Professional Documents
Culture Documents
Nathan Eppich
Dr. Bennion
December 8, 2018
MEDICATION ERRORS IN THE NURSING WORLD 2
Background
Decreased cognitive function from long working hours increases risks of medication
errors. Night shifts as well as long working hours can cause overtired nurses, leading to a
decrease in cognitive function (Unver, Tastan, & Akbayrak, 2012). Medication administration is
the American Journal of Critical Care 27% of the nurses in the study made at least one error, and
38% reported making at least one near error, as a result, a total of 224 errors, and 350 near errors
were made during the study period from decreased cognitive function and long shift hours (Scott,
Rogers, Hwang & Zhang, 2006). Medications, when administered improperly, may have lasting
environmental noise, and medication room layout and size are likely to cause errors in
medications preparation (Mahmood, Chaudury, Gaumont, & Rust, 2012). In the citation
referenced above there was a research conducted in which the staff had to divide their attention
between moving safely around the small medication room, environmental noise, and preparing
the medication. Due to the division of attention, the nurses prepared the medication incorrectly
and gave a patient the wrong dosage. In a research conducted by the UNAC/UHCP, 983 nurses
were asked what they believed was the biggest reason for medication errors (Duncan & Mayo,
2004). 65.6% of the 983 nurses said they believed the errors were due to environmental
surroundings. These two studies show that medication errors can happen because of the
nursing personal. Most medication errors occur because of abbreviations in prescriptions and
similarities in the drug names (Cheragi, Manoocheri, Mohammadnejad, & Ehsani, 2013).
Although medication errors can occur in all aspects of the medical world, nursing medication
errors are by far the most common. About 40% of a nurse’s day consists of dealing with
medication. With the large amount of time nurses deal with medication it is easy to see how
errors can occur, especially with how similar their names can be.
Significance
Medication errors are compromising patient’s safety in the hospital. This is a very real
problem in the nursing world that decreases the safety in the hospital setting (Unver et al., 2012).
According to Gladstone’s Scale of Medication’s research, the most common type of medication
errors that result in harm to patients is wrong dose (40.9 %), wrong drug (16 %), and wrong
route (9.5 %). This study also reports that only 41.6% of nurses believe that medication errors
are reported (Unver et al.,2012). Based on the information above, patients’ safety is being
compromised and the causative agents are decreasing the safety among patients in the hospital.
Medication errors are increasing cost for patients and hospitals. It is estimated that
medication errors have costs hospitals in the United States on average 76.6 billion dollars
annually (Samp, Touchette, Marinac, & Kuo, 2013). According to a study down by American
College of Clinical Pharmacy, a local hospital had to pay an excess of $4685 per person for
medication errors. This resulted in an increase cost of 2.8 million per year for this single
hospital. Another study done by the NCBI shows that medication errors increased costs of
hospital stays by $2000 – $2500 per patient (Cheragi et al., 2013). All of these medication errors
significantly contribute to the increase costs for patients as well as the hospitals.
MEDICATION ERRORS IN THE NURSING WORLD 4
Medication errors are increasing mortality rates in the hospital setting. It has been
reported that medication errors have accounted for as many as 251,000 deaths annually in the
United States (Anderson & Abrahamson, 2017). According to a study done by the NCBU,
medication errors account for 9% of all deaths in the United States. This statistic makes
medication errors the third leading cause of death in the United States behind heart disease and
cancer. This exact same study shows that death by medication error increase from 22% to 48%
when four or more physicians are involved in patient care. These statistics show that death by
medication errors are very common and should not be taken lightly. Medication errors are
decreasing patient’s safety, increasing cost for patients and hospitals, and increasing mortality
rates.
Florence Nightingale’s theory focuses on creating the perfect atmosphere around her
patients to promote a positive health environment. During the Crimean war, Nightingale first
implemented this theory to improve the environment around her patients in promoting healing
(Hegge, 2013). She understood that an unfavorable environment could compromise the health of
ventilation, light & noise, observation, and hope, she was able to empower the nature of health
and healing. Nightingale knew that the high mortality rates were not because of the disease
alone, but also the environment that they were put in to recover (Sher & Akhtar, 2018). She
knew that in order to provide the best outcome for the patient, all aspects needed to be in
complete balance. This can only be done by making the patient the main focus, which is exactly
Nightingales theory provides an environment that can transform how patients are being
cared for. In this theory, the nurse’s duty is to balance the patient’s environment, which in return
helps the patients conserve energy to properly heal from disease (Medeiros, Enders, & Lira,
2015). For example, during the Crimean war Nightingale was able to balance the environment
of the 2,000 solders through observation, decreasing the noise and light, giving hope, and face to
stimulations, she was able decrease the stress put on patients during their time at the hospital.
