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Full APA formatted citation of selected article.

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Gorgich, E. A., Barfroshan, S., Ghoreishi, G., & Yaghoobi, M. (2016). Investigating the Causes of Medication Errors and Strategies to Prevention of Them from Nurses and Nursing Student Viewpoint. Global journal of health science, 8(8), 54448. https://doi.org/10.5539/gjhs.v8n8p220.

Izadpanah, F., Nikfar, S., Imcheh, F. B., Amini, M., & Zargaran, M. (2018). Assessment of frequency and causes of medication errors in pediatrics and emergency wards of teaching hospitals affiliated to Tehran University of Medical Sciences (24 Hospitals). Journal of Medicine and Life, 11(4), 299.

Simonsen, B. O., Daehlin, G. K., Johansson, I., & Farup, P. G. (2014). Differences in medication knowledge and risk of errors between graduating nursing students and working registered nurses: comparative study. BMC health services research, 14(1), 1-11.

Whitehair L, Provost S, Hurley J. (2014). Identification of prescribing errors by pre-registration student nurses: a cross-sectional observational study utilising a prescription medication quiz. doi: 10.1016/j.nedt.2012.12.010. Epub 2013 Jan 30. PMID: 23374975.

Evidence Level *

(I, II, or III)

Level II

Level III

Level III

Level II

Conceptual Framework

Describe the theoretical basis for the study ( If there is not one mentioned in the article, say that here).**

According to Gorgich et al. (2016), medication errors are a severe issue that affects patient safety and can even lead to death. They note that it is the most common type of medical error. For these reasons, they hope to shed light on the problem by investigating its causes and providing strategies for preventing them from nurses and nursing student's points of view.

This scholarly article’s purpose was to analyze the frequency, causes, and types of errors, specifically related to medication affecting the pediatric and emergency department in different healthcare organization. Izadpanah et al. (2018) cite that medical errors, to a great extent are among the main reasons facilitating avoidable mortality in healthcare. Plus, medication errors challenge is the most common type of medical error threatening the safety of patients. Hence, the need to and reason for conducting the study.

According to Simonsen et al. (2014), nurses, to some degree, lack adequate medication knowledge, especially when it comes to drug management. The study also points out that nurses still lack the expertise needed during drug dose calculations. They further comment that this insufficient expertise may result from healthcare organizations failing to provide continuing medication training during practice. In this light, the researchers aimed to compare medication knowledge, certainty and risk of errors between experienced RNs and graduating nurse students.

Whitehair et al. (2014) believe that limited research suggests that students and qualified nurses straggle identifying prescribing errors with precision and skillfulness. For this reason, their study focused on collecting baseline data about undergraduate student nurses' capacity to identifying errors related to prescribing

Design/Method

Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).

Cross-sectional descriptive design is the research design employed in this study. Through it, the scholars were able to conduct a research on the nursing staff working in a in a specific hospital and intern nursing students undertaking a midwifery nursing program. Inclusion criteria of this study for the participants included selecting nurses working in a current ward with at least one year of nursing experience. These nurses were to also provide a certification indicating that they have a degree in any nursing related- programme. For the nursing students, the study required them to have passed a pharmacology course. The researchers used a three-part questionnaire to collect data after confirming its validity and reliability. The exclusion criteria for the study cited unavailability of cooperation in filling out the data collection instruments in some of the surveyed sections. To respect the ethical considerations of research, the researchers made the study voluntary and assured the participants that their information was secure.

Like the first article, this study employed a cross-sectional descriptive study design. This research design aided the researchers to oversee the success of the study they conducted on nurses working in different teaching hospitals in 2017. These hospitals were specifically connected to Tehran University of Medical Sciences. The study did not list any inclusion/exclusion criteria. But, the researchers collected the necessary data using a three-part data collection tool, with the first section describing the demographic information of the participants. The second part entailed a series of medication errors caused by nurses that transpired within the last couple of months. Lastly, the final segment collected data about the root origins of errors. In this section, the selected group were to record the amount and type of errors that occurred within the given period. At the end of the questionnaire, the participants had to answer an open-ended question asking them to suggest some techniques for reducing medication errors.

