This is supported in a study by Haw, Stubbs, and Dickens (2015) which they did on medication management where nurses pointed out distraction as error causation, especially in mental health. Furthermore, staff might also lack the understanding of the importance of signing NIMC.
The in-service educational and visual prompts intervention had a good effect on the behaviour change of the clinicians. As was pointed by pointed Rowe and Ilic (2009) in their study, visual posters archive great success in projects by improving staff knowledge, and changing their attitude and behaviour and also the way the posters are designed are of importance as they can define success in promoting behaviour change. The project confirms previous research into the omitted doses where the incidence of administration errors reduced significantly from 49% to 31?ter the implementation of education intervention (Chedoe et al 2012).
The post-intervention missed doses reduced significantly, the errors which were reported in stage one reduced by 96 %. Despite not reaching 100% target improvement, at 96% the project can be deemed a success, the illustration of the pre- and post-intervention results in Table 1 show change across the daily prescribed doses.
However, the improvement might also be contributed to the fact that staff were aware that the patient medication charts were being audited which might have a behavioural change, this is echoed by Elden & Ismail (2016) suspected that the Hawthorne effect could have affected both the occurrence and detection of errors in their study.
No ethical approval was required for the project as no patient-identifiable data were used; however, before the project approval was sought from the Nurse Unit Manager.