COMMENTARY
Medication administration errors made by nurses reflect the level of pharmacy administration and hospital information infrastructure Mei-Juan Lan, Ling-Ling Zhu and Quan Zhou
Introduction We read with great interest Kim’s paper which highlights that medication administration guidelines are not always strictly followed by clinical nurses (Kim & Bates 2013). We are from a 2200-bed Joint Commission International (JCI)-accredited academic medical centre hospital in China. We agree with Kim’s view that education, performance tracking, barcoding and electronic medication administration records help to reduce medication administration errors (MAEs). These are our perspectives on this issue.
The value of hospital information and pharmacy support The depth, breadth and efficiency of cooperation between nurses, pharmacists and information engineers are pivotal to medication safety (Zhu et al. 2012). Appropriately labelled information in combination with a barcoding system has greatly improved medication administration safety in our hospital. Where appropriate, nurses must perform bedside barcode scanning prior to medication administration and immediately after the completion of infusion. Pharmacists can electronically trace whether infusion time is in accordance with the physicians prescription. Wrong time and drug omissions are common types of MAEs (Keers et al. 2013); however, our experience shows such MAEs Authors: Mei-Juan Lan, MHA, RN, Associate Professor, Nursing Administration Office, Division of Nursing, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang; Ling-Ling Zhu, BN, RN, Associate Professor, Geriatric VIP Ward, Division of Nursing, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang; Quan Zhou, MHA, PhD, Professor, Clinical Pharmacy Specialist, Department of Pharmacy, the Second Affiliated Hospital, School of
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can be prevented by automatic warnings and the presence of an electronic tracing system. A double-check policy for administering controlled medications is well implemented using personal digital assistant. Inpatient pharmacy services adhere to unit dose dispensing procedures and ensure each medication dispensed have a label containing barcode, patient name, identification number, drug information (name, dose, route, frequency and time) and warnings (drip rate, stability, infusion set type, light protection, signs of high-alert medications or medications that increase fall risk). We have an online query system of oral solid medication appearance (colour, size and shape) that provides a convenient way for nurses to check medication or identify medications temporarily discontinued by physician. We achieved zero occurrence of MAEs related with oral medications in 2012. In our hospital, regular multidisciplinary team meetings are regularly held in to ensure the medication system works optimally. These operation procedures were revised and updated during the journey to JCI accreditation. For example, pharmacists found that MAEs related with pipeline management were easily neglected by nurses. Therefore, a special protocol was drafted to address the issue; adherence to the guidelines was assessed using tracing methodology. We agree with the finding of Kim’s study and believe it is vitally important to find solutions for MAEs, as opposed to blaming nurses who make these MAEs. Severity and Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China Correspondence: Quan Zhou, Professor, Clinical Pharmacy Specialist, Department of Pharmacy, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, China. Telephone: +86 571 87784615. E-mail: [email protected]
© 2013 John Wiley & Sons Ltd Journal of Clinical Nursing, 23, 894–895, doi: 10.1111/jocn.12495
Commentary
Commentary
frequency of MAEs reflect the level of pharmacy administration and hospital information infrastructure. In the clinical environment, teamwork and efforts to ensure high levels of quality assurance will help reduce the number of these errors.
Funding This work was supported by Bureau of Health (No.2012KYA090) and Bureau of Traditional Chinese Medicine (No.2011ZB075) in Zhejiang Province.
References Keers RN, Williams SD, Cooke J & Ashcroft DM (2013) Prevalence and nature of medication administration errors in health care settings: a systematic review of direct observational evidence. Annals of Pharmacotherapy 47, 237–256.
© 2013 John Wiley & Sons Ltd Journal of Clinical Nursing, 23, 894–895
Kim J & Bates DW (2013) Medication administration errors by nurses: adherence to guidelines. Journal of Clinical Nursing 22, 590–598. Zhu LL, Wang HQ, Jin JF, Wang HF & Zhou Q (2012) Appropriateness of
administration of nasogastric medication and preliminary intervention. Therapeutics and Clinical Risk Management 8, 393–401.
