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Medication errors continue to be a significant issue affecting patient safety in United States hospitals. The researchers conducted a qualitative study to explore the understanding and management of medication errors by practicing nurses. The results indicated a belief that late medication administration does not always constitute an error, the use of nursing judgment helps determine when and if medication should be given, and an increased reliance upon computerized and systematic checks put into place in health care systems.
The Institute of Medicine reports 44,000 to 98,000 people die in hospitals annually as a result of medical errors that could have been prevented (Kohn, Corrigan, & Donaldson, 2000). Medication errors accounted for 7,391 deaths in 1993, compared to 2,876 deaths in 1983 (Kohn et al., 2000). These medication errors and the adverse reactions connected with them result in increased length of stay, increased cost, patient disability, and death.
The medication delivery process is complex and involves hand-offs between many individuals and departments. Errors may occur at any of the process steps: prescription, transcription, dispensing, or administration. Most error-reporting systems rely on voluntary self-reporting and are imbedded into what remain largely punitive management systems. Nurses widely report reluctance to disclose medication errors, particularly if an error does not result in patient harm (Wakefield, Wakefield, Uden-Holman, & Blegen, 1996; Walker & Lowe, 1998). The purpose of this phenomenologic study was to explore the management of medication errors by practicing nurses by examining the ways that nurses define medication errors and make decisions regarding the reporting of medication errors, and how medication errors affect nurses' day-to-day practice. Results from this study may help nurses and hospital administrators understand the reluctance to report medication errors.
Review of the Literature
Several studies have explored nurses' experience with medication errors. These studies demonstrate inconsistency with the definition of medication errors and with the likelihood of reporting some events even when they are identified as errors. Osborne, Biais, and Hayes (1999) surveyed registered nurses on medical-surgical units in a 700-bed community hospital in Florida. The study was approved by institutional review boards of the hospital and the affiliated university of the researchers. Surveys were distributed to 92 full-time and part-time RNs who administered medication at the hospital; 57 surveys were returned (61.9%)....