Chapter 1 DRUG ADMINISTRATION: GENERAL PRINCIPLES
Medicine Management Skills for Nurses, Second Edition. Claire Boyd.
© 2022 John Wiley & Sons, Ltd. Published 2022 by John Wiley & Sons Ltd.
LEARNING OUTCOMES
By the end of this chapter you will have an understanding of the general principles of drug administration, including improving medication safety factors.
PROFESSIONALISM
You may well worry about making mistakes. Everyone is human after all and prone to error (known as ‘Human Factors’). The key is to minimise where the faults can occur. As health carers we always put the patient first and apply our professionalism. As with any clinical skill we need to highlight the importance of vigilance, knowledge, and professionalism when administering drugs, as many drug errors occur when staff fail to follow correct procedures or do not recognise the limitations of their own knowledge and skill. Let's look at the cost of drug errors, both monetary and to the individual.
Nurses are expected to display competent and skilful behaviour.
PROFESSIONAL JUDGEMENT
When administering medication, we need to be aware of the following:
It is not solely a mechanistic task to be performed in strict compliance with the written prescription of a medical practitioner.
It requires thought and the exercise of professional judgement (Lister, Hofland, and Grafton 2020).
What does this actually mean? Let's look at an example.
1 If a patient has senna and lactulose prescribed and informs you that they have opened their bowels four times that day, do you administer their prescribed laxatives?
Also remember, it is very easy to get distracted, and lose concentration in the clinical area, so always concentrate on the job in hand.
MEDICATION ERRORS
What is a drug error? Well, the Department of Health informs us that:
A medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of health professional, patient, or consumer.
Because nurses predominately administer drugs, they are often the last potential barrier between a medication error and serious harm to a patient, with drug errors frequently featuring in professional misconduct cases.
It is estimated that there are more than 230 million medication errors per year in the National Health Service (NHS). The cost to the NHS was estimated at £98.5 million for the 712 confirmed deaths from drug errors in hospital. However, if we add on the extra cost of patients made seriously ill, or potentially killed by drug errors in primary care, the estimated cost to the NHS is £1.6 billion (yes – billion!) equating to 3.8 million bed days.
So, why do drug errors occur? Well, we have been informed from the same report giving us the facts and figures above that they occur due to:
Failure to properly monitor patients on powerful drugs,
Poor communication between general practitioner (GP)'s and hospitals,
Giving patients the wrong medication.
We also know that mistakes happen due to:
Drugs that look or sound alike,
High staff workload,
Low staffing levels,
Inexperienced staff.
As a means to combat some of these medication errors, the UK government pledged an investment of £75 million to implement electronic prescribing in hospitals.
Drug Errors and Adverse Reactions
The NHS has graded drug errors and adverse reactions, as follows:
1 Medication errors that do not result in patient harm, i.e. near misses (example: a dose of 500 mg amoxycillin is prepared instead of 250 mg, but corrected before reaching the patient).
2 Medication errors that result in patient harm (example: giving an antibiotic to a patient with a known allergy to that drug).
3 An adverse drug reaction that is not the result of a medication error (example: giving antibiotics to a patient with no previous history of drug reactions, but who then reacts: this is the only non‐preventable type of mistake).
What is a near miss? Think of an example.