895
Medication administration errors made by nurses reflect the level of pharmacy administration and hospital information infrastructure Mei-Juan Lan, Ling-Ling Zhu and Quan Zhou
Introduction We read with great interest Kim’s paper which highlights that medication administration guidelines are not always strictly followed by clinical nurses (Kim & Bates 2013). We are from a 2200-bed Joint Commission International (JCI)-accredited academic medical centre hospital in China. We agree with Kim’s view that education, performance tracking, barcoding and electronic medication administration records help to reduce medication administration errors (MAEs). These are our perspectives on this issue.
The value of hospital information and pharmacy support The depth, breadth and efficiency of cooperation between nurses, pharmacists and information engineers are pivotal to medication safety (Zhu et al. 2012). Appropriately labelled information in combination with a barcoding system has greatly improved medication administration safety in our hospital. Where appropriate, nurses must perform bedside barcode scanning prior to medication administration and immediately after the completion of infusion. Pharmacists can electronically trace whether infusion time is in accordance with the physicians prescription. Wrong time and drug omissions are common types of MAEs (Keers et al. 2013); however, our experience shows such MAEs Authors: Mei-Juan Lan, MHA, RN, Associate Professor, Nursing Administration Office, Division of Nursing, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang; Ling-Ling Zhu, BN, RN, Associate Professor, Geriatric VIP Ward, Division of Nursing, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang; Quan Zhou, MHA, PhD, Professor, Clinical Pharmacy Specialist, Department of Pharmacy, the Second Affiliated Hospital, School of
894
can be prevented by automatic warnings and the presence of an electronic tracing system. A double-check policy for administering controlled medications is well implemented using personal digital assistant. Inpatient pharmacy services adhere to unit dose dispensing procedures and ensure each medication dispensed have a label containing barcode, patient name, identification number, drug information (name, dose, route, frequency and time) and warnings (drip rate, stability, infusion set type, light protection, signs of high-alert medications or medications that increase fall risk). We have an online query system of oral solid medication appearance (colour, size and shape) that provides a convenient way for nurses to check medication or identify medications temporarily discontinued by physician. We achieved zero occurrence of MAEs related with oral medications in 2012. In our hospital, regular multidisciplinary team meetings are regularly held in to ensure the medication system works optimally. These operation procedures were revised and updated during the journey to JCI accreditation. For example, pharmacists found that MAEs related with pipeline management were easily neglected by nurses. Therefore, a special protocol was drafted to address the issue; adherence to the guidelines was assessed using tracing methodology. We agree with the finding of Kim’s study and believe it is vitally important to find solutions for MAEs, as opposed to blaming nurses who make these MAEs. Severity and Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China Correspondence: Quan Zhou, Professor, Clinical Pharmacy Specialist, Department of Pharmacy, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, China. Telephone: +86 571 87784615. E-mail: [email protected]
© 2013 John Wiley & Sons Ltd Journal of Clinical Nursing, 23, 894–895, doi: 10.1111/jocn.12495
Commentary
Commentary
frequency of MAEs reflect the level of pharmacy administration and hospital information infrastructure. In the clinical environment, teamwork and efforts to ensure high levels of quality assurance will help reduce the number of these errors.
Funding This work was supported by Bureau of Health (No.2012KYA090) and Bureau of Traditional Chinese Medicine (No.2011ZB075) in Zhejiang Province.
References Keers RN, Williams SD, Cooke J & Ashcroft DM (2013) Prevalence and nature of medication administration errors in health care settings: a systematic review of direct observational evidence. Annals of Pharmacotherapy 47, 237–256.
© 2013 John Wiley & Sons Ltd Journal of Clinical Nursing, 23, 894–895
Kim J & Bates DW (2013) Medication administration errors by nurses: adherence to guidelines. Journal of Clinical Nursing 22, 590–598. Zhu LL, Wang HQ, Jin JF, Wang HF & Zhou Q (2012) Appropriateness of
administration of nasogastric medication and preliminary intervention. Therapeutics and Clinical Risk Management 8, 393–401.
895
