NHS-FPX4000 Assessment 4 Analyzing a Current Healthcare Problem Current Health Problem: Medication Errors

 NHS-FPX4000 Assessment 4 Analyzing a Current Healthcare Problem
Current Health Problem: Medication Errors
Medication use is undoubtedly the most important aspect of patient care worldwide. With the increased and widespread use of medications comes an increased risk of harm. For instance, there are approximately 6800 prescription medications in the United States, not to mention the countless over-the-counter medications (Tariq et al., 2022).

This, combined with the numerous herbal medications and health supplements used to treat various conditions, raises the risk of harm to consumers. As a result, the Medical Product Safety Commission established goals to focus on overall patient treatment improvement and ensuring the appropriate use of medical products (USDHHS, 2020). According to the Medical Product Safety Commission, medical products include drugs, biological products, and medical devices.

Although there is no universally accepted definition, the National Coordinating Council for Medication Error Reporting and Prevention (2021) defines medication errors as a preventable event that may result in inappropriate medication use or patient harm when the medication is in the control of the healthcare provider, patient, or consumer.

The good news, as suggested by the definition, is that medication error is a preventable action, and thus the go-ahead for all stakeholders to work in unison to integrate and coin preventive interventions. This paper aims to describe the context of a medication error, its causes, the populations affected, and why it is essential. A further discussion of the problem’s potential solutions and ethical implications follows.

Description of Medication Errors and Possible Causes
While interventions have been put in place to reduce the occurrence of medication errors, they have yet to be eliminated. The question that the majority would ask is the reason for the perpetual occurrence of medication errors. Before delving into the causes of medication errors, it is critical to understand their classification.

Medication errors can be classified in a variety of ways, including the stage in the sequence of medication use, the type of errors, the severity, and whether the act is the result of omission or commission (WHO, 2018). Medication errors can occur at any stage of the medication use process, including prescription, transcription, dispensing, administration, and monitoring (WHO, 2018). Based on the type, medication errors are classified as wrong dosage, frequency, route, or patient (WHO, 2018).

A further classification includes acts of commission, such as giving the incorrect dosage of a drug, and acts of omission, such as forgetting to administer a drug (WHO, 2018). Regarding severity, medication errors are classified into levels 0 through 6, with level 0 being a non-medication error and level 6 being a fatal error (Gates et al., 2019). These approaches to categorizing medication errors are mutually exclusive, and there is no strong evidence to support a particular classification criterion, particularly in primary care facilities.

Several studies have delved into examining the factors that contribute to medication errors. According to a Commonwealth Fund International Health Policy Survey, 11% of patients experienced medication errors due to the following risk factors: poor coordination of care, multimorbidity and hospitalization, and cost-related barriers to medical services or medicines (Walsh et al., 2018). 

In summary, the survey categorized the key factors associated with medication errors into the following categories: healthcare provider-related, patient-related, work environment-related, and computer system-related. According to the survey, healthcare provider-related factors include a lack of therapeutic training, insufficient knowledge of the patient and the drug, fatigue, emotional burden, inadequate perception of the risk, and poor communication with patients (Walsh et al., 2018).

Patient-related risk factors include, but are not limited to, (1) individual characteristics such as literacy and language barriers and (2) clinical issue complexity such as polypharmacy, multimorbidity, and high-risk medications (Walsh et al., 2018). Work environment-related factors include workload and time pressures, distractions, a lack of standardized protocols, insufficient resources, and physical work environment issues such as lighting.

Medication-related factors such as packaging, labeling, and naming of medicines as well as computerized information system issues such as difficult processes, inadequate design, and lack of accuracy of patient records, are all strongly linked to medication errors (Walsh et al., 2018). While all factors contribute to some degree to the risk of a medication error, some have been shown in studies to play a much larger role in medication error causation than others.         

Distractions in the workplace are a significant contributor to the vast majority of medication errors. Tariq et al. (2022) attribute over 75% of medication errors to distraction. Physicians are tasked with many tasks, including history taking, physical examination of patients, ordering laboratory tests, and patient education. Amidst all this, they are asked to write drug orders and prescriptions. A lapse in judgment may occur in the rush to write orders and prescriptions, resulting in medication errors (Tariq et al., 2022).

Physicians may scribble drug orders quickly, not paying attention to dosages, frequency, or route, potentially leading to medication errors. Furthermore, while the percentage of contribution is not known, distortions are a common cause of medication errors. The term “distortions” refers to the physicians’ poor penmanship, abbreviations, and misunderstood symbols. Clearly, these contributing factors are largely avoidable with a little forethought and meticulousness.