Running head: MEDICATION ERRORS AND MANAGING DISTRUPTIONS 1

Medication Errors and Managing Disruptions

Lauren Neff

Brigham Young University Idaho

Nursing 420 Section 02

Sarah Hawkins

July 11th, 2017

MEDICATION ERROS AND MANAGING DISRUPTIONS 2

Medication Errors and Managing Disruptions

Medication administration errors has been a highly researched topic in the past years.

However, errors are still being made despite all the technical advancements and implementations

of safety precautions such as the rights of medication administration. This triggered more

questioning and provided a new topic of research including the correlation between the level of

nursing expertise and the ability to manage distractions to avoid medication errors.

Background

There is a very real chance of errors when administering patient medications considering

how many distractions and interruptions nurses work with. Medication errors can have lasting

impacts on patients and their loved ones. Many pharmacological interventions have the potential

to hurt and even kill patients if administered wrong.

Significance

There is little known about the ability to manage interruptions in relation to the level

nursing expertise. This is a necessity when administering medications to patients so that patient

care is as safe as possible (Hayes, Jackson, Davidson, & Power, 2015). Kelly (2004) mentions

that in 2001 only 39% of medication errors were reported, and of those 3% caused harm.

Furthermore, more than 90% nurses have made errors in drug administration (91.56%), which is

most significantly related to the wrong dose (34.7%) and the wrong time of administration

(32.4%) (Dimitrios, Martha, Theodore, 2012). Patient safety is being compromised and the

causative agent is preventable.

Problem Statement

Medication errors are still occurring despite the implementation of preventative actions

such as the 5 rights of medication administration and barcode scanning. Further research needs
MEDICATION ERROS AND MANAGING DISRUPTIONS 3

to be conducted to show the correlation between managing disruptions and medication errors so

that techniques can be taught and applied to the nursing career and patient care can improve.

Theoretical Framework

Benners theory focuses on the differences in practice based on level of expertise in

nursing. It suggests that there are stages of expertise including the novice, advanced beginner,

competent, proficient, and expert. The higher level of intuition and expertise, the better quality

of care can be provided because of the increased clinical experience, education, etc. This theory

claims that reaching the intuitive, or instinctive, component of expert practice is claimed to have

a valid and critical role in nursing care (Lyneham, Parkison, & Denholm, 2009). Every nurse

gains this intuition through time and experience.

Link Between Theory/Concept and Research Problem

The research study will use Benners theory because of its focus on the differences in

practice based on expertise level. Medication errors are proposed to be profoundly affected by

level of expertise in this research work (Lyneham et al., 2009). This theory correlates the

medication errors association with distractions and how the level of expertise plays a role in

allowing distractions to affect the medication administration process.

Method

The study aims to determine (a) the risk of medication errors in relation with distractions

and (b) how the level of expertise affects nurses ability to cope with distractions associated with

medical administration errors.

Research Design

Qualitative research is an approached used to describe the experience. This type of

research generates rich descriptions that can provide a plethora of insight from the individuals
MEDICATION ERROS AND MANAGING DISRUPTIONS 4

perspective (Grove, Gray, & Burns, 2015). This research design will be used so that the

individuals experience with medication errors can be descriptive and give further insight on their

personal causes for the errors. It will also offer supporting data on whether or not it correlates

with their level of expertise in relation to Benners theory.

The research approach that will be utilized in this research study is phenomenology. It

will, guide the study of experiences or phenomena and provide a thorough description of a

lived experience (Grove et al., 2015, p. 69). Again, this will help provide personal interpretation

of the reasons for medication errors and outline the relationship with being a novice or expert

nurse. The documented human experience will provide information necessary to develop this

study.

