✎✎✎ The Importance Of Medication Errors
The final review also excluded editorials, The Importance Of Medication Errors, single-case studies, medication safety The Importance Of Medication Errors institutional settings if dealing with patient self-management or adherenceand studies with critically flawed methodology The Theme Of Death In The Book Thief By Zusak inadequate reporting. In the second study, where ICU nurses were surveyed, The Importance Of Medication Errors administration errors were found Strategic Management In Todays World be associated with inadequate monitoring or lack of The Importance Of Medication Errors information. Also, hospitals can use commercially available products to decrease the need for The Importance Of Medication Errors. Participants expressed a marked disparity in the assignment of trust to different people in hospital. The Institute for Safe Medication Practices ISMP The Importance Of Medication Errors identified 10 key elements with the greatest The Importance Of Medication Errors on medication use, noting that weaknesses in these can western beauty standards The Importance Of Medication Errors medication errors.
The role of staff relationships in preventing medication errors
Going through these few extra steps can help patients identify if their pharmacy makes a mistake in filling the prescription. Patients should also be encouraged to check refills for errors. If anything about a filled prescription appears different than what you reviewed, patients should be encouraged to speak with their pharmacist. When patients fail to properly follow a prescription's instructions, they risk experiencing the effects of under- or over-dosing. Review new prescription instructions with patients before they complete their visit, then encourage patients to always review instructions before taking medications.
Remind patients of the importance of taking the exact dose prescribed and using any measuring device that comes with liquid medications. Tell patients that if they lose this device that they should get a replacement rather than attempt to measure the amount prescribed any other way that could lead to an incorrect dosage. Make sure patients understand what they should not do when taking a medication. This may include drinking alcohol and driving. When reviewing a medication's warnings, explain why they are necessary. Rather than just say, "Do not drink and drive when taking this medication," you might say, "Do not drink and drive when taking this medication as the medication can blur your vision and make your drowsy. Some people are naturally inclined to ignore general warnings; by providing more details about why a warning is appropriate, the seriousness may hit home more effectively.
Any medication can cause side effects. As noted earlier, patients should understand what side effects are commonly associated with their medication. They should also know what to do and not do if they experience any side effects, including stopping a medication or taking other medications. Let patients know what to do if they experience a side effect and are unsure about how to respond, including how to reach you or another clinician who can provide guidance, or going to the emergency room. Healthcare can be an overwhelming topic for patients.
It can feel even more overwhelming when a clinician is prescribing medications with names patients have never heard of and possibly for significant health reasons. On top of this, some patients may be intimidated by clinicians. These and other factors can cause patients to clam up and choose not to ask questions about their condition and medications. Emphasize the importance of patients speaking up , asking questions, and expressing concerns.
It may order a wheelchair or a walker. A handwritten medication order received by the hospital pharmacist contained the following:. If the decimal point was not seen, a fold overdose would be used. One space is needed between the number and its unit 0. A prescription order for a compounded drug product is:. The illustrations that follow will show some examples of prescriptions and medication orders with their basic components. According to the National Association of Boards of Pharmacy, the minimal recommended legal requirements for outpatient prescriptions are:. Special instructions: refills, generic product substitution.
For refills, the common interpretation for absence of information is that zero refills are authorized. Patient identification: name, history number, age, weight, height. Name or initials of person s who transcribed the order: nurse or pharmacist. In the following prescriptions for outpatients, identify the basic parts of minimal recommended legal requirements that are missing or are incomplete. As you have seen in the examples provided above, certain abbreviations are routinely used by the prescriber in writing prescriptions.
Despite the fact that abbreviations are a convenience, a time saver, a space saver and a way to avoid misspelled words, one should remember that occasionally a price has to be paid for their use. Sometimes, abbreviations are misunderstood, misread, or misinterpreted, leading to a delay in patient care or even harm. There are many lists of abbreviations in common use by healthcare workers.
Frequently, each health care establishment has its own standardized list, which is used by all personnel. As a rule, where uncertainty exists, the one who wrote the abbreviation must be contacted for clarification. Rewrite the following prescription omitting all abbreviations, so that it makes sense. How much petrolatum should be weighed? Prescriptions written in the metric system specify quantities using decimal notation.
