NRSG 314 Unit 2 – Individual Project
Assignment Description
Medication errors are the number one patient safety issue at most medical facilities.
You are a member of the risk management team at a medical facility. You have been assigned to develop a professional paper that will assist nurse managers in reducing the number of errors made by new employees concerning medication. Your paper should include all of the following:
- Discuss the most frequent cause and incidence rate of medication errors at a medical facility.
- Incorporate the continuous quality improvement (CQI) process into the identification, implementation, and measure of the plan to reduce the medication errors.
- Discuss the rationale for reducing the errors.
- Give at least 2 actions that the nurse should take to assist with the reduction of errors.
- Cite at least 3 scholarly sources. Two of the sources must be recent (within the past 5 years), and the third source must come from an Institute of Medicine (IOM) report that is related to medication errors.
Please click on this APA Style for CTU Students link for help with APA formatting. Use the CTU Writing Style Guide (templates provided)—not the Introductory Writing Style Guide.
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The improvement of patient safety and quality of care in the nursing practice is an on-going process. One of the largest categories of mistakes seen in the healthcare setting is during medication administration that can lead to patient harm and mortality. Sherwood & Barnsteiner (2021) writes that medication errors account for over 7,000 deaths annually due to reasons such as distractions and interruptions, insufficient staffing and poor team collaboration.
I agree that all those reasons listed are contributing factors that can lead to medication errors so stronger and effective prevention processes need to be applied. In my work environment, a hospital setting, there are interventions and protocols set to help prevent and/or reduce the amount of these errors. Daily huddles led by our nursing leadership and management emphasize the importance of patient safety. We must verify the 5 patient’s rights and match it with their identification band, scan and document through an electronic medication administration record (eMAR) which also verifies if the medication scanned is the correct medication, dosage and administration time for that specific patient. Verification and a co-signature are needed with a second registered nurse for high risk medications such as insulin or heparin.
The steps we are currently taking at my hospital are great ways to reduce these preventable errors but there’s always room for improvement. Education should be incorporated and emphasized more, not only to the staff but to patients as well. Although it may become time consuming, each medication should be explained and understood by the patient or given supplemental resources before administering. Medication administration should be a responsibility across the interprofessional team caring for the patient, such as the provider explaining new medications being added to the regimen to the patient, the pharmacist to verify these new orders and deem it safe, and for the pharmacy technician to deliver the correct medications in a timely manner.
Reference
Sherwood, G., & Barnsteiner, J. (2021). Quality and Safety in Nursing (3rd Edition). Wiley Global Research (STMS).
Medication errors are very dangerous and occur in all health care settings. Unfortunately, the NICU is an area that sees a higher than average number of medication errors (Alghamdi et al., 2019). The NICU is arguably one of the areas most at risk for adverse outcomes. Heparin has become a high alert medication in the NICU. Central lines are prevalent in this unit, so heparin must be available to flush central lines. The NICU population consists of newborn babies. The physical size of these patients is so small that even in very small doses, the frequent use of heparin administration can lead to undesired effects. In order to prevent accidental heparin overdose, the NICU that I work in has implemented a heparin administration safety policy. This policy ensures that only the appropriate dose of prefilled heparin syringes are loaded into the pyxis on the floor. Heparin syringes are only available by removal from the pyxis. Each syringe that is removed from the pyxis must be scanned and accounted for before patient administration. This policy ensures that documentation occurs before an infant receives heparin.
This policy has created responsible use of heparin among neonatal patients. The policy has also ensured that the nurse is following the six rights of medication administration. I do think that the system could be improved by allowing only one syringe to be removed at a time. When the pyxis opens there is a drawer of heparin syringes presented. The nurse should only remove one, but if they are in a hurry or do not want to revisit the pyxis multiple times that shift, they could remove a handful and leave the syringes at the patient’s bedside. I have seen this happen. This can lead to undocumented heparin administration. This also allows heparin to be administered without scanning and following medication administration guidelines. If the pyxis only presented a single syringe when opened, the temptation to take more than one would be eliminated. This would help to ensure safe heparin use in the NICU.
