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Medication errors or adverse drug events are inappropriate dispensing and administration of drugs which cause harmful effects such as liver damage and excessive bleeding. Over-the-counter (OTC) drugs are the most common example of medication error (Porcheï€ˆ, 2008). Such drugs are usually taken without doctor's prescriptions thus are prone to wrong dosage or use. For example OTC drugs containing acetaminophen when administered in wrong dosage can increase risks of liver damage. Although these errors can occur anywhere, Aspden (2006) cites that they are preventable. Globally, Porcheï€ˆ (2008) estimates that between 200,000 and 500,000 people die annually from adverse drug events and related cases. In addition adverse drug events causes increased cost of medication, patient disability and reduced confidence in health care providers (Daniels, 2004). Most cases of adverse drug events in hospitals occur as a result of; wrong diagnosis by doctors leading administration of inappropriate drug, poor communication between doctors and nurses and between patients and nurses who issue the drugs. However, Aspden (2006) reports that significant efforts have been made to improve medication safety. Such efforts explain the roles of nurses in ensuring medication safety by emphasizing the 'Five Rights' including; right drug, right patient, right dose, right route, and right time for safety medication.
This paper explains some of the roles and measures including; accurate patient information and medication history, drug information, adequate communication and environmental precautions which nurses can take to prevent medication errors. This is because nurses play integral role in health care delivery and are responsible both legally, morally and ethically for every drug they dispense to their patients. The paper also looks at the importance of employing such roles by the nurses to effectively reduce cases of adverse drug events.
Roles of Nurses in Prevention of Medication Errors
Since consequences of medication error are severe, it is therefore the responsibility of each nurse to ensure every that every measure is accurately followed as they greatly influence medication use (Cima and Clarke, 2011). These measures include: Patient information; it is the most important and the first of the 'five rights'. According to Cima and Clarke (2011) accurate patient demographic information such as name, age, date of birth, allergies and history of infection gives right information that identifies the patient every time they access medical services. Such information appropriately guides doctors and nurses in choosing appropriate drug, its dosage administration route and frequency (Cima and Clarke, 2011). The age is important in providing right dose since certain drugs are only given to specific ages of people while allergy history of a patient helps the nurse accept or decline to issue medication that they believe would result in serious allergic reactions with the patient. Daniels (2004) asserts that laboratory information is significant element of patient's information that should be carefully translated by the nurse before issuing medication. For example wrong interpretation of laboratory result or administration of Methyciline drug for the treatment of Staphylococcus bacterial infection has resulted into resistant strains of the bacteria thus increasing the cost of treating such infections and prolonged suffering of patients. Patient demographic information can be confirmed using specific patient identifiers like armband barcode scanning machine which has successfully been used to reduce medication errors related to patient information ((Porcheï€ˆ, 2008).).
Secondly, drug information is another measure that can be taken by the nurse to avoid medication error. Name of a drug, general knowledge for using a particular medication, its therapeutic dosage and its possible side effects to monitor are some of the key elements in drug information a nurse should not over look (Cima and Clarke, 2011). Knowledge of a drug regarding how and when to use it can help significantly in reducing adverse drug events. For example when and how to use antimalarial therapy in reducing the increasing incidences of drug resistant malaria infection in the tropical African regions while certain drugs should not be prescribed to pregnant patients. Knowing drug information will also help a nurse avoid dispensing wrong drug such as antimalarials for treatment of flu or worm infection (Aspden, 2006). Since certain drugs resemble each other in color and package while other has different names with similar pronunciation, it is upon each nurse issuing the medication to ensure every drug details are confirmed as right. Cima and Clarke (2011) illustrates that Daunorubicin and Idarubicin, Lamictal and Lamisin antibiotics are examples of such drugs which are easily mistaken and can be dispensed instead of the other. Checking for drug information is also helpful in avoiding prescription of expired drugs and subsequent update of drug profiles (Porcheï€ˆ, 2008). For this reason, each nurse should carefully read text references of each drug packet, check drug protocols which are guidelines on correct dosage and precautions or generate computerized drug information systems to avoid adverse drug event resulting from lack of drug information (Porcheï€ˆ, 2008).
Similarly, adequate and effective communication between nurses, other Medicare providers and patients also play a key role in reducing medication errors (Aspden, 2006). Lack of common language between nurse and patient, unclear words or writing are some of the causes of language barrier. Consequently such barriers can result in wrong prescription by the doctor and issuance of inappropriate medication by the nurse. Aspden (2006) further elaborates that communication barriers among these groups can be overcome by proper assessment of situation and giving appropriate recommendations. Seeking clarifications on every conflicting issue especially between the nurse and physicians regarding drug administration should be done. Translations may be necessary in cases of language barrier.
Environmental factors such as cluttered work environment, fatigue for nurses on long shifts, inadequate lighting in drug administration areas and external destructions while administering a drug is another measure that should be considered by nurses. Severe adverse drug events have resulted from disruption of the nurse while administering medication causing wrong dosage or giving inappropriate frequency of a particular drug (Cima and Clarke, 2011). For example a drug which should be taken once in a day can be prescribed or administered twice. Untidy working areas also increase the risks of medical errors especially when working in busy environment (Aspden, 2006). This can cause a nurse to administer a drug intended for a different patient; fatigue by the nurse and inadequate lighting of drug preparation and administration areas are also associated with such errors (Daniels, 2004). To avoid such mistakes nurses should avoid taking long shifts which may cause them to have fatigue; they should also ensure their working areas are kept tidy. In addition nurses should also ensure proper lighting of drug preparation and administration rooms
In conclusion, adverse drug events can be avoided and nurses can ensure tremendous decline in such incidences if they carefully observed stated roles. To achieve this, it is important that strict legislative measures were put in place to ensure these measures are effectively kept. This paper has therefore highlighted patient and drug information, adequate communication between doctors, nurses and patients as well as environmental factors as some of the key measures and roles nurses should consider in order to appropriately prescribe or administer medications.