Research Population

This research study requires participants for each level of Benners theory including

novice, advanced beginner, competent, proficient, and expert. Novice nurses will be defined as

nurses with 1-3 years of experience, advanced beginners will be those with 3-5 years of

experience, competent nurses will have 5-7 years of experience, proficient nurses will have 7-10

years of experience, and expert nurses will have 10 years or more of experience. All participants

will be required to have their Bachelors in Science of Nursing. Simple random sampling will be

conducted for this research study. There will be 20 nurses randomly selected from each level of

expertise to participate for a total of 100 participants. This will allow for both saturation and

verification for the research study ensuring that findings will be accurate and reliable.

Data Collection Methods and Measurements

Interviewing participants will be used for data collection which allows them to describe

their thoughts, ideas, and perceptions (Grove et al., 2015). Open-ended interviews will be
MEDICATION ERROS AND MANAGING DISRUPTIONS 5

conducted. This allows the participants to elaborate on their own experiences and connections

can be made between the differences in levels of expertise. Every participant will be prompted

with the statement, Tell me about distractions experienced during medication administration and

how that effects your ability to appropriately administrate. The authenticity received from

open-ended interviews will provide great insight in the relation between medication errors and

level of nursing expertise.

Ethical Considerations

Ethical considerations that are noted with this research study are the participants right to

privacy. Privacy is the freedom people have to determine their time, extent, and general

circumstances under which their private information will be shared with or withheld from

others (Grove et al., 2015). To ensure participant protection and confidentiality, informed

consent will have to be signed in order to participate in the study. De-identifying will be applied

by removing any personal tags to the participant including things such as name, geographical

location, account numbers, etc. The participants will be assigned a number instead of their name

to ensure there is no breach of confidentiality. Participants will also have the option to take out

their portion of the study at any point in time. The Institutional Review Board will have to deem

this research study approved before any part of it is conducted.

Annotated Bibliography

Reid-Searl, K., Moxham, L., & Happell, B. (2010). Enhancing patient safety: The importance of

direct supervision for avoiding medication errors and near misses by undergraduate

nursing students. International Journal of Nursing Practice, 16(3), 225-232.

doi:10.1111/j.1440-172X.2010.01820.x
MEDICATION ERROS AND MANAGING DISRUPTIONS 6

There have been multiple research studies conducted to link medication errors made by

nurses. Colleagues Kerry Reid-Searl, Lorna Moxham, and Brenda Happell have been

one to contribute to these research studies. They are professors at the School of Nursing

and Midwifery, and Institute of Social Science Research in Rockhampton and

Queensland, Australia. The research conducted worked with undergraduate nurses. Their

research question was aimed to answer not only if, but why medication errors were

occurring with undergraduate nurses. The research was written for undergraduate nurses,

preceptor nurses, nursing instructors, as well as anyone related to health care safety.

Their findings suggest that undergraduate nursing students are at risk for making errors

when administering medications in the clinical setting. The main cause was inadequate

supervision from the experienced registered nurse being followed. This article was

chosen because it supports the research statement suggesting that level of expertise

effects the occurrence of medication errors.

Papastrat, K., & Wallace, S. (2003). Educational innovations. Teaching baccalaureate nursing

students to prevent medication errors using a problem-based learning approach. Journal

Of Nursing Education, 42(10), 459-464.

At the time of publication, Karen Papastrat MSN RN, and Sharon Wallace MSN RN,

were Junior-Level and Senior-Level Coordinators at Thomas Jefferson University,

Jefferson College of Health Professions, Philadelphia, Pennsylvania. Their research aim

focused on the how Problem-Based Learning (PBL) application helped facilitate nursing

students transfer medication error knowledge into preventative action in the clinical

practice. Their study included two tables that clearly outlined the summary of

preventative adverse drug events and the summary of students initial analysis of the
MEDICATION ERROS AND MANAGING DISRUPTIONS 7

Problem-Based Learning Scenarios. Research concluded that using Problem-Based

Learning Scenarios is an excelled approach in nursing school that proved to be

energizing, dynamic, and a creative teaching method with positive outcomes for both

students and faculty. They stated that this type of learning produced dramatic results in

terms of student performance, motivation, and satisfaction. This research had a focus on

the population of nursing professors as well as nursing students. The study was chosen

for its excellent synopsis of preventable adverse drug events and why they occur. Within

these included environmental factors such as distractions, noise, lighting, and space

which supports the research problem of this study on how managing interruptions effects

medication errors.

