Nmc drug errors. Role and Responsibility of the Nurse in Medicine Management 2022-10-27
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The National Patient Safety Agency (NPSA) defines a medication error as "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." Medication errors are a common and serious issue in healthcare, with the World Health Organization estimating that at least half of all medication errors occur during prescribing, dispensing, or administering medications.
In the United Kingdom, the Nursing and Midwifery Council (NMC) is the regulatory body responsible for setting and enforcing standards of practice and conduct for nurses and midwives. The NMC has published guidance on medication errors, which includes recommendations for how nurses and midwives can prevent and mitigate the risk of medication errors occurring.
One key way that nurses and midwives can reduce the risk of medication errors is by following the "five rights" of medication administration: the right patient, the right drug, the right dose, the right route, and the right time. This means ensuring that the medication is being given to the correct patient, with the correct medication, at the correct dose, through the correct route (e.g., oral, intravenous, subcutaneous), and at the correct time. Nurses and midwives should also check the patient's medical record and allergy status before administering any medications.
Another important prevention strategy is double checking. This involves having another qualified healthcare professional check the medication and the administration process to ensure that everything is correct. This is especially important when administering high-risk medications or when working with complex medication regimens.
In addition to prevention, it is also important to have systems in place to identify and report medication errors when they do occur. The NMC recommends that nurses and midwives report any medication errors, near misses (incidents that could have resulted in a medication error but did not), or concerns about medication safety to the appropriate person or organization, such as the nurse in charge or the patient's GP.
Medication errors can have serious consequences, including harm or even death to patients. It is therefore crucial that nurses and midwives take steps to prevent these errors from occurring and to report them when they do occur. By following the NMC's guidance and best practices, nurses and midwives can help to ensure that patients receive the safe, high-quality care that they deserve.
Read the professional duty of candour
From reviewing Mary's notes, it appears that previous administrations of this drug at this dose have given Mary adequate analgesia, so Clare feels confident that this dose is both safe for Mary, likely to be well tolerated and likely to make her more comfortable. This article has been double-blind peer reviewed Scroll down to read the article or download a print-friendly PDF here. Nurses should seek support from the prescriber in this event, but also be aware of the necessary emergency care required to support a patient having a serious reaction. Clare therefore feels confident that carrying out the administration of this dosage is safe and not contraindicated. In 2013, the Francis Report published the results of an investigation into systematic failures in patient care and safety at the Mid Staffordshire NHS Foundation Trust, which ultimately resulted in multiple preventable patient deaths.
Role and Responsibility of the Nurse in Medicine Management
The Medical Journal of Australia, 188 5 , pp. If lined up together, the solid areas of safeguarding interventions should overlap the holes in other layers, so that the hole is not present throughout the slices. Transparency Will Only Change Culture If We Eradicate Blame as A Response. Any information must be provided in a way the patient can understand NMC 2008. Medication error can be defined as failure in the drug treatment process that leads to or has the potential to lead to harm to the patient Aronson 2009. This is an example of paternalistic empowerment, where the expertise gap is the main characteristic of the nurse-patient relationship Gomm 1993.
Exploring the factors contributing to drug errors and how to improve knowledge
Staff, patients and visitors can be made aware of the importance of not distracting the nurse performing the drugs round, for example by displaying educational posters around the ward setting. Journal of Clinical Nursing; 12: 4, 519-528. If there is any uncertainty over any aspect of the prescribed instructions, the nurse should investigate this further by contacting the prescribing healthcare professional for clarification. Or is the dose adequate to achieve the aims of the patient care plan? For example, understaffing may result in nurses having inadequate time or provision to concentrate on drug preparation, or a poor medical equipment maintenance schedule could result in a drug administration error from malfunctioning equipment. Medicines in tablet form should not routinely be crushed to make it easier for the patient to take it without approval by a pharmacist. In England and Wales, medical and drug administration errors should also be reported to the National Patient Safety Agency NPSA via the National Reporting and Learning System NRLS so that the circumstances of the error can be considered at a national level and that any lessons that can be learnt from the error e. Knowledge-based errors can also occur as a result of a lack of knowledge and understanding on the part of the nurse regarding a drug's action, usual route of administration or mechanism.
Preventing and reporting drug administration errors
This also includes following the specific restrictions in place for the administration of controlled drugs discussed in the previous chapter. Nurse Education in Practice, 10 3 , pp. Have previous doses of the drug been administered at the right time? Grandell-Niemi H et al 2003 Medication calculation skills of nurses in Finland. Legal and ethical accountability therefore resides in the supervising registered nurse. Rogers AE et al 2004 The working hours of hospital staff nurses and patient safety. No healthcare professional should ever administer medication they have not helped prepare. Department of Health 2009.