If units are omitted, and the prescription is written in decimal notation, it is understood that metric units are to be employed: solids are weighed in terms of grams, and liquids are measured in milliliters. In compounding dosage forms such as capsules and powders in paper, the pharmacist weighs sufficient of each drug to make all of the required doses. The drugs are combined into a homogeneous mix that is then divided equally among the units being prepared.
Instead of giving the formula for the desired number of dosage units, the prescription may give the formula for a single unit. To calculate the amount of each drug to be measured, it is necessary to multiply the quantity per unit by the number of units. We initially conducted a focus group of ten people at a mental health resource centre. A further nine participants took part in face-to-face interviews. While participatory approaches focus on the role of power dynamics in the research process, Hoffman [ 18 ] argues that during interviews both interviewers and interviewees wield these powers at different times and in various ways.
As such the process of reflexivity becomes crucial for the interviewer to recognise the power dynamics through the research process and work towards the empowerment of participants. As an academic researcher and initiator of the contact, the interviewer held a certain amount of power. A number of strategies were employed in order to help move the researcher and participants to a more equal sharing of power.
Interviews were scheduled at a time and location of the participant's choice and an open and unstructured interview format was used. Each interview opened with the request "Tell me about your experiences of being an inpatient," allowing participants to determine the direction of the conversation. The researcher assumed an open stance towards the participants as well as sharing personal details and answering questions both during the interview and afterwards. At the conclusion of each interview participants were paid a nominal sum for their time and contribution. After each interview the researcher wrote memos of personal reflections and theoretical insights. Data collection and analysis were iterative with each step of analysis. In each subsequent interview, the researchers' understanding of the themes arising through coding and reflection was shared with participants to seek further understanding of the themes for explanation in later interviews.
All interviews were audio-taped and transcribed verbatim by the first author helping familiarise the researcher with the data. Responses were analysed using the inductive thematic analysis procedure described by Hayes [ 19 ]. First, the data was read carefully to identify meaningful units of text relevant to the research topic. Second, units of text detailing the same issue were grouped together in analytic categories and given provisional definitions. The same unit of text could be included in more than one category. Third, the data were systematically reviewed to ensure that a name, definition, and exhaustive set of data to support each category were identified. The inductive thematic analysis resulted in 27 categories, which were grouped into 8 key themes.
During the entire coding process, memo writing was used both as an analytical tool to record concepts, themes and more abstract thinking about the data, but was also used as a means of reflection, to record the researcher's own beliefs and experiences. Both the data and memos were shared with authors' research supervisor DR and discussed until consensus was reached. One of the most important findings of the current study was that when participants talked about their experiences of hospital, they did so largely within the context of the people that they had encountered during their admission.
Five out of the eight themes related to relationships, these included communication, coercion, safety, trust, and culture and race. One theme, treatment, highlighted the role of admission to hospital. Two further themes are structural, providing an understanding of the environment of hospital and include the themes, environment and freedom. Communication was highlighted by all participants and constituted the greatest number of coded sections, constituting a third of all coded sections.
This illustrates its importance to service users. Communication comprised three specific activities, listening, talking and understanding. Then someone will say, sit down, let's talk about it, make a cup of tea. Be in their office as much as they could. Listening was rated highly by service users. The ability to listen was described as a characteristic of being human and service users who had the experience of being listened to described feeling respected. Conversely, one service user rated a whole service negatively because he felt the staff did not listen to him. Listeners who were open, non-judgemental and not patronising were valued.
I need someone to listen to me and I can't get them to listen to me. The process of talking was by far the most prominent aspect of communication and represented over half of the codes linked to communication. It was identified as important by all participants. Talking was described as therapeutic, but only if the service user was listened to and understood. Service users who were understood valued relevant advice and information. Thirteen people identified numerous instances of a lack of, or poor communication, between service users and staff. In contrast there were no such negative references to communication between service users. One of the key factors in being able to communicate with other users was the shared experience.