This goes right along with a major goal in the nursing field, which is to provide assistance for
environment plays on a patient’s health. This theory of Nightingales can be viewed as a system
in which the patient is in the center, surrounded by all aspects of the environment all in balance
(Zborowsky, 2014). If that environment becomes unbalanced it puts stress on the patient
resulting in an unfavorable atmosphere for patients to regain their full health. Similar to
Florence Nightingale, nurses today understand the role the environment plays on the ability to
heal. Having this knowledge has allowed nurses to contribute greatly to the continuation of
increased patients’ health that was started by Nightingale many years ago.
The issue of medication errors in the work place can be linked to Florence Nightingale’s
environmental theory of light and noise. The environment around nurses can greatly deter
administration, social interaction, noise, and medication room layout are likely to cause errors in
preparation and incorrectly prepares the proper amount of medication it could potentially kill the
patient or cause adverse effects. Nightingale’s environmental theory focuses on controlling the
noise and distractions in order to provide a safer environment for the patient (Zborowsky, 2014).
If this environment is not controlled it becomes unbalanced causing stress and an unfavorable
environmental noise allowing for a more favorable atmosphere for the patient.
observation. Long shifts and long working hours can cause overtired nurses, leading to a
decrease in cognitive function (Unver et al., 2012). A main focus of Nightingales theory is
observing the patient for any signs of decreased health. For example, during the Crimean War,
Nightingale cared for 2,000 soldiers observing each one’s health, hoping to improve their
surrounding to establish balance in their recovery (Hegge, 2013). She was only able to properly
balance the environment through proper observation, which requires full attention and cognitive
function in the observer. As we can see from the research by the American Journal of Critical
Care, 224 of the 393 nurses made at least one error because of decreased cognitive function
(Scott et al., 2006). This research shows that there was improper observation of the patients
because of decreased cognitive function. Proper observation of the surrounds and safe care is
provided for patients when cognitive function is not diminished because of long shift hours.
observation. The goal of a nurse is to place the patient in the best conditions for nature to act
(Selanders, 2010). This can only be done through observing the environment and altering it in a
way to improve or maintain health of the patient. Observation of the surroundings includes
proper understanding in the similarities and abbreviations of medications given. About 40% of a
MEDICATION ERRORS IN THE NURSING WORLD 7
nurse’s day consists of dealing with medications (Cheragi et al., 2015). For this it is important
that nurses develop proper observational skills to prevent errors in preparation of medication.
Many errors occur because of abbreviations in prescriptions and similarities in the drug names.
For example, chlorpropamide and chlorpromazine are very similar in spelling and are easily
mistaken for each other. Without proper observation of the surroundings, one medication can be
Research Methods
environment can compromise the health of patients, resulting in an increase in mortality rate
(Zborowsky, 2014). By focusing on controlling the noise and distractions around patients, a
safer atmosphere can be provided. That same focus can be implemented into the environment
surrounding nurses while preparing and administering medications to help keep patient safe.
Research Design
This research will use a qualitative grounded theory method. Qualitative research is a
method of observation to gather non-numerical data (Grove, Gray, & Burns, 2015). This
research provides meaning, characteristics, definitions, and descriptions that help understand the
individual experience that the participant is going through. Grounded theory is a type of research
that involves observation, analyzing, and interviewing subjects to gather a deeper understanding
of their experience (Grove et al., 2015). Subtle messages and meanings derived from the
subjects can give further understanding of their experience to help formulate themes and
establish a theory of the research topic. Qualitative grounded theory is the best research for
medication errors because it allows for observational analysis of nurses on the ICU/medical
MEDICATION ERRORS IN THE NURSING WORLD 8
surgical unit as well as interviews of the participants (nurses). The information obtained from
observing and interviewing nurses will help formulate a theory on how environmental
Research Population
This research will study nurses administering medication within a hospital setting. There
will be 15-20 participants involved in the research. The inclusion criteria for this study will be
nurses in southern Idaho, ICU/medical surgical floor, and working a 12-hour shift. Including
nurses in southern Idaho will provide a larger population of nurses that work in acute care in
comparison with southeast Idaho. With this larger population, there will be more ICU nurses
dealing with multiple medications and distractions. There will also be more medical-surgical
nurses dealing with a larger load of patients. Lastly, medication errors are more likely to occur
during long shift hours. This research will exclude nurse managers, nurses in orientation, and
nurses not taking full patient loads. The reasons for excluding these individuals is because nurse
managers do not have a lot of patient interaction, orientation nurse provide a second nurse to
catch errors, and nurses without full patient loads are exposed to less medication administration
opportunities. This information will provide the research with a plethora of valuable information
Recruitment will first be done by contacting the IRB (Institution Review Board) of four
different hospitals in southeast Idaho with a level two ICU and a medical surgical unit that is full
20 out of 30 days of the month. Having data from four different hospitals in southeast Idaho will
give pertinent research data to better understand the effect the environment has on medication
errors. After attaining permission from the IRB, the directors of nursing will then be contacted
MEDICATION ERRORS IN THE NURSING WORLD 9
and asked to send out an email for recruitment. The email will only be sent out to those that
meet the inclusion criteria mentioned in the research population sections above. Of those that are
willing to participate, eight to 10 will be chosen from the ICU and eight to 10 from the medical
surgical unit. Once the research is over the participant will be rewarded 20 dollars for his or her
services.