Hill, K. (2010). Improving quality and patient safety by retaining nursing expertise. Online

Journal of Issues in Nursing, 15(3), 1. doi:10.3912/OJIN.Vol15No03PPT03

Karen S. Hill PhD is the Vice President/Nurse Executive at Central Baptist Hospital in

Lexington, Kentucky. She presents nationally on a variety of topics such as leadership

development, intergenerational workforce concerns, and retention of nursing staff along

with a number of other board memberships, honors and awards. She focused her article

on questioning if nursing experience matters in relation to outcomes and patient safety.

In her conclusion she supported her hypothesis and explained that experience does affect

patient care in a positive manner. She also concluded that more research needs to be

completed to develop and implement strategies to retain experienced nurses. This

supports this research topics hypothesis based on Benners novice vs. expert theory

which, again, states that the level of experience and intuition does affect patient care.
MEDICATION ERROS AND MANAGING DISRUPTIONS 8

The article was intended for all nurses no matter their expertise as well as those involved

in the hiring process.

Franklin, A. E., Gubrud-Howe, P., Sideras, S., Lee, S. C. (2015). Effectiveness of Simulation

Preparation on Novice Nurses' Competence and Self-Efficacy in a Multiple-Patient

Simulation. Nursing Education Perspectives (National League For Nursing), 36(5), 324-

325. doi:10.5480/14-1546

These three colleagues of the Texas Christian University Harris College of Nursing &

Health Science, Fort Worth Texas, conducted a study that examined the influence of three

simulation preparation methods including: expert modeling/intervention, voice-over

PowerPoint/active control, and reading assignments/passive control. The goal was to find

which method improved novice nurses competence and self-efficacy for providing care

to multiple simulated patients. This study was written for nursing professors and

programs as well as undergraduate nurses. They concluded that expert modeling videos

and voice over PowerPoint were more effective than reading assignments to increase self-

efficacy. This research study was chosen to demonstrate the important of proper nursing

preparations to increase self-efficacy once put into the work force. It stressed the fact

that it is imperative to evaluate interventions that increase the sense of self-efficacy

alongside competence and other educational outcomes for nurses. Novice nurses have to

learn to cope with work load and proper training to help reduce the number of medication

administration errors.
MEDICATION ERROS AND MANAGING DISRUPTIONS 9

Implications

Knowledge

Nursing research is conducted in order to build a stronger foundation in knowledge,

which in turn results in optimal patient care. Through this research study, the knowledge gained

that will help define why it is so important to reduce medication errors. What is so unique about

this study is that not only will there be a focus on how the level of experience affects the number

of medication errors made, but also how experience affects the way nurses are able to manage

interruptions. Managing interruptions will be a major focus in this study and will bring much

more insight to this area of research.

Theory

Despite all the technical advances in the medical field that help reduce the errors when

administering medications, errors inevitably occur. The nursing field focuses simply on

improving the health of patients by providing appropriate care. This study will advance safe

practice by showing ways for nurses to increase their accuracy when giving patients their

medications. This will be another study that confirms Benners theory. It also has potential to

add implications by developing a new theory that explains why medication errors are happening

and how to best manage care. Being able to cope with distractions will help less experienced, as

well as experienced, nurses provide optimal care for their patients.

Practice

Increased knowledge will reduce medication administration errors. With the increasing

demands on novice nurses, is it crucial to implement and evaluate the interventions found within

the study (Franklin et al., 2015). Applying the techniques found in this research study will

reduce the number of medication errors. As a result, with a reduction in the mistakes occurring,
MEDICATION ERROS AND MANAGING DISRUPTIONS 10

patient care will improve and patients will be given the best chance of reaching their optimal

health.