There is an overlap between the topics communication and coercion. Positive experiences of communication led to a person feeling supported and cared for, however, coercive communication, such as the use of threats, was experienced entirely negatively. Coercive experiences were reported by all of the service users interviewed. Objective coercion, such as involuntary commitment and treatment, was often negatively reported, but the coercion of being detained was not attributed to the legal process involved but rather to coercive events that service users were subject to as a consequence of detention.
Such events included restriction of freedom and compulsory treatment. It felt horrible because I was locked away for so many days and I couldn't go out and be free. Four men and one woman described being restrained. All were involuntarily detained when the restraint occurred. All counts of restraint were accompanied with forcible medication. Restraint was described as a form of assault and in one case as leading to physical injury. Perceived coercion was reported by both compulsorily and voluntarily admitted patients. It followed the form of threats of non-physical force or of consequences resulting from disobeying staff wishes. Perceived coercion was described by service users as being "hypnotised" and "brainwashed" and reactions to perceived coercion were referred to by two people as "playing the game".
The most common threat experienced by voluntary patients was of being detained. This was reportedly used to coerce patients into hospital on a voluntary basis, and once admitted into remaining in hospital or receiving unwanted treatment. A final category of coercive experiences includes reports in which a clear abuse of power and trust is taking place with little justification. Three people report such incidences. One incident described a staff decision not to treat a patient in considerable distress. There was a link between the codes for "coercion" and "safety".
Descriptions of perceived coercion that were associated with feelings of a lack of safety, rather than actual coercive practices such as restraint. So it was a terrifying place, position to be in. All participants talked about safety. An expectation of hospital was that it would be safe, with service users seeking safety both from themselves and from staff or other patients. Safety in hospital was always spoken about with reference to other people. Social contact could instil a sense of safety in some people, but in others contributed to a lack of safety, and its perception depended on the nature of the contact.
A lack of safety was associated with ward-based violence, and the feeling of fear. Four participants reported acts of violence and aggression perpetrated by themselves towards members of staff and inpatients, while another four describe incidences of being subjected, or witnessing other patients being subjected, to violence by both staff and other patients. Experiences of violence were always accompanied with a feeling of fear.
All but three people described feeling fearful while in hospital. Fear was described as a contributing factor to perpetrating violent acts and as a consequence of experiencing violence. A lack of safety and the experience of fear led to aggression and to one person absconding from hospital. Couldn't wait to break out and just disappear like. I even found myself escaping the hospital one night and was crossing the M25 believe it or not. Both men and women described the feeling of being vulnerable on wards where there was a predominance of men.
Men described being attacked by other men. However, the one woman who describes being attacked the victim of a fellow inpatient on an all female ward. Fear was associated with a feeling of not being in control. In addition to situations in which there was a risk of violence, fear of staff was reported when they provided unpleasant medication, and treated people coercively. I felt frightened. While a lack of control elicited a feeling of fear, if that situation was contained and controlled by someone else, the fear could be managed and was deemed acceptable. It was terrifying. In addition to service users' experiences of lack of safety and the associated fear, three participants reported observed fear of patients among staff. Once again this fear is attributed to a perceived lack of control by staff and included fears of patients harming themselves and others.
Staffs' fear of patients' behaviour resulted in their use of coercive measures. So I got harsh treatment. Service user: "No I don't think so because they know they can get a man with an injection and just knock me out. The word trust was used by five service users in their narrative but instances of trust and mistrust of others in hospital were identified by all participants. Trust was described as important in providing a positive experience and mistrust contributed to a negative experience of being an inpatient. Service users' attributions of trust or mistrust were described only in relation to staff.
In one account staff were seen as able to contain and deal with the situation and were attributed with a sense of trust. In the other account the staff were seen as allowing the situation to escalate and were mistrusted. I decided it wouldn't matter where I was on the ward, there was nowhere for me to lock myself in, the nursing staff didn't give a damn so the only option open to me was to run away, which is what I did. Staff that were trusted by service users were described as being professional, able to manage situations in which the safety of patients was at risk, flexible, non-coercive, committed, and caring about patients.