Participants in the research will be observed and then interviewed over their experience
during medication administration. Observation will take place on the ICU/medical surgical
units. Medication errors and environmental distractions affecting medication preparation will be
observed throughout the day. Semi-structured interviews will be used for data collection, which
allows participants to provide thoughts, ideas, and perceptions of medication errors (Grove et al.,
2015). Open-ended questions will be used in the interview to allow participants to elaborate on
their own experience. Connections can then be made between the environment and medication
errors. All participants will be asked questions like “discuss the distractions experienced during
medication preparation/administration and how those distractions affected your ability to prepare
medications appropriately.” And “what environmental distraction do you feel have the biggest
impact on medication preparation, and why.” The information received from these open-ended
questions will be observed and coded to gather themes to help develop a theory of the
relationship between medication errors and the environment (Grove et al., 2015). After coding
has taken place, observational and interviewed data will be examined to see how distractions
Ethical consideration
In this research, nurses participating do not want to be stated by name. This ethical
consideration is called right to anonymity and confidentiality (Grove et al., 2015). To insure
protection and confidentiality, informed consent will be signed in order to participate. De-
identification will be applied after interviews are conducted by removing any personal
information that can be traced back to participants such as names and specific details in
experiences. Each participant will be assigned a number to ensure all information is safe.
Lastly all interview and observational data gathered in the research will be intensively examined
In this research participants will be able to choose whether or not to participate, and to
withdraw when they wish. This ethical consideration is called right to self-determination (Grove
et al., 2015). All participants will be informed of the research and will not be coerced into doing
anything against their own will. A packet of information will be handed out to each participant
prior to observation to inform them of all that will be observed. Participants being interviewed
will have a full understanding on exactly what type of questions are being asked and can pass on
any question if they decide not to answer. Those being interviewed can decide if they no longer
want to participate and can withdraw from the interview at anytime with no repercussion of
decision.
In this research, participants will be treated equally and receive the same respect as others
being observed. This ethical consideration is called the right to fair selection and treatment
(Grove et al., 2015). All participants in the research will be chosen at random to prevent any
possibility of favoritism. Once participant have been chosen they will be required to sign a
consent form regarding the roles pertaining to the research. If any changes need to be made to
MEDICATION ERRORS IN THE NURSING WORLD 11
the rules, they will not be done without consent from the subject and IRB’s permission. All
subjects will be respected and treated the same no matter the race, age, or socioeconomic level
Annotated Bibliography
McLeod, M., Barber, N., & Franklin, B. D. (2015) Facilitators and barriers to safe medication
administration processes and systems (the MAPS Study). PLoS ONE, 10(6): e0128958.
These three authors are colleagues in the Pharmacy and Medical Department at the
Imperial College Healthcare NHS Trust in London. They have received their Doctorate
was to identify factors that hinder successful medication administration. One of the
greatest strengths to this research was the ethnographic approach. This allowed the
researchers to gather observational data on real world practice and see what really caused
errors in medication administration. One of the weaknesses in the literature is that they
failed to categorize the nurses used in the study (age and qualification), and only a few
environmental factors were included. For example, there was no research done on noise,
light, and co-workers. The quality of this study was moderate because the research was
organized very well and there were a lot of charts and facts to support the finding,
however, there was not enough research done on environmental distractions causing
medication errors. This research is best utilized by nurses to help enhance the safety of
patients during medication preparation and administration in the hospital setting. The
intended audience for this research study is nurse managers and nurses in the hospital
MEDICATION ERRORS IN THE NURSING WORLD 12
setting. This literature is relevant to the research problem because they both focus on the
Özkan, S., Kocaman, G., & Öztürk, C. (2016). Interruptions during pediatric medication
The authors in this study have received their Doctorate in Nursing and are professors at
Sifa University in Izmir, Turkey. In addition, each of the authors has contributed in
multiple research studies, many of which were focused on medication errors. The type of
study conducted in this literature was a quantitative descriptive study. One of the greatest
strengths to this study was the pre-test that was performed on the usability of the form to
document the data. This form allowed for easy and proper documentation of the start and
finish times of medication preparation and administration. It also takes into account the
frequency and reason for interruption. One of the biggest weaknesses in the study is the
interruption periods were not calculated. For example, when a nurse was interrupted, the
duration of the interruption was not documented. This data would have allowed the
researchers to make a connection between the duration of the distraction and medication
errors. Overall the quality of this research was high because the form that was used was
very thorough and a pre-test was done to make sure it was adequate for the research.
