Safe Medication Administration – Evidence-Based Nursing Blog

The UK Nursing Midwifery Council’s (NMC) standards for nursing include keeping patients protected (NMC, 2015), with the 2010 guidance on the preparation and administration of medicines remaining unchanged (NMC, 2010). Although the nurse’s role in medication management has modified during the last decade to incorporate independent prescribing of medicines, nurses are primarily accountable for preparing and administering medications to patients. Medication errors can occur at any stage of the medication administration process, from prescribing, meting out, preparing and administering medications and monitoring their effects, so it’s a multidisciplinary activity (Pentin et al., 2016). As the last person within the chain, nurses play a key role in identifying and stopping actual and potential medication errors.

Dual medication monitoring, where two nurses are accountable for the protected administration of medication, is commonly an area requirement but stays controversial. Recent EBN comment:

Medication errors may be reduced by applying Berdot and Sabatier’s (2018) double-checking method, https://ebn.bmj.com/content/21/3/67 summarized and validated a randomized controlled trial on the effect of dual control on the detection of medication errors (Douglass et al., 2018).

The comment emphasized that the study failed to find out the effectiveness of dual monitoring in reducing the danger of medication errors. Although the unique study adds to the growing evidence base on medication errors, this study was underpowered and the 2 groups weren’t comparable, nevertheless it nonetheless raised some essential issues related to the prices and effectiveness of dual control in reducing medication errors. The comment is unclear whether the double-checking procedure applies to the patient or simply the drug: this raises potential legal issues if local policy doesn’t clearly define what the double-checking procedure is. If a nurse administers a drugs to the mistaken patient because they didn’t discover the patient, the responsibility and accountability of the nurse who double-checked the medication could also be unclear. Two recent systematic reviews examining the causes of medication errors suggested that errors largely relate to human aspects (unsafe actions corresponding to misidentification of a drug, lack of patient knowledge), local workforce aspects (poor communication, disruptions and interruptions, workplace dynamics, insufficient medication supply) and storage) and organizational aspects (poorly designed protocols and error management systems) (Keers 2013a, b). Double checking is unlikely to account for lots of these aspects, and more evidence is required to verify whether double checking can reduce the human aspects related to medication errors.

There could also be some value in examining whether the introduction of electronic medicines has any effect on reducing medication error rates or whether it has actually introduced latest sorts of errors. While the prescribing process, checking and administering medications is similar as with paper prescriptions, electronic medications reduce some potential errors corresponding to misreading poor handwriting, lost or duplicated medication charts, and former prescriptions may be easily viewed. As practice changes and evolves and coverings change into more complex, there’s a must proceed to develop a powerful evidence base for the protected administration of medicines.

Douglass A.M., Elder J., Watson R.A., et al. (2018) Randomized Controlled Trial of the Effect of Dual Control on the Detection of Medication Errors. Ann Emerg Med. 71(1): 74–82.

Keers RN, Williams SD, Cooke J, Ashcroft DM (2013a) Causes of medication errors in hospitals: a scientific review of quantitative and qualitative evidence. Drug safety. 36, 1045-1067.

Keers RN, Williams SD, Cooke J, Ashcroft DM (2013b) Incidence and nature of medication administration errors in healthcare settings: a scientific review of direct observational evidence. Annals of pharmacotherapy. 47, 237-256.

Nursing and Midwifery Council (2015) CodeProfessional standards of practice and behavior.London, NMC.

Nursing and Midwifery Council (2010) Medicines management standards. London, NMC.

Pentin, J., Green, M., Smith, J. (2016) Undertaking the protected administration of medicines to children Part 1: Principles of effective medicines management. Nursing children and adolescents. 28, 6, 34-40.

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