DOI: 10.5176/2251-3833_GHC17.24

Authors: Lee Poh Suan

Abstract: Medication errors have been established as the leading cause of preventable death in the healthcare institution, however, very little is known about the incidence and causes of medication errors (MEs) in Singapore. This review aims to, improve the medication administration safety amongst final year nursing students, from an understanding of the type and causes of the MEs committed in the clinical setting. Students (n=12) were observed in one teaching hospital that is fully equipped with an integrated hospital system, during the first 2 weeks of their clinical posting. These observations (n=23) were followed up with individual interviews, reflections, and a focus group (n=6) meeting. The themes elicited from the findings were matched against Reason’s (2000) model of error causation. In all, the majority of MEs made by students, resulted from slips and lapses (46.3{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465}), followed by knowledge-based (24.4{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465}) and rule-based (17.1{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465}) errors. Nevertheless, the underlying causes for these errors, stem from within the organizational system itself. The new findings in this study, as the predominant cause of student errors, lie in the design of the Electronic Medication Administration Recording System (eMAR) system (39{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465}) and the lack of system training on-campus (22{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465}). Other latent conditions in the ward, like presence of distraction (10.5{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465}), interruptions from a lack of preparation of mixtures (15.8{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465}), and communication failures (4.9{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465}) contributed to the Medication Administration Error (MAE) to a lesser degree. The best defense link against students’ ME, is the level of supervision, guidance, and support that students’ received from Registered Nurses (RNs). Double checking (89.5{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465}) the drugs with RNs were most effective, in the prevention of error from reaching the patient. System alerts and pharmacist checks act as additional systemic buffers against error commission. The inclusion of system thinking into the pharmacological and nursing skills module is needed if students are to be better prepared for their future clinical posting.

Keywords: Medication errors Nursing Students Singapore


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