Also, the charts and graphs showed in great detail the various distractions and cause that
contributed to medication errors. This research is useful for nurse managers and nurses
to help pinpoint the distractions on the floor that are causing medication errors. The
intended audience is nurse managers and nurses trying to pinpoint what distractions make
the most medications errors. This article was chosen because it links to the research
MEDICATION ERRORS IN THE NURSING WORLD 13
problem through nurses with 12-hour shifts (population), and medication errors
(intervention).
Vazin, A., & Delfani, S. (2012). Medication errors in an internal intensive care unit of a large
teaching hospital: A direct observation study. Acta Medica Iranica, 50(6), 425-32.
The researchers in this article have received their PhD in Pharmaceutical practice and are
Research in Shiraz, Iran. This research includes a quantitative direct observational study.
The researchers conducted this study to determine the frequency, type, and consequences
of medication errors in the ICU. One of the greatest strengths from this research study is
the researchers provided a variety of specific causes of medication errors. For example,
in the charts that were created, it provides a number of different categories in which the
reader can see the exact cause of medication errors. A weakness in this study is of ethical
consideration. For example, individuals that were being observed in the study did not
know they were being observed for medication errors. The quality of this study is strong
because the data was clear and precise. This study also provided adequate data, graphs,
and charts from their observation of each nurse that backed up the reasons for medication
errors in the ICU. The data collected in this research would be useful to nurse managers
in the ICU unit looking to decrease the occurrence of medication errors and for those
looking for ways to improve quality of care. The intended audience in this research is
nurse managers, and nurses looking to decrease medication errors and improve quality of
care in the ICU. A link can be made between this literature and the research problem
Keers, R. N., Madalena, P., Bennett, K., Clayton, K., Brown, P., & Ashcroft, D. M. (2018). What
Researchers from this study have received their PhD in Pharmaceutical practice and are
professors at the University of Manchester in the United Kingdom. This research study
includes a qualitative grounded theory approach. The researchers are conducting this
study in aim to pinpoint the causes of medication errors in mental health. A strength
found in this literature is that semi structured interviews were used to gather information
from participants. This aloud researchers to gather experiences from participants to help
focus the research towards a specific theory. A weakness found in this research study is
participants were asked to recall experiences up to six months back. The data collected
from these experiences could have been inaccurate, causing falsified date. Overall
strength of this study was high because researches broke up causes of medication errors
into multiple categories allowing the reader to distinguish exactly what caused each error.
Also, there are charts and graphs provided braking down each category into specific facts
and percentages. This article is useful for nurses in all practices striving to decrease
medication errors and improve patient safety and outcomes. It will allow nurse managers
to pinpoint exactly what to focus on to decrease medication errors. The audience that this
research is directed to is nurse managers and nurse’s working in mental initiations. This
study is relevant to the stated research problem because they are addressing the
Implications
Nursing Knowledge
After this research study is concluded, nurses will have a greater knowledge of how
environmental distractions and decreased cognitive function can effect medication preparation.
This study will allow nurses to have a proper understanding of the most common distractions
during medication preparation so they can be removed from their surroundings. For example,
social interaction during medication preparation, and high volume workflow at the medication
station are some of the most common reasons for medication errors. Knowledge gained from
this study will warn nurses of these distractions and allow them to prepare medications properly.
Nurses will also have a greater knowledge on how diminished cognitive function can increase
medication errors. For instance, medication errors are most likely to occur in the last three hours
of the shift when cognitive function is at its lowest. The knowledge gained from this research
study on medication errors will supply nurses with the proper information needed to provide a
Nursing Theory
Despite all the technical advances in the medical field that help reduce errors when
environmental theory into practice, medications errors can be decreased and patient safety
cleanliness, nourishing foods, ventilation, light & noise, observation, and hope, she was able to
empower the nature of health and healing in her patients. Nightingales environmental theory
supports this research study because properly observing the surroundings to decrease distractions
MEDICATION ERRORS IN THE NURSING WORLD 16
allows for proper medication preparation, resulting in a favorable environment for patient
recovery.
