Practice Tip of the Week | Mitigating Medication Errors within the Inpatient Psychiatric Setting

 By Tiara K. Stepp, BA, BSN, RN, PMH-BC

As new graduate nurses enter the profession, they are confronted with
extensive challenges as they acclimate to an independent role, laden with responsibilities to their patients, regulatory standards of their profession, and expectations of their institution. Educational initiatives have been developed to ease the transition from academia to independent practice, including nurse residency programs, which were made available over 40 years ago throughout the Unite
d States (Pillai et al., 2018
). Within residency programs, graduate nurses are offered additional
resources to bolster critical thinking skills, enhance communication and collaboration amongst the multidisciplinary team, and meet the competencies required of their independent role (Chan et al., 2021
; Pillai et al., 2018
). While nurse residency programs have been implemented to facilitate
professional growth and hone graduate nurses’ clinical skills, they have been associated with a lack of consistency in curriculum, program length, and method
ology of validating performance and readiness for independence (Brown et al., 2022
; Pillai et al., 2018
). The consequences of new nurses being unprepared
are discussed by
Brown et al. (2022)
, including the impact on patient safety and employee turnover
. Patient safety can be significantly impacted
by medication errors, a cause for concern on a national and global scale. 

Patients
impacted by medication errors can experience psychological or physical harm with long-term emotional and financial sequelae (Isaacs et al., 2023
). Examples of medication errors include administering an incorrect dose, an incorrect medication, or providing the medication to the wrong patient (Isaacs et al., 2023
; Suzuki et al., 2022
). Errors have been associated with factors including fatigue, negligence, and insufficient knowledge (
Treiber & Jones, 2018
). Failure to report, particularly among new nurses, has been attributed to apprehension
regarding retaliation or disciplinary actions following the error (Treiber & Jones, 2018
). A second victim
phenomenon has been associated with healthcare professionals following medication errors and such employees may be subject to maltreatment by others or experience emotional distress (Isaacs et al., 2023
; Treiber & Jones, 2018
). For the ever-growing population of new nurses entering the profession, continued education on medication administration practices may serve to benefit patients as well as nurses, enhancing confidence and sharpening critical thinking skills in the formative years of one’s profession
.     

Working
within an inpatient psychiatric unit, discrepancies in medication administration practices were identified in
nurses with less than two years of experience, through review of event reports and electronic medical record audits. Errors were discovered
in areas of documentation, disposal of medications
, and identification of controlled substances. 

PICOT question
proposing a solution to the issue:

In new nurse graduates, including nurse residents (P), how do structured, bi-monthly educational sessions on principles of medication administration
(I) compared to the current absence of
medication administration sessions
(C) affect the rate of medication errors
(O) within the first two years of independent practice (T)?

A literature review was performed to explore the evidence surrounding nurse graduates, medication errors, and existing educational strategies to support the proposed intervention for practice change.
Four databases were utilized in the search, of which four keeper studies were selected
; these contained quasi-experimental, cohort, descriptive, and qualitative
designs. 

Recurrent
Themes

(Myroniak & Elder, 2021
; Murray et al., 2019
, Rossler et al., 2021
; Schneidereith, 2021
)

Additional
Findings

Proposal

Based on the literature review findings, t
he writer proposes a method to decrease medication errors on the inpatient unit through added educational sessions each month, specifically
simulations pinpointing principles of medication administration, psychopharmacologic agents and teaching points for patients. Implementation of the plan to add two educational sessions per month would occur among nurse residents and new nurses within their first two years of practice
. Each session would focus on a different concept relating to medication administration, associated hospital policies, and
federal and state requirements. 

Ongoing transformation and evaluation of
the proposed educational process includes random auditing and review of patient charts indicating medication administration, direct observation of nursing practice, and investigation of event reports. Continued debriefings will occur following case studies and simulations to encourage feedback from participants and
adjust the educational methods as necessary to
facilitate success
among new nurses.

References

Brown, J. D., Hart, L., &
Wludyka, P. (2022). Improving practice readiness among nurse residents. The Journal of Continuing Education in Nursing, 53
(9), 411-416. https://doi.org/10.3928/00220124-20220805-07

Chan, G. K., & Burns, Jr., E. M. (2021). Quantifying and remediating the new graduate nurse resident academic-practice gap using online patient
simulation.
The Journal of Continuing Education in Nursing, 52(5), 240. https://doi.org/10.3928/00220124-20210414-08

Isaacs, A., Raymond, A., & Kent, B. (2023). Content analysis of nurses’ reflections on medication errors in a regional hospital.
Contemporary Nurse, 59(3), 202-213. https://doi.org/10.1080/10376178.2023.2220432

Murray, M., Sundin, D., & Cope, V. (2019). New graduate nurses’ understanding and attitudes about patient safety upon transition to practice.
Journal of Clinical Nursing, 28, 2543-2552. https://doi.org/10.1111/jocn.14839

Myroniak
, K., & Elder, S. (2021). Improving safe medication administration in new RNs using simulation.
The Journal of Continuing Education in Nursing, 52(1), 30-33. https://doi.org/10.3928/00220124-20201215-08

Pillai, S., Manister, N. N., Coppolo, M. T., Ducey, M. S., & McManus-Penzero, J. (2018). Evaluation of a nurse residency program.
Journal for Nurses in Professional
Development, 34(6), 23-28. https://doi.org/10.1097/NND.0000000000000499

Rossler, K. L., Sankaranarayanan, G., &
Hurutado, M. H. (2021). Developing an immersive virtual reality medication administration scenario using the nominal group technique.
Nurse Education in Practice, 56. https://doi.org/10.1016/j.nepr.2021.103191

Schneidereith
, T. A. (2021). Medication administration behaviors in prelicensure nursing students: A longitudinal, cohort study.
Nurse Education in Practice, 56.
https://doi.org/10.1016/j.nepr.2021.103189

Suzuki, R., Sakai, T., Kato, M., Takahashi, M., Inukai, A., &
Ohtsu, F. (2022). Analysis of medication and prescription background risk factors contributing to oral medication administration errors by nurses: A case-control study.
Medicine, 101(33), e30122. https://doi.org/10.1097/MD.0000000000030122

Treiber, L. A., & Jones, J. H. (2018). After the medication error: Recent nursing graduates’ reflections on adequacy of education.
Journal of Nursing Education, 57(5), 275-280. https://doi.org/10.3928/01484834-20180420-04