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Health care leaders have an opportunity to create innovative strategies through a collaborative effort and to develop solutions that will build a safer environment for patients and registered nurses.
Implications for practice: Optimal staffing is essential in order to provide optimal patient care.
To achieve quality care, better patient outcomes and financial stability, optimal nurse staffing should be viewed by health care employers as a necessity rather than an option—particularly as health care reforms and new regulations take hold. The 2012 ANA Principles for Nurse Staffing identify the major elements needed to achieve optimal staffing, which enhances the delivery of safe, quality care. There are many types of medical errors, and they can occur anywhere in the healthcare system-from hospitals, to nursing homes, to pharmacies. The fragmented nature of our healthcare system has contributed to an epidemic of medication and other medical errors today.
This includes the patient's name, age, date of birth, weight, vital signs, allergies, diagnosis, and current lab results. Breakdowns in communication among physicians, nurses, pharmacists, and others in the healthcare system can lead to medication errors. High-alert medicines such as heparin can have devastating consequences if not administered properly. Ask for mandatory training sessions about medications that are introduced to your facility.
It’s often been said that to eliminate medication errors in health care, we have to get five things right: the right medication, right patient, right dose, right route, and right time. Closed loop medication management is an example of a patient-centric technology, designed to protect patients from adverse drug events. Yet, an increasingly popular approach to medication management is based on the idea that no technology should stand alone, but should integrate with all other steps in the medication process.
To “close the loop” and eliminate gaps in the four steps above, technology is used to automate every part of the process and eliminate many of the most common types of errors. American Sentinel University is accredited by the Distance Education Accrediting Commission, DEAC (Formerly Distance Education and Training Council-DETC), which is listed by the U.S. American Sentinel's bachelor's and master's nursing education programs are accredited by the Commission on Collegiate Nursing Education (CCNE). The Accreditation Commission for Education in Nursing (ACEN, formerly NLNAC) has awarded accreditation to American Sentinel University's Doctor of Nursing Practice (DNP) program with specialty tracks in Executive Leadership and Educational Leadership. Medication administration errors (MAE) is one of the factors causing death and harm to patients and the most common important challenges threatening healthcare system in all countries worldwide [2]. American Society of Health System Pharmacists (ASHP), (2003) recognises that medication errors can be minimised by assessing the medication use process, identifying inadequacies within systems, and developing interventions to correct the recognised deficiencies. A possible contributing factor to MAEs in the ED is the unique medication distribution system used.
Although the results are mixed, several studies suggest that links exist between medication error and systemic organisational factors. Previous studies have examined important factors in refusal or act as barriers to report medication errors [10-13] or the analysis and improvement medication error reporting practices by emergency department physicians, nurses, and pharmacists [14]. Understanding factors that contribute to medication error is the first step toward preventing it to ensure safety and quality of patient care.
This study was carried out in emergency department at teaching Main University Hospital in Alexandria governorate, Egypt which contains 42-bed during the period from June 2013 to the end of august 2013. All nursing staff (n=84) who were working in the previously mentioned setting and willing to participate in such study were included. Medication Administration Error Survey: It was developed by Wakefield in 1998 [1] included 16 items regarding reasons why medication errors occur. The Ethics Committee of Faculty of Nursing, Alexandria University has approved the study protocol. Before embarking to data collection, an informed consent was obtained from each participant to share in the study. After data were collected it was revised, coded and fed to statistical software SPSS IBM version 20. Table 1 illustrated the demographic characteristics of nursing staff at emergency department in Main University Hospital.
Figure 1 represents the perception of participants for why medication administration errors occur. Table 2 describes the relationship of socio-demographic data with the four reasons of why medication administration errors occur.
In this study, results of the factor analysis ranked four categories of factors influencing the occurrence of MAEs in emergency department.
The present study factor analysis for MAEs causes ranked pharmacy processing as the third factor influencing the occurrence of MAEs in ED .Ideally, the pharmacist should collaborate with the prescriber in developing, implementing, and monitoring a therapeutic plan to produce defined therapeutic outcomes for the patient.
Based on the nurse perception, the results of the current study showed that regarding demographic characteristics, there was no relation between participants’ age, marital status and their experience in units with nurse staffing and pharmacy processing factors that influencing the occurrence of MAEs. An interesting finding in this section of the study, in relation to nurses’ experience in nursing and hospital, there were statistically significant relationship between nurses experience and medication packing reasons of why MAEs occur, in which nurses who have more working experience highly perceived that medication packaging is factor causing the occurrence of MAEs compared to nurses who have worked less years of experience. This study showed statistically significant correlation between participants’ most frequent shift with medication packaging reasons of why MAEs occur where nurses who are working night shift has highest mean for perception that medication packaging is the most factor causing MAEs.