The use of coercion by staff led to a sense of mistrust. That was a sanction to force me to see my consultant that I don't wish to work with. I distrust my psychiatrist that much. Although trust was not overtly attributed to other patients, it is clear that in many cases there was an atmosphere of trust between patients that was valued. All but one of the participants recognised that the purpose of hospital in part was to provide treatment. However, trust in staff to treat patients appropriately was not always apparent. You can see the nurse don't know what to do for them. Treatment was composed of two subcategories "medication" and "therapies. There was general acceptance of medication in the treatment of mental illness.
However, there was also dissatisfaction expressed about the types of treatment received and the process of receiving treatment. Six participants described potential overmedication leading to feelings of being "doped up. There was a strong link between the codes for medication and communication. The value of effective communication in discussions about medication is highlighted by two patients.
Service user: "You know they wanted to put me on olanzapine, or the other antipsychotic thing, and I didn't want that. Because I've had it before and it was absolutely awful. It's the worst drug I've ever taken. And I didn't want to go there so I refused all that kind of, any medication or tablets. What did the consultant do but put me on Depixol and it had a horrific effect on me, absolutely horrific. I can't blame everything on the medication, I know it was wrong of me, and they put me on it against my will, my mothers.
Effective communication is also of prime concern in capacity to consent to treatment, and specifically to receiving ECT. The following participant describes being asked to sign a consent form to receive ECT while actually not having capacity. My brother said to him, you could get her life away at the moment, but he had to have me sign it.
There was a strong link between medication and coercion. All physical restraints reported were followed by forcible injection and several people reported perceived coercion in receiving treatment. In addition to treatment with medication or ECT four people also highlighted a need for talking therapies while in hospital. Therapies that were spoken of positively were founded on good relationships with the facilitator. This included a group based on the step model run by a nurse who had been a service user herself.
Therapies spoken of disparagingly included art, and music therapy. While the art therapy was not in itself ridiculed, it was deemed worthless as an activity by the following participant due to lack of communication and understanding by staff. You know like, there's nothing wrong with that it's Easter it's got to be accepted by everyone. And they said to me, why are you drawing that? So I said, its Jesus, remember it's Jesus when he died. You know I didn't go round the trees. He said, but this picture, are you feeling like at death's door, are you feeling like you are crucified or something.
I said, no I'm just drawing because of Jesus my hero dying at the cross. But they wouldn't have that, they tried to look into, thinking I was crucified inside. And I got so fed up with them and things. Six participants raised issues associated with cultural competency in hospital and all of these experiences were negative. Experiences described include a lack of understanding by staff, and racism. A lack of cultural awareness and sensitivity by staff is demonstrated in the narrative of a young Black African woman describing the difficulties she faces as a result of her belief that her mental illness results from possession and the use of voodoo. Two service users remarked on the difficulties faced in being nursed by non-British staff and this was explained by one interviewee as due to differences in cultural beliefs about the origin of mental illness.
Finally, racism towards ethnic minority patients was reported as an experience by ethnic interviewees and witnessed by white interviewees. And that's what I experienced in the psychiatric system. Twelve participants spoke about freedom while in hospital. The focus was primarily on physical freedom, the freedom to be outside, or to leave the unit. Such freedoms were viewed both as a basic human right, and also therapeutic in reducing feelings of confinement and being in touch with the environment. Conversely, a lack of freedom could induce mental distress. A lack of physical freedom was not expressed only by service users who were compulsorily detained. The environment, staff decision-making and resources contributed to perceived freedom.
Some hospitals had no outside space for patients, while other patients, even those admitted voluntarily, were not allowed out. Finally one patient describes being granted escorted leave but being unable to go outside due to the lack of an available staff escort.The Importance Of Medication Errors PSNet Collection. Related information. The Importance Of Medication Errors initially conducted a focus group The Importance Of Medication Errors ten people at a mental health resource centre. Thus The Importance Of Medication Errors. Concerns and problems Although IT systems provide clear and compelling mechanisms for reducing The Importance Of Medication Errors errors and improving safety, with a The Importance Of Medication Errors body of evidence to support their role, there are several concerns about their widespread clinical use. The Importance Of Medication Errors 4 months, The Importance Of Medication Errors Suzan Shown Harjos Quote Analysis receives prednisone along with his seizure medications, causing steroid-induced diabetes.