References
Alghamdi, A. A., Keers, R. N., Sutherland, A., & Ashcroft, D. M. (2019). Prevalence and Nature of Medication Errors and Preventable Adverse Drug Events in Paediatric and Neonatal Intensive Care Settings: A Systematic Review. Drug safety, 42(12), 1423–1436. https://doi.org/10.1007/s40264-019-00856-9
In our department the process in place is using scanners when administering medications. Using scanners has decreased medication errors tremendously. The physician will enter orders in the computer. Once the orders are signed, they will appear in the patient’s medication administration record (MAR). The nurse will have to acknowledge the medications ordered. Orders are linked by pharmacy to a medication dispensing machine (PYXIS). Once the nurse removes the medication from the pyxis the nurse will scan the patient’s arm band and then the medication barcode. If this is all correct it will show in the MAR the time scanned as time administered. If the wrong patient or wrong medication is scanned, the MAR will show an error. This process works if it is being followed as implemented.
Preventing interruptions during medications administration can be an additional process that can be implemented. The nurses would have to be educated/reminded that during medication administration times they would have to focus on that one patient. Staying focused on one patient would prevent errors. Medication errors may cause patient harm, inappropriate treatment, allergic reactions, adverse reactions and so many other negative outcomes for both the nurse and the patient. The teaching can be implemented by as simple as talking about it in the morning huddles before the beginning of each shift. You can also have a resource nurse helping out in each area and reminding the nurses to follow the new MAR process and offering to help with the other patients so the nurse can focus on one patient at a time (Belcher,2022).
Belcher, S.,A.D.N.R.N. (2022). No phone zone: Medication error reduction on a progressive care unit. Missouri Nursing News, 2(3), 5-5,10. https://coloradotech.idm.oclc.org/login?url=
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Unit 2 Assignment: Medication Errors
Health care facilities should be safe settings for patients and health care practitioners. At the administrative level, organizations’ leaders should ensure health care staff is adequately facilitated and workplace issues are addressed timely and satisfactorily. Besides, patient safety, care quality, and efficient processes should be prioritized. Although many organizations apply diverse measures to enhance patient safety, many adverse events still occur. Nurses should be adequately aware of the causes of adverse events and their role in reducing them. The purpose of this paper is to describe medication errors as a leading adverse event and appropriate measures for reducing errors.
Cause and Incidence Rate of Medication Errors
After joining a facility, new nurses look forward to cooperation with experienced colleagues, management support, and leaders’ continuous guidance. Providing the necessary support and guidance requires health care organizations to have adequate nurses and nurse leaders. However, this is not the case due to the prevalence of the nursing shortage, which is among the leading causes of medication errors. Salar et al. (2020) explained that most medication errors happen due to the nursing shortage, which increases the nurses’ ratio to patients. A nursing shortage increases fatigue and workplace stress among nurses. As a result, they cannot concentrate fully as the practice requires; thus, they are highly likely to administer drugs without confirmation or erring in reading labels. The incidence rate of medication errors varies across organizations and health care professionals. Salar et al. (2020) found that 39% of medication errors are caused by general practitioners and nurse-specific incidences ranging between 16-27%. The high prevalence poses a significant to patient safety and quality care hence the need for practical and lasting interventions.
Continuous Quality Improvement
Health care organizations should embrace quality improvement and support quality improvement initiatives. Continuous quality improvement (CQI) involves asking what is being done in patient care delivery and what is needed to achieve excellence (Tibeihaho et al., 2021). Due to its benefits, nurse leaders and staff identify performance gaps and their causes and intervene appropriately. An effective CQI initiative for addressing a nursing shortage is supporting nurses to cope with the shortage. Generally, health care facilities do not have adequate financial resources to support the continuous recruitment and training of nurses. Enabling nurses to cope through training, empowerment programs, and self-care opportunities could play a vital role in preventing nurse burnout. Preventing nurse burnout reduces nurses’ chances of committing medication errors since they are not fatigued, stressed, or dissatisfied. The first part of the initiative should be identifying the causes of medication errors and the relationship with a nursing shortage. Next, the most appropriate coping strategy should be implemented depending on the magnitude of the problem. Outcome measures include a progressive reduction in medical errors, engaging in teamwork, and participating in activities that foster health and well-being.
