Running head: THERAPEUTIC NURSING INTERVETNION PAPER 1

Therapeutic Nursing Intervention Paper

Rebecca Eimer

Old Dominion University

THERAPEUTIC NURSING INTERVETNION PAPER 2

Therapeutic Nursing Intervention Paper

Medication errors can happen in any stage in the clinical setting, therefore it continues to

be one of the many clinical problems that are highly seen. According to Linda Cloete, "a

medication error is defined as a preventable event related to medication which results in a

failure in the treatment process that leads to, or has the potential to lead to, harm to the patient"

(Cloete, 2014, p 50). This definition clearly presents this clinical problem a threat to patients,

especially patients that are children. A specific setting that has this clinical problem is a 70-bed

neonatal intensive care unit (NICU) in an urban area. This specific practice setting is a teaching

hospital that deals with critical neonates, and has no bar-coding technology for medication

administration. The overall scope of the problem in this unit is medication errors because of the

lack of technology and amount of people responsible for a large amount of critically ill neonates.

Clinical Problem

A medication error is a clinical problem that continues to effect many children in the

neonatal intensive care unit. This is a problem in the practice setting because the unit currently

doesn't scan there medications in a medication system, and there are many entry level nurses

with no experience administering medication, as well as a unsafe nurse-patient ratio in the unit.

These settings in the unit increase medication errors that compromise the lives of patients. The

reason medication errors was chosen for this discussion is because the risk is children is to high

and studies show errors cause appreciable morbidity and mortality in children (Rinke, at, el.,

2014). Furthermore, this clinical issue has been a concern to the nursing staff because of the

sensitive dosages according to weight and various gestational age neonates. Specifically, there

was a case in the NICU unit that a nurse didn't double check a neonates name, knowing that there

was another neonate with the same last name and gave the wrong analgesics medication to the
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patient. Another case was when a patient that needed glucose IV fluids was given 1/2 Normal

Saline instead of D10W as ordered. It wasn't until the next assessment was done 3 hours later

that the nurse realized the IV fluids were hanging, compromising the neonates glucose levels.

These are just some of the examples why a medication scanning system needs to be started in the

unit.

Current Practice

The formal mechanism of having an electronic medication scanning system is a standard

of practice that is missing in this specific NICU unit. According to the U.S Department of Health

& Human Service, one widely discussed method of reducing errors during the "administration"

phase is bar-coded medication administration (BCMA) (U.S Department of Health & Human

Service, 2017). This mechanism is absent in the unit and by not having a BCMA; nurses are

more prone to jeopardize the safety of patients. Not only does a BCMA need to be place in the

unit but also modification of pharmacy, change of practice and workflow changes for nurses in

the unit need to also take place. The formal mechanism BCMA helps users to be in compliance

with the "Five Rights" of medication administration: right patient, right dose, right route, right

time, and right medication as well (U.S Department of Health & Human Service, 2017).

An informal mechanism related to medication error problem in the unit is there current

practice of not scanning medication before administering medication, and not having a

technology based system to double check patient lab values, or any other medication check that

need to done before administering them to patients. The current practice doesn't have nurses scan

ID bands from patients, and has nurses just independently checking medication prior to

administration. The discrepancy of this informal method is the human error factor that is

increased in high stress level settings in a NICU. According to Gluyas and Morrison, "a
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significant component of human error is flaws inherent in human cognitive processes, which are

exacerbated by situations in which the individual making the error is distracted, stressed or

overloaded, or does not have sufficient knowledge to undertake an action correctly" (Glyuas &

Morrsion, 2014). All these various situations increases the level of the discrepancies and

ultimately is related to not having a bar code scanning system for medication in the NICU. The

formal method mechanism has no discrepancies that can be compared in the informal method

since it is standard of practice that increases patient safety and can decrease medication errors.