Recommendations

One key limitation in this study related to the method of data collection is the lack of

variability within different units. This research design primarily focuses on randomly selecting

nurses with different levels of expertise (defined as the number of years in practice). There may

be contrasting ways to manage interruptions during medication administration among the

different units.

Another gap in this research study is the lack of information provided on the impact of

education in undergraduate nurses and their ability to manage distractions and reduce errors. The

research study defines novice nurses as those with 1-3 years of experience but does not include

the undergraduate nurses. The results of the study pertain to undergraduate nurses, however,

they are currently excluded from the study.

There are currently 20 randomly selected nurses within each level of expertise with a

total of 100 participants. This small sample size can limit the amount of data gathered during

this study. Incorporating a large sample size would provide more accurate and reliable

information to implement into the nursing profession.

Conclusion

In summary, this research design will allow nurses to implement techniques used to

manage distractions and reduce medication errors. Although several strides have already been

made to reduce the amount of errors occurring, this research will further the progress and

decrease the amount even more. With this new knowledge, there will be a decrease in

medication administration errors and patient safety and health outcomes will improve.
MEDICATION ERROS AND MANAGING DISRUPTIONS 11

References

Dimitrios, M., Martha, K., & Theodore, K. (2012). Factors which affect the occurrence of

nursing errors in medication administration and the errors' management. Rostrum Of

Asclepius / Vima Tou Asklipiou, 11(2), 293-312. Retrieved from

http://ejournals.teiath.gr/index.php/tovima/index

Franklin, A. E., Gubrud-Howe, P., Sideras, S., & Lee, S. C. (2015). Effectiveness of simulation

preparation on novice nurses' competence and self-efficacy in a multiple-patient

simulation. Nursing Education Perspectives (National League For Nursing), 36(5), 324-

325. doi:10.5480/14-1546

Grove, G. K., Gray, J. R., & Burns, N. (2015). Understanding nursing research building an

evidence-based practice. St. Louis, Missouri: Elsevier Inc.

Hayes, C., Jackson, D., Davidson, P. M., & Power, T. (2015). Medication errors in hospitals: A

literature review of disruptions to nursing practice during medication administration.

Journal Of Clinical Nursing, 24(21/22), 3063-3076. doi: 10.1111/jocn.12944

Hill, K. (2010). Improving quality and patient safety by retaining nursing expertise. Online

Journal Of Issues In Nursing, 15(3), 1. doi:10.3912/OJIN.Vol15No03PPT03

Kelly, W. N. (2004). Medication errors. Professional Safety, 49(7), 35-41. Retrieved from

http://web.a.ebscohost.com.byui.idm.oclc.org/ehost/pdfviewer/pdfviewer?sid=eb2b3282-

59e9-4ad7-9774-7a10b067102f%40sessionmgr4010&vid=13&hid=4106

Lyneham, J., Parkinson, C., & Denholm, C. (2009). Expert nursing practice: A mathematical

explanation of Benners 5th stage of practice development. Journal of Advanced Nursing,

65(11), 2477-2484. doi:10.1111/j.1365-2648.2009.05091.x

MEDICATION ERROS AND MANAGING DISRUPTIONS 12

Papastrat, K., & Wallace, S. (2003). Educational innovations. Teaching baccalaureate nursing

students to prevent medication errors using a problem-based learning approach. Journal

Of Nursing Education, 42(10), 459-464.

Reid-Searl, K., Moxham, L., & Happell, B. (2010). Enhancing patient safety: the importance of

direct supervision for avoiding medication errors and near misses by undergraduate

nursing students. International Journal Of Nursing Practice, 16(3), 225-232.

doi:10.1111/j.1440-172X.2010.01820.x