Two cross-sectional studies served as the research design for this scholarly article. The target groups were graduating nursing students and experienced RNs. This group completed a similar form that included relevant background information. They were further required to answer a multi-choice questionnaire (MCQ) test. The quiz entailed information pertaining medication knowledge and skills in pharmacology (Simonsen et al., 2014). The participants were allowed to fill the questionnaire forms within two and half hours under controlled conditions. Inclusion criteria in this study for RNs required them to provide documentation of them working in a healthcare environment for at least one year. For the students, the criteria required the bachelor nursing student- participants to be in their 3rd year. The exclusion criteria of the study excluded nurses working in outpatient clinics. It also did not allow any nurse who did not administer drugs or who had difficulties speaking in Norwegian language.

This research material also used a cross-sectional observational study design conducted in one Australian University. The researchers employed a prescription medication test to collect the required data. The form used to test the participant integrated some prescriptions questions derived from the national medication chart, and contained the most common types of prescribing errors. The study did not provide any inclusion/ exclusion criteria.

Sample/Setting

The number and characteristics of

patients, attrition rate, etc.

The researchers selected 327 nurses working in different hospital units and 32 student nurses to form the sample volume for the research. The selected group were to be employed in different wards specifically in specialty and subspecialty hospitals (3). On the other hand, the selected nursing students were undergraduate students of the nursing and midwifery school. The sampling method used was simple, non-random.

In this research, stratified sampling method played a pivotal role during population sampling. Through this technique, the researchers selected 423 nurses as study subjects. Out of the selected hospitals, which served as the location for the study, the researchers selected 49 and 11 teaching and general hospitals respectively. 14 specialized hospitals were also chosen for the random sampling of the participants.

The sample size of the study included 243 students recruited from two university colleges and 212 registered nurses. It was a requirement that RNs have at least one year of job experience in 50% or more of a part-time job. (Simonsen et al., 2014). The hospitals chosen for the sampling (two Norwegian hospitals) had 2300 registered nurses, while the three municipalities that played a significant role during participants selection had 500 nurses.

The sample volume included participants enrolled in a nursing course. The researchers sampled 192 participants for the study. These participants were 3rd year undergraduate nursing students.

Major Variables Studied

List and define dependent and independent variables

The Independent variable in research is the variable that the researcher manipulates and is often termed presumed cause, while the dependent variable is the variable being tested and can also be said to be a perceived effect. In this study the major variable are; nurses and nursing student viewpoint and medication errors causes and practices that can prevent them.

Causes of medication errors in teaching hospitals; indistinct shape and packaging of drugs, inappropriate dispensing space for dispensing medications, limited nursing staff, staff burnout and carelessness, low pharmaceutical knowledge of nurse.

Frequency and status of medication errors.

Medication errors.

Differences in medication knowledge between nursing and working RNs.

Risk of errors.

Undergraduate nurse’s ability to identify errors.

Detecting prescribing errors.

Measurement

Identify primary statistics used to answer clinical questions ( You need to list the actual tests done).

The statistical instruments used in this study include descriptive statistics, and T-test. The ANOVA statistical method was also applied to evaluate and assess the collected findings.

In this research article, different measurement tests including ANOVA test analysis and Pearson correlation coefficient. The t-test were part of the data analysis process. Later, the study presented results as frequency, percentage, mean, and standard deviation.

Chi-square also Fishers exact test; t-test; ANOVA and Kruskal-Wallis were the prime tests used to analyze the data. Additionally, Pearson also known as Spearman test was employed for correlations.

The study employed different statistical measurements. They include independent sample t-tests, Pearson's r and 2-tailed test. One of the main measurement that played a pivotal role during data analysis is descriptive statistics.