The rationale for Reducing Medication Errors
Reducing medication errors implies a proportional increase in positive outcomes. In the United States, approximately 7000-9000 people die due to medication errors (Tariq et al., 2018). The number could be higher considering that a significant proportion of patients do not report adverse reactions related to medication complications. As a result, reducing medication errors is instrumental in reducing deaths and health complications related to medication errors. Tariq et al. (2018) added that medication errors lead to patient dissatisfaction and low trust in health care professionals. It is crucial to prevent such outcomes to promote progressive organizational growth. Reducing medication errors also increases nurses’ self-confidence and ensures they are not victims of the second-victim syndrome, which is typical among nurses who commit errors leading to death and health complications.
Nurses’ Actions to Reduce Medication Errors
Nurses have a personal and professional responsibility to reduce medication errors. One of the nurses’ actions that can assist in preventing medication errors is timely reporting of incidences. Reporting is founded on the precept that erring is human, as underscored in the Institute of Medicine (IOM) Report (Afaya et al., 2021). Timely reporting encourages a collaborative approach to solution implementation as nurses learn from their mistakes to prevent a recurrence. Nurses should also embrace teamwork to learn from experienced colleagues about medication administration. Teamwork also gives nurses the needed support to confirm drugs before administering them to patients. Above all, nurses should embrace technology to reduce medication errors. For instance, barcode scanning is effective in confirming drugs hence reducing possible errors.
Conclusion
Whether new or experienced in practice, nurses are likely to commit medication errors more than other practitioners. Causes vary depending on the facility and the type of patient activities that a nurse is allowed to undertake in an organization. As explained in this paper, the nursing shortage is a leading cause of medication errors. Exhaustion and stress stemming from a high workload prevent nurses from concentrating fully and delivering care as expected. As a result, a CQI initiative focusing on addressing the nursing shortage can help to reduce medication errors. Nurses should also embrace teamwork, timely reporting, and technology in patient care to prevent errors.
References
Afaya, A., Konlan, K. D., & Kim Do, H. (2021). Improving patient safety through identifying barriers to reporting medication administration errors among nurses: An integrative review. BMC Health Services Research, 21(1), 1-10. https://doi.org/10.1186/s12913-021-07187-5
Salar, A., Kiani, F., & Rezaee, N. (2020). Preventing the medication errors in hospitals: A qualitative study. International Journal of Africa Nursing Sciences, 13, 100235. https://doi.org/10.1016/j.ijans.2020.100235
Tariq, R. A., Vashisht, R., Sinha, A., & Scherbak, Y. (2018). Medication dispensing errors and prevention.Statpearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK519065/
Tibeihaho, H., Nkolo, C., Onzima, R. A., Ayebare, F., & Henriksson, D. K. (2021). Continuous quality improvement as a tool to implement evidence-informed problem solving: experiences from the district and health facility level in Uganda. BMC Health Services Research, 21(1), 1-11. https://doi.org/10.1186/s12913-021-06061-8
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Important information for writing discussion questions and participation
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Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to
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Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.
Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.
I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!
Hi Class,
Please read through the following information on writing a Discussion question response and participation posts.
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Important information on Writing a Discussion Question
- Your response needs to be a minimum of 150 words (not including your list of references)
- There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
- Include in-text citations in your response
- Do not include quotes—instead summarize and paraphrase the information
- Follow APA-7th edition
- Points will be deducted if the above is not followed
Participation –replies to your classmates or instructor
- A minimum of 6 responses per week, on at least 3 days of the week.
- Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
- Each response needs to be at least 75 words in length (does not include your list of references)
- Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
- Follow APA 7th edition
- Points will be deducted if the above is not followed
- Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
- Here are some helpful links
- Student paper example
- Citing Sources
- The Writing Center is a great resource