Nursing Practice
After the completion of this research, nurses will implement changes into their practice.
Things nurses will do differently is make sure that they remove themselves from distracting
coworkers and patients, loud noises, and heavily trafficked areas before preparing and
administering medications. By doing this, medications will be properly prepared and patients
will be given the best chance of reaching their optimal health. Another change that nurses will
make after completion of this study is strive to maintain cognition function during the last few
hours of their shift. By acknowledging that cognitive function decreases during this time, nurses
can take measures to prevent this from occurring. Prior to this study nurses were advised to
check medication twice, do six rights, and only prepare one patient’s medications at a time but
did not always follow through with these stipulations. After reviewing this research nurses will
make an extra emphasis on following through with these three guidelines. By implementing
these changes into practice nurses will provide patients with an environment that promotes
This research study will improve patient care in the hospital setting by improving patient
safety. Every year medication errors account for as many as 251,000 deaths annually (Anderson
& Abrahamson, 2017). Although several strides have been made to reduce the amount of
medication errors that occur, they continue to happen. These improperly prepared and
administered medications can potentially cause damage and harm to the patients. For example,
gentamicin can cause kidney problems, and morphine can cause respiratory depression. This
MEDICATION ERRORS IN THE NURSING WORLD 17
research will help further the progress and decrease the amount of errors that happen because of
environmental distractions and in turn, provide a safer environment. With this new knowledge
provided there will be a decrease in medication administration errors and ultimately, patient care
This research study will improve patient care by saving hospitals and patient’s money.
As stated previously in this research, there are multiple medication errors every year and these
errors cost patients and hospitals thousands of dollars. For example, these errors on average cost
patients anywhere between $2,000-$2,500 per stay and hospitals around 2.8 million per year
(Cheragi et al., 2013). Many of these errors that occur are related to environmental distractions
deterring the focus of nurses. By reviewing this study and adding to the knowledge that
hospitals already have, a focus can be put on reducing the most common distractions in the
hospital. Decreasing these environmental distraction will minimize medication errors and money
This research study will improve patient care and in turn provide the best possible
outcome for patients. Proper medication administration is very important and can be altered
through distractions like co-works, patients, and other environmental surroundings. With the
knowledge that will be gained from this study, nurses will be able to prevent these errors and
alter their surroundings in a way that will provide patients with an environment that promotes
healing and a better patient outcome. 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,
patient outcomes will improve and patients will be given the best chance of reaching their
optimal health.
MEDICATION ERRORS IN THE NURSING WORLD 18
Recommendations
Nursing administration can use this study to cut down on the amount of medication errors
occurring in hospitals. By reviewing this study they will find that environmental distractions are
a very prevalent reason for medication errors. For example, increased noise, patient loads, and
conversations with coworkers at the medication station are a common reason for medication
errors. Once this data is reviewed, nursing administration can come up with strategies on how to
prevent these environmental distractions from causing medication errors. By implementing the
information gained from this research study, patient care and safety in the hospital settings will
continue to improve.
This research study can be transferred to cardiac floors and emergency centers. Because
semi-structured interviews were used to gather information for this research, this form of data
collection can easily be transferred to the emergency department and cardiac floor to gather
statistical data in those departments. Also, with cardiac floors and emergency centers having a
higher intensity of care with multiple patients and a large amount of distractions, the information
from this study can easily be implemented into their practice to help reduce medication errors.
By applying the techniques found in this research study the amount of errors caused by
environmental distraction will be reduced and patient satisfaction will be met. As a result, the
patients experience and safety will be improved while in the emergency center and cardiac floor.
A future study that can be done on medication errors is a quantitative descriptive study.
This type of study takes a large group of participants in a situation as it naturally happens and
identifies theories or problems with the practice to gather statistical data on a specific topic
(Grove et al., 2015). This type of research can be used in a future study because it will allow the
researcher to incorporate a larger sample size. By including a larger sample the data gathered
MEDICATION ERRORS IN THE NURSING WORLD 19
will be more accurate and reliable information. Also, a ratio level measurement will be included
in this future study to help separate the most common environmental distractions into different
References
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Cheragi, M. A., Manoocheri, H., Mohammadnejad, E., & Ehsani, S. R. (2013). Types and causes
of medication errors from nurse’s view point. Iranian Journal of Nursing and Midwifery
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3748543/
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