Data Analysis Statistical or

Qualitative findings

( You need to enter the actual numbers determined by the statistical tests or qualitative data).

Gorgich et al. (2016) found that medication errors result from burnout due to increased workload. 97.8 % of the study population reported this cause, while 77.4 % of the nursing student reported drug calculation to be the prevalent cause of medication errors. Based on the analysis of variance test, the researchers found out a significant relationship between the working shift (p=0.012), type of employment (p=0.003), and type of ward (p=0.019) with the mean of medication errors that occurred in nurses. Based on the nurse and nursing student's opinion, the best ways to prevent these errors include increasing the number of staff, while considering the nurse; patient ratio, and creating a unit as medication calculation space. Their independent t-test (p=0.08) also pointed out that medication errors and gender do not significantly correlate.

This study’s results, provided a total mean of errors of 41.9 cases within a month in emergency and pediatric wards at the fault of nurses. The results showed that the prevailing type of errors include; incorrect administration of the drugs in terms of timing, employing a wrong administration method, the wrong dosage, failing to recall the proper dosage of the drug, administrating extra doses, and giving medication to the wrong client. Based on the statistical mean, they also noted that men rate of causing medication errors was higher than women’s. Based on the results, the initial two variable that were investigated; type of shift and gender were found to correlate with medication errors. Specifically, the results noted that errors were higher first in the evening and night hours. During the morning hours the reported cases were less compared to evening nursing shifts.

This study found out that the nurse’s knowledge was superior to that of undergraduate students. The statistical analysis for the nursing students and RN tests showed 68.9% (8.0) and 61.5% (7.8) correct answers, respectively, (p < 0.001). The researchers noted a significant difference in drug management and dose calculations. They noted that since the participants showed an excellent level of certainty in pharmacology sections, the risks of errors were lower (p < 0.01). The tests indicated that high knowledge and a high sense of managing were related to risk of errors (p < 0.001).

Results from the study population indicated that student nurses had difficulties in detecting and identifying prescribing errors included in the prescription medication quiz. Of the five prescriptions containing an error, 7.3% of students identified all five errors. Also, 13% identified 4, 21.9% identified 3, 26.6% identified 2, and 20.3% identified only one error (Whitehair et al., 2014).

Findings and Recommendations

General findings and recommendations of the research

This study found that tiredness due to increased workload and drug calculation are the main causes of medication errors. It also notes that the best measure for counteracting this issue is decreasing work pressure by increasing nursing staff. The scholars recommend that nurse managers mitigate the workforce issue increasing burnout among staff. The study also suggests that organization to provide workshops and in-service training about medication preparations and education that strengthens pharmacological knowledge.

This study points out that the medication errors occur in clinical wards due to common inappropriate practices, which include unreadable doctor’s orders, limited workforce and increased workload. The findings also made it apparent that insufficient physician orders, lookalike and similarly-pronounced drugs, limited pharmaceutical expert in the units, and inadequate training for drug therapy are other main causes. The study recommends that hospitals devise ways to manage workload and shift hours, increase healthcare provider’s awareness of the vitality of identifying medication mistakes, and re-evaluate the existing drug prescription mechanism, if they wish to reduce these errors.

The researchers found out that even though experienced nurse’s medication knowledge is better than that of nursing students, still it is inadequate. Therefore, they recommend that the healthcare industry emphasize basic nursing education. According to these scholars, improving nurses’ medication skills and knowledge by introducing medication procedures in clinical practice can also help lessen risk of errors.

The study noted that nursing student’s capacity to pinpoint prescribing mistakes is somehow poor. The researchers recommend that nursing educators should find other alternative modes for teaching nursing students about safety measures related to medication. They also propose that healthcare specialist should address need to mitigate the apparent void in education by considering the application of simulation.

Appraisal and Study Quality

Describe the general worth of this research to practice.

What are the strengths and limitations of study?

