Medication Administration Discussion
Ensuring the safe administration of medications within the health care system is complex and requires a health care professional’s attention to multiple factors during the process. No one professional can prevent all medication errors. The nurse is at the sharp end of delivery of medications that may have started out wrong in the physician’s , in the drug packaging, in the pharmacy, or in labeling and packaging similarities. The professional who is attentive to these multiple factors increases the chances for safe medication administration. In to reliably and safely administer medications, the nurse needs to determine the patient’s condition and/or stability, the actions and side effects of the medication to be administered, the patient’s current medications, the patient’s environment, and the activities that other health care professionals are carrying out on behalf of the patient. Conscious patients should be enlisted to assist with safe administration of medication by clearly identifying themselves to the nurse and being informed of their medications taken at home and in the hospital.
Adverse medication effects can occur even under optimal conditions. A medication combined with other medications, substances, and/or the patient’s physiology has the potential to create life-threatening reactions within the patient, causing temporary or permanent harm to the patient. Computerized information programs on drug interactions, solubility, safe routes, dosages, and complications are an indispensable aid in avoiding delivery of a contraindicated drug to a patient. The nurse must learn to use these systems, and hospitals need to ensure their accessibility to all members of the health care team.
Considerable effort is devoted to mastering the requisite knowledge related to finding the best information on the actions and synergistic effects of medications, incompatibilities, and the ways in which groups and individual patients respond to specific medications. This effort is well spent and essential, because of the array of potential adverse reactions that may occur. Each individual patient’s responses need to be evaluated to determine whether the response to the administered medications is within the expected range or if the patient is having adverse reactions.
Nurses who are knowledgeable about patients’ illnesses and medications are able to provide competent care as they are alert to information sources about the known or expected side effects, medication contraindications, and incompatibilities. Clearly, nurses are well positioned as the patient’s last line of defense to protect patients from unsafe medication administration by using all the available resources pertaining to the particular patient and medication, double-checking all aspects of medication appropriateness in terms of correct dosage, route of administration, timing, purpose, and whether this is the correct patient ( Page, 2004 ).
Identified points within the processing of medications that are particularly vulnerable to practice breakdown noted above include medication prescribing or ing, dispensing, and administration ( Williams, 2004 ). Nurses’ work takes place primarily at the health care system-to-patient interface, and medication administration is a traditional nursing role within this context. The Institute of Medicine (IOM) discussed these types of practice breakdown as “errors” in its report To Err Is Human ( Kohn et al., 2000 ), in which it described latent errors as those being removed from the direct control of the operator (or in this case the nurse) and include as poor design and poor management decisions or policies. The IOM report describes an active error as an action of the frontline operator in which the results are immediately known. For example, a nurse may convert a latent error to an active error by not recognizing that a medication with a name similar to ibuprofen was erroneously dispensed by a pharmacy. As a result, a nurse may accidentally administer bupropion (Wellbutrin) to the patient instead of ibuprofen.
Investigators discussed possible causes leading to medication errors and nurse involvement:
· …medication errors, an activity directly involving nursing care, have been the subject of many of the studies on error. Within this research focus, studies have typically analyzed errors associated with the and administration of medications. All too common and preventable are errors such as inappropriate dosage, overlooked known allergies, and wrong drug or route of administration. Such errors often stem from a confluence of factors including environmental distractions, miscommunications, and drug-labeling problems ( Maddox, Wakefield,
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