In conclusion, this study determined the factors influencing the occurrence of medication administration errors, as perceived by nurses in emergency department. In summary, the findings from this study highlight the need to further examination on how hospital management is addressing the problem of MAEs occurrence in ED and the role of the nurse managers in preventing medication errors through participation in quality management processes. Staffing solutions require leadership support and recognition to assure an appropriate number and skill mix of registered nurses who are able to deliver safe quality patient care.
Innovative and collaborative strategies that focus on developing long-term solutions will improve the quality of patient care outcomes. These principles and the supporting material in this publication will guide nurses and other decision-makers in identifying and developing the processes and policies needed to improve nurse staffing at every practice level and in any practice setting. Double check high alert medications with another nurse to prevent accidental overdoses and other medication errors. Hospitals often invest in technology that helps to prevent errors at various points in the process – like the bar codes that nurses check at the bedside when administering a drug, for example.
It’s known as “closed loop medication management,” to reflect its focus on eliminating gaps in information and minimizing the opportunities for error when tasks are handed over to another department.
If you have a keen interest in health care informatics, you might want to consider a career specialization in this area. Department of Education as a nationally recognized accrediting agency and is a recognized member of the Council for Higher Education Accreditation.

For more information, contact CCNE at One Dupont Circle, NW, Suite 530, Washington, DC 20036, (202) 887-6791. Weinberg, MSN, RN, Executive Director.The National Council of State Boards of Nursing (NCSBN) membership approved the “Enhanced” Nurse Licensure Compact in May of 2. The definition typically cited in literature that is authored by nurses defines MAE as mistakes associated with drugs and intravenous solutions that are made during the prescription, transcription, dispensing, and administration phases of drug preparation and distribution [1,3]. For example, on-pharmacy profiled automated dispensing cabinet (ADC), unit stock, or refrigerator, as the prescriber’s order may not be reviewed by a pharmacist before the drugs are given (Flynn et al. These include nurse staffing adequacy, hours worked per week, overtime, staffing mix (professional versus unregulated), and other factors reflecting how the work system is designed [5-7].
However, few studies have focused only on the assessment of the occurrence and reasons of nursing medication errors, these studies recommended further studies to determine and investigate the causes of medication errors [15-18].
Therefore we have conducted this study to explore the most important factors influencing the occurrence of MAEs in ED from nurses’ perspective which can lead to improve medication administration process, diminish the risks of adverse events that impact patient morbidity and mortality, improve patient safety, and lower cost of patient care. Respondents were asked to how much they believe they affect the occurrence of medication errors in the emergency department using a six points Likert type scale with fix values ranging from 6= strongly agree to 1= strongly disagree.
They have determined that this survey does not fall under the committee’s jurisdiction. This study revealed no statistically significant relation between participants’ sex, residence, and educational level and their experience in units with reasons of why MAEs occur. In descending order of magnitude, these categories included physician communication, followed by medication package, then pharmacy processing and finally nurse staffing. In addition, Peth in 2003 [22] in USA reported that the explosion of new drugs appearing in the marketplace has made it virtually impossible for physicians, nurses, and pharmacists to keep abreast of all of the latest data concerning the indications, contraindications, drug interactions, and adverse effects associated with each new drug. This finding is consistent with Wakefield in 2000 [23], who showed that workload and type of care delivery system, and other factors such as number of consecutive hours worked, rotating shifts, staffing mix and numbers, nurse-to-patient ratios, assignment of floating nurses to unfamiliar units . This means that all nurses are almost ranking these factors influencing the occurrence of MAEs regardless of their age, marital status or years of experience.
Anderson and Townsend in 2010 [20] mentioned that fatigue and sleep deprivation are linked to decreases in vigilance, memory, information processing, reaction time, and decision making. Top management should provide adequate staffing and fair scheduling for all urgent care to provide fair workload between nursing staff that reduce the occurrence of MAEs. Alternate methods may need to be created for a supportive unit culture that encourages multidisciplinary team from nurse, physician, and pharmacist to prevent medication errors and improve patient safety in the ER hospital setting. Wakefield BJ, Wakefield DS, Uden-Holman T, Blegen MA (1998) Nurses’ perceptions of why medication administration errors occur. Sanghera IS, Franklin BD, Dhillon S (2007) The attitudes and beliefs of healthcare professionals on the causes and reporting of medication errors in a UK Intensive care unit. Peris-Lopez P, Orfila A, Mitrokotsa A, van der Lubbe JC (2011) A comprehensive RFID solution to enhance inpatient medication safety. Flynn EA, Barker K, Barker B (2010) Medication-administration errors in an emergency department. Rogers AE, Hwang WT, Scott LD, Aiken LH, Dinges DF (2004) The working hours of hospital staff nurses and patient safety.