What are the risks associated with implementation of the suggested practices or processes detailed in the research?

What is the feasibility of use in your practice?

This article is worth assessing because, through their investigations, one can get an in-depth overview of the most common causes of medication errors. One strength of this research is its ability to use credible data collection after confirming its validity and reliability. Not all recommended strategies will work in particular clinical settings. The investigation was carried out in specific work environments that may not be similar to other hospital work settings. Thus, this might present as a risk for a healthcare organization wishing to incorporate the provided strategies. In clinical practice, this article perceptions, suggestions and practices can be incorporated to established evidence-based interventions for medication errors.

This scholarly article provides excellent input about the rate at which errors occur and the root causes of these errors in clinical settings, specifically in pediatric and emergency awards. Healthcare organization can use these study findings to create awareness on the effects of medication errors among staff members. The results can also be used to incentivize nursing managers to reduce nurse workloads and revise existing prescription techniques at work. The study met several limitations, including participants being apprehensive of losing patient’s and colleagues’ respect. Another limitation that became apparent is that the selected group dreaded receiving disciplinary actions, being blamed, and doubted changes and corrective processes after the sampling team reported errors. But, it strengthened its findings by verifying content validity, internal consistency and reliability of the data collecting instrument. One of the practices this study suggests is making pharmacology books available in every clinical ward. The risk associated with this practice is incurring additional costs as an institution may need to purchase these books.

This study is significant when trying to understand the value of improved and sufficient knowledge in pharmacology and drug management among nursing staff. In practice, it can be used to formulate training medication programs for nursing students and working RNs. Since the study adhered to ethical research considerations by making all data anonymous and making the participation voluntarily, it strengthened its research quality. The study also measurements and results fully corresponded with the initial study’s aim. However, one of its limitations is that since the data collection instrument was developed only for the study, it was not validated. The risk associated with this study is that it was performed years ago, and thus, some of its practices may be deemed outdated.

The research article informs the need to train nursing students about medication and prescription. In practice, its ideas can be incorporated to devise a training program for drug management. One strength of this research is that it utilized a prescription medication quiz that simulated a national inpatient medication chart. One of the study's limitations is that the participants did not represent an equal portion of the accounted population of students and nurses. This fact may have negatively affected the external validity of the results. The study only suggested the need to improve in-training in medication procedures and pharmacological areas even after the first year of nursing practice. Still, it did not provide the framework for this training. Individuals wishing to adopt this strategy will not understand how to go about it.

Key findings

Tiredness and insufficient drug calculation knowledge are the common cause of this clinical issue. Using electronic medication cards, creating a unit as a medication calculation and increasing personnel are measures that can reduce medication errors.

Compared to physicians, nurses have a massive role in preventing medication errors in clinical settings. Based on the study findings, it is essential to take corrective measures and address the necessity of educating medical staff about the importance of medication errors and the significance of reforming the techniques of medical prescriptions.

Compared to practicing nurses, nursing nurses still lack when it comes to drug management and prescription. Still, experienced nurses are not sufficiently skilled to ensure safe medication for patients. It is also apparent that educators and nursing curricula do not provide or do not employ proper approaches to instil medication knowledge.

When it comes to prescribing errors, student nurses still have difficulties identifying them. Therefore, it is imperative to describe this gap in nursing education.

Outcomes

The article provides the highest level of evidence, gives specific measures and adheres to research ethics.

The study provides exhaustive causes of medication errors and uses quality statistical research methods.

This study also provided viable practices that can be integrated by educators and healthcare practitioners.

The two recommended practices suggested by this research are worth recommending.

General Notes/Comments

Compared to the other three research materials, this article provides the highest level of evidence that inform about medication errors.

This study provides a comprehensive and detailed findings of the causes of medication errors and requisite preventive measures.

This study also provides high level of evidence and gives clear and precise description of the variables under study.

This article does not provide in-depth information but suggest unique practice.