Nursing Interventions

In order to improve the NICUs clinical problem, there are various inventions that the

unit and nurses can do to improve patient safety. Some interventions are implementing a bar

code scanning technology in the NICU, have adequate nursing staff to improve workflow, and

educate nurses consistently on standardized checklist to have accountability of all safety

medication procedures. According to Clifton-Koeppel, technology can improve patient safety by

standardizing processes, improving efficiency and managing data (Clifton-Koeppel, 2012).

Additionally, having low nurse-patient ratio can also help decrease distractions and decrease

medication errors, as well as improve the workflow. Nurses workflow is also an important

factor in ensuring medication safety during administration and monitoring of patients (Klingner

and Prasad, 2013). Developing a standardize checklist will also improve the attention to detail

nurses much develop before administering medication. All these interventions are focused on

improving patient safety and reduce the human factor that can increase medications errors.

Research shows that having the right bar-code scanning technology system is key to

improving medication safety. According to Klinger and Parsad, technology includes better

patient identification (improved wristbands), medication storage (radiofrequency identify),

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computerized decision support (CDS) systems that caution for high-risk medications, and

surveillance systems that allow prompt detection of adverse event (Klingner and Prasad, 2013).

This evidence-based strategy improves medication safety and is an effective in todays culture,

as todays society is driven by technology. Developing a bar-code scanning medication system,

this nursing intervention would be favored to test and handle the problem in the NICU. Overall,

the adoption of appropriate technology in storing, administering, and monitoring medications has

enhanced medication safety (Klingner and Prasad, 2013).

Summary

Infants are at higher risk of a medication error, which is more likely to have a

detrimental effect (Beauman, 2017). In a specific NICU there is a clinical problem of medication

errors that clearly needs to improve in order to increase patient safety. Particularly in a neonatal

population, the patients are in a complex work environment that medication errors are likely to

happen. Some interventions to prevent this clinical problem is implementing a bar code scanning

technology in the NICU, have adequate nursing staff to improve workflow, and educating nurses

consistently on standardized checklist before admintering medication. Overall, implanting a bar-

code scanning system is a resource the NICU unit is lacking, and can ultimately benefit from to

decrease medication errors. It is obvious that patient safety should always come first and harm

has never been the intention but requires great care to ensure harm does not come to the tiniest

and most fragile patients (Beauman, 2017).

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References

Beaurman, S. (2017). The Prevention of Medication Errors. Retrieved from http://blog.neonatal

perspectives.com/2015/05/14/the-prevention-of-medication-errors/

Clifton-Koeppel, R. (2012). Improving Medication Safety in the NICU. Retrieved from

https://pdfs.semanticscholar.org/5d91/686ffc4b67463f8e2c22cf4e86adaa99c295.pdf

Cloete, L. ( 2015). Reducing medication errors in nursing practice. Nursing Standard. 29(20)50-

59. doi:10.7748/ns.29.20.50.e9507.

Gluyas, H. Morrison, P. (2014). Human factors and medication errors: a case study.

Nursing Standard. 29(15). Retrieved from https://rcni.com/sites/rcn_nspace/files/ns.

29.15.37.e9520.pdf

Klingner, J., Prasad, S. (2013). Evidence-Based Medication Safety Quality Improvement

Programs and Strategies for Critical Access Hospitals. Retrieved from http://www.flex

monitoring.org/wp-content/uploads/2013/05/PolicyBrief33-Med-Safety-QI-CAH-1.pdf

project/docs/2013SOR%20MentalHealth.pdf

Rinke, at, el. (2014). Interventions to Reduce Pediatric Medication Errors: A Systematic Review.

Pediatrics. (0031)4005. doi: 10.1542/peds.2013-3531

U.S Department of Health & Human Service. (2017) Bar-coded Medication Administration.

Retrieved from https://healthit.ahrq.gov/ahrq-funded-projects/emerging-lessons/bar-

coded-medication-administration
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I pledge to support the Honor System of Old Dominion University. I will refrain from any form
of academic dishonesty or deception, such as cheating or plagiarism. I am aware that as a
member of the academic community it is responsibility to turn in all suspected violators of the
Honor Code. I will report to a hearing if summoned.
Name: _____29 June 2017_______