McGillis Hall L, Doran D, Pink GH (2004) Nurse staffing models, nursing hours, and patient safety outcomes.
Whitman GR, Kim Y, Davidson LJ, Wolf GA, Wang SL (2002) The impact of staffing on patient outcomes across specialty units.
Fairbanks RJ, Hays DP, Webster DF, Spillane LL (2004) Clinical pharmacy services in an emergency department.
Al-Youssif S, Mohamed L, Mohamed N (2013) Nurses’ Experiences toward Perception of Medication Administration Errors Reporting. Abou Hashish E, El-Bialy G (2013) Nurses’ Perceptions of Safety Climate and Barriers to Report Medication Errors. Baker M, Attala H (2012) Medications errors, causes, and reporting behaviors as perceived by nurses. Lisa D (2009) Medication error reporting by physicians, nurses, and pharmacists in a Level 1 Trauma Center Emergency Department. Kamel S (2008) Studying medication administration errors in Ain –Shams University Hospital.
Abo El-Maged N, Gaber E, El-Maghraby M (2002) Relationship between work setting and the occurrence of medication errors among nurses of Assiut University Hospital, Egypt. Mousa S (2000) Assessment of nursing medication errors factors causing them in the critical care unit At El Manial University Hospital, Egypt. Dumo MA (2012) Factors Affecting Medication Errors among Staff Nurses: Basis in the Formulation of Medication Information Guide. Peth HA (2003) Medication errors in the emergency department: a systems approach to minimizing risk. Wakefield J B, Uden-Holman T, and Wakefield S D (2000) Development and Validation of the Medication Administration Error Reporting Survey, Journal of Advances in Patient Safety 4: 475-89. Al-Shara M (2011) Factors contributing to medication errors in Jordan: a nursing perspective. Hartel MJ, Staub LP, Röder C, Eggli S (2011) High incidence of medication documentation errors in a Swiss university hospital due to the handwritten prescription process. Physicians may inadvertently prescribe a drug that is inappropriate for a patient because of known allergies, potential drug interactions, or an existing medical condition like high blood pressure. Errors of transcription occur at the pharmacy and generally involve illegible handwriting on a paper prescription. When pharmacy staff is busy or distracted, they may grab the wrong medication or dosage off the shelf or count pills incorrectly. Errors at the bedside make up the second largest category of medication errors – between a quarter and a third, depending on the study being cited.
This tool is integrated with the EMR, so providers receive instant alerts regarding patient allergies or other potential safety issues. Pharmacists may fill orders manually or may rely on automated dispensing systems to eliminate counting errors.
Barcodes and other bedside technologies help nurses ensure the right patient is receiving the right dose of the right medication. Health care is in need of nurses who can analyze technologies from both the bedside and IT perspectives, to help create patient-centric tools. Medication administration errors (MAEs) in the ED are common, with errors occurring most often in the prescribing and administration phase [4]. Evidence of links between stress in the clinical workplace and medication error is also emerging.

In addition data were collected on nurses’ sociodemographic data including sex, marital status, age, education level, years of experience, working unit, and the most frequent shift they work. The Medication Administration Error Survey was translated into Arabic language and accordingly, minor changes were made for a few unclear words.
Finding of the current study illustrated that participants perceived physician communication reason as the highest ranked factor influencing the occurrence of MAEs.
Moreover, all medications have side effects, and rare but potentially fatal side effects are unlikely to show up in preliminary clinical trials. Also, the finding of this study showed a significant difference between nurses’ marital status and physician communication as factor influencing occurrence of MAEs, since single nurses had higher ranking for this factor than married ones. This result is consistent with the study of Flor et al in 2012, Zein Eldin and Abd Elaal in 2013 [25,26].This result is in contrast with Al-Youssif et al.