Avoiding the near misses. Nursing Standard, 23 30 , p. These are not published on the Hearings pages, which are for new outcomes or changes to sanctions. It is also possible to make errors when calculating the dosage of a drug; for example, if the instruction stipulates a particular dosage per kg of patient body weight, the nurse may need to determine what the total dosage should be for that specific patient. Jenny records the error she has observed in John's notes, and the drug administrations she has just made of salbutamol and ipratropium bromide. The delegation experience can also be included in Phil's performance review from the placement on the ward as part of his ongoing training record. A student nurse is legally considered in the UK to be responsible for their practice, but to not yet have the experience and ability to be considered fully accountable for their practice.
It is thought that the risk of error with intravenous drug administration is particularly high, with one UK based study indicating that almost 70% of IV drug administrations included some degree of clinical error. While current practices continue to be examined, an agenda is in progress to further pair the CPOE with clinical decision support systems. Diagnosing the problem: Using a tool to identify pre-registration nursing students' mathematical ability. As no other nurse was in sight, she therefore hurried to the second patient and performed the necessary emergency care to clear the patient's airway. Finally, the application of these concepts to everyday nursing practice will be illustrated using a detailed hands-on scenario. He then completes Bill's patient records with the appropriate information.
A common cause of errors is tiredness; long shifts or repeated night shift working can cause all healthcare professionals to make errors in judgement or by omission. More information on how to do this can be found in the cookie policy. Right medication Is the medication correct, could there be an error in the written instructions? They suggested that clinical areas with patients who are more seriously ill and have more complex medication regimens influence medication errors. Most studies were carried out in the US and New Zealand. This has led to students entering nurse training courses with different qualifications, such as NVQ at level 3 and GCSEs. Right circumstances Does the individual being delegated to have the right resources and equipment to carry out the task safely? The need for advanced clinical decision making skills and knowledge of guidelines and laws to enable a high standard of practice in medicine management has also been highlighted.
The administration of medication in an institutionalised setting involves adherence to relevant local trust policies and procedures in addition to legal frameworks and professional standsards such as the Medicines Act Great Britain. In order to reduce the risk of drug administration errors occurring it is essential that we understand how these errors can occur, and the factors which can make their occurrence more likely. Safe practice in the management and administration of medication is an essential part of the role of the nurse NMC 2008. Check by asking the patient for their name and date of birth and checking wrist bands Right dosage Has the medication been prescribed at the right dosage? When interviewed, Susan becomes distressed at the thought of having endangered John's health and reveals that she feels the reason she made the error of omitting the prednisolone and ipratropium bromide dosages was due to having too many critical care patients to care for. This investigation identified that although Susan had made the medical error by omitting to carry out all prescribed drug administrations, the real cause of the drug administration error was the lack of support that Susan had, and the lack of available staff to care for the other acutely ill patients on the ward. Clare asks Mary if she has any history of allergy to this medication to identify if Mary is at a risk of an adverse reaction. This indicates that the right response to the medication has occurred.
She remembers administering John the prescribed salbutamol dose via a nebuliser as soon as she was able, but that she became distracted due to an alarm going off on another patient's monitor to indicate that their oxygen saturation levels had fallen below a safe level. Although this research also involved procedural, transcription and charting errors, of the 199 errors and 213 near errors, more than half the errors 58% and near errors 56% involved medicines administration. An awareness of these factors which contribute to medication errors may help nurses address these issues and better manage their working environment. Although information about preventing and reducing medication errors is widely available, such errors are surprisingly common and costly to the nation. For example, student nurses at the University of Wolverhampton are now assessed for medicines administration summatively in the clinical area, using an essential skills cluster booklet to enable them to link theory to practice. However, there are also novel ways in which errors can be prevented that are specific to the underlying cause. IIt is important to identify the factors that increase the potential for medicine administration errors and address how best to overcome these Authors Vernel Emanuel,MSc, PGCert, DipHE, BSc, Managers Award NVQ-4, RGN, is senior lecturer adult division ; Maxine Pryce-Miller, MA Ed , PGDip, PGCE, BSc, RSCN, RGN, is senior lecturer child division ; both at University of Wolverhampton School of Health and Wellbeing.
Full disclosure of both actual and potential medication errors and transparency in an inherently litigious healthcare culture is difficult but necessary to further develop risk reduction strategies for improved medication safety practices. Studies have found that a third or more of medication errors involve the incorrect dose being administered LaPointe and Jollis, 2003; Tang et al, 2007. These rules are shown below in Figure 1. . However, Hughes 2004 suggested that human factors such as lack of experience or skill predispose people to errors.
