3.8 Factors Affecting Medication Safety — Healthcare Provider, Systems, and Client Factors V2
Healthcare Provider Factors
The act of prescribing, dispensing, and administering medicine is complex and involves several healthcare professionals. Even the most dedicated healthcare professional is fallible and can make errors. Some provider-related errors include:
- misinterpreting an abbreviation;
- misidentifying drugs due to look-alike labels and packages;
- mis-programming a pump due to a pump design flaw;
- distractions while preparing or administering medications;
- lack of therapeutic training or inadequate knowledge;
- poor communication with patients;
- a language barrier between healthcare professionals and patients;
- increased workloads;
- interruptions and distractions;
- lack of accuracy of patient records;
- a poor interface between prescribers and electronic health records; and
- lack of protocols and standardized procedures in the work environment.
Systems Factors
Systems factors, also called the environment in hospitals, can contribute to error-provoking conditions for several reasons. Some factors include:
- busy or understaffed units, which can contribute to inadequate supervision or failure to remember to check important information;
- interruptions during critical processes (e.g., administration of medicines), which can have significant implications for client safety;
- fatigue and the need to multitask when busy or flustered, which can be compounded by poor electronic medical record design;
- poor interprofessional communication;
- unavailable or inaccurate patient information; and
- preparing and administering intravenous medications, which are particularly error-prone.
Strategies for reducing errors include:
- checking at each step of the medication administration process;
- preventing interruptions;
- electronic provider order entry; and
- utilizing prescribing assessment tools.
Clinical Reasoning and Decision Making Activity
A nurse is preparing to administer insulin to a client. The nurse is aware that insulin is a medication on ISMP Canada’s list of high-alert medications.
What strategies should the nurse implement to ensure safe administration of this medication to the client?
Note: Answers to the Clinical Reasoning activities can be found in the “Answer Key” sections at the end of the book.
Client Factors
Clients can also present risk factors. For example, it is well-known that adverse drug events occur most often at the extremes of life (in the very young and older people). As discussed in the previous chapter, pharmacokinetic factors are important considerations for any age group, but more so in children, especially infants, and in the older population.
In neonates (particularly premature neonates), elimination routes through the kidneys or liver may not be fully developed. In the older population, renal insufficiency is an expected norm but can lead to delayed excretion of many drugs. For both age groups, they are less likely to tolerate adverse drug reactions, either because their homeostatic mechanisms are not yet fully developed or because they may have deteriorated. Additionally, certain medical conditions predispose clients to an increased risk of adverse drug reactions, particularly renal or hepatic dysfunction and cardiac failure.
Medication errors in children, where doses may have to be calculated in relation to body weight or age, are also a source of major concern. Older adults are also at risk of adverse drug events, either due to polypharmacy, multiple health issues, or age-related pharmacokinetic changes. For example, if they receive several medications concurrently, this can lead to a synergistic effect that can pose harm to the client.
To minimize harm, interprofessional strategies are based on a systems approach with a “prescribing partnership” between the client, prescriber, pharmacist, and nurse. The development and use of medication tools such as Beers Criteria for the older adult population and KIDs list for the pediatric population can be utilized by any healthcare provider to raise awareness of problematic medications.
In the following section, medication safety in pediatrics and older adults will be explored, as well as the issue of polypharmacy, inappropriate medication use, and deprescribing initiatives.