A person who works a 12-hour shift and has a long commute may need to stay awake for up to 18 consecutive hours. Developing and disseminating the patient safety guidelines in all hospital setting especially in nursing and pharmacy departments. A baseline assessment of patient safety culture among nurses at Student University Hospital. When they are working from memory, they may jot down the wrong dose or frequency – or even get the name of the drug wrong, since so many sound alike. Even when a prescription is written legibly, a busy pharmacist may enter it into the system incorrectly. It may also be considered a dispensing fault if the pharmacist fails to catch a known drug allergy or potential drug interaction. These occur anytime a patient gets the wrong drug or wrong dose, misses a dose, or is medicated at the wrong time. Ideally, nurses have access to all prescription and pharmacy information, as well as the patient’s clinical data, so they can speak up if they see a discrepancy that has slipped through the cracks. An online MSN degree in nursing informatics is the perfect way to improve your knowledge, skills, and value to your organization.
See this news article from the IBON's Executive Director, Kathy Weinberg to explain: Enhanced Nurse Licensure Compact Article.
However, high patient acuity, crowding, and frequent interruptions are pervasive in the ED’s clinical environment. Also it was tested for content validity by five experts in the same field of the study of nursing at Alexandria Faculty of Nursing.
A pilot study was carried out on 10 nurses who were working in other unit rather than the studied units and the necessary modifications were made. Discrete items concerning nurses responses for each domain were summed together to have the domain total score. In fact, once a medication has been removed from its packaging, it’s hard to identify and can be easily confused with another one [11].
The nursing shortage has increased workloads by increasing the number of patients for which a nurse is responsible.
This could be due to physicians either male or female underestimating nursing as profession which result in poor relationship between younger nurses and physicians however, as new graduated nurses become older and experience nurses receive more respect from them.
Moreover, Tully in 2009 and Hartel et al in 2011 [27,28] stated that fatigue and sleep deprivation also may diminish a nurse’s ability to recognise subtle patient changes.
Actually, reducing these errors requires the commitment of everyone with a stake in keeping patients safe. The researchers recommended for provision of on-going education & training on practice of safe medication administration for all nurses especially in urgent care units.
Many studies have found that the majority of all medication errors (up to 50 percent) occur at the prescribing stage.
American Sentinel University is an innovative, accredited provider of online nursing degrees.
Interruptions in the ED are conservatively estimated to be as frequent as every minute for attending physicians and every 14 minutes for resident physicians. Clearly, adverse drug events that occur in the ED are a significant public health problem and need to be reduced, but this must be accomplished without making the ED less efficient [9].
The questionnaire was hand delivered to each study participant in the morning and afternoon shifts and it was completed through self-report method. Descriptive statistics in the form of frequencies and percent were used to describe the categorical data variables while mean and standard deviation was used to describe domains scores.
Many nurses still feel that physicians don’t understand, respect, or care to listen to nursing perspectives on patient care that lead to misunderstanding and conflict between nurses and physicians. Also Anderson and Townsend in 2010 [20] reported that, nurses perform many tasks that take them away from the patient’s bedside, such as indirect activities, answering the telephone. As a result, the nurse may not notice an adverse reaction to a drug quickly enough to avoid a devastating outcome. The physician who wrote the prescribed medications, pharmacist who dispensed it and the nurse who received the medications and administered to the patient, all play an important role in preventing MAEs. To test for association between sample characteristics and their scores at different domains, independent samples t-test and One Way ANOVA were used. While, Al-Youssif in 2013 [11] illustrated that participants perceived physician-nurse relationship reason as the fourth category of MAEs. When medication errors occur, multifactorial causes in a badly shaped system affect their occurrence, as well as manual prescriptions, lack of bar codes, stress, fatigue, lack of attention and lack of ability. To identify the relative importance of each domain at committing error, factor analysis was used to express factor loading which is the correlation between each domain and the overall hidden factor. The third factor was pharmacy processes reason (0.76) for example, pharmacy delivers incorrect doses, and pharmacy does not prepare and label the medication correctly, as well as pharmacists unavailable 24 hours a day. Moreover, poor communication accounts for more than 60% of the root causes of sentinel events reported to the Joint Commission (JC) Anderson and Townsend in 2010 [20]. The last factor was nurse staffing (0.72) was perceived as the least reason of MAEs occurrence. To read more in- depth information about the NLC see this page on our website: Nurse Licensure Compact - Proposed "Enhanced". Administrative, regulatory law defense for physicians, nurses, dentists, pharmacists and other health.Education Law Article 139, Nursing Effective June 18, 2010 §6900.

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