Running Head: Conflicts with Medical Administration

Conflicts with Medical Administration

Tori Temple
Writing for Work
University of Arkansas at Little Rock

Running Head: Conflicts with Medical Administration

Medical Administrations is the undergoing of nurses or others, given the authority, which
has given a medical error or dosage of medicine to a patient. According Pamela Anderson (2010)
she writes that there is a patient coming back from surgery. The patient has several I.V. tubing
lines and an intracranial pressure (ICP) monitor in place. I.V. tubing is different in the patients
care room from in the operating room. The nurse taking care of the patient was running in a haste
and prepares to inject morphine into the patients ICP drain. She manages to stop herself because
she mistakes the central line with the ICP drain. She realizes what she was almost about to do
and also realized that it could have been a very serious mistake (Anderson, 2010, Vol. # No. 3).
Over the years there has been sadly several accounts of nurses giving patients the wrong medical
administration. The problem is when administering Medications there is a process to do this such
as identifying the client, informing the client, administering the drug, provide adjunctive
interventions as indicated, and recording the drug administered. Some nurses, or pharmacists, are
not doing this process before beginning administration. After your do this process, it is still
required to check the medication three times for safe medication administration.
Purpose
According to Berman, Snyder, and Frandsen (P. 773) the three checks are first to check
the patient information and make sure the dosage matches with the MAR (Medical
Administration Records). If dosage does not match you are required to do a math calculation to
insure you have the right amount. The second check off is when preparing the medication look
for the medication label and check it against the medical records. The Third check off is to
recheck the label on the container with the medical records. You are to do this before you return
the medication to the storage place, or when giving it to the patient. The three check offs should

Running Head: Conflicts with Medical Administration

keep you from making medication errors, but there are still going to be some careless moves in
the process. Medication administration errors are common and mostly minor. Direct observation
is a useful, sensitive method for detecting medication administration errors in psychiatry and
detects many more errors than chart review or incident reports. The technique appeared to be
acceptable to most of the nursing staff that were observed (Haw, C., & Stubbs, J., & Dickens, G,
(2007)). Medication errors result form system and individual factors. Individual factors include
fatigue and stress. Many studies report medication errors occur related to the system factor of
interruptions and distractions during medication administration. (Berman, Snyder, Frandsen,
2016, p. 768). Distractions need to be dealt with before beginning the first process of
administering medications to patients. According to Ghenadenik, A., & Rochais, E., & Atkinson,
S., & Bussieres, J.F. (2012) there was a study done that delivered nursing care in small settings
showed for 16% of a nurses time was in preparing or administering medications. Interruptions
occurred in 22% of medication preparation leaving a high number of interruptions which in the
end leads to medication errors.
Problem
According to Haw, C., & Stubbs, J., & Dickens, G, (2007) they did a study that was
conducted at St. Andrews Hospital, Northampton that provided psychiatric care for patients.
Nine nurses administered medication on a routine medication rounds. Errors were very common
in one of every four doses. These nurses were given information prior to the study. Observers
defined as an administration error as deviation form a prescribers valid prescription or
hospitals policy in relation to drug administration They were also given a questionnaire to have
a full experience of being observed. The most common type of error was unauthorized crushing
of tablets or opening capsules and failing to sign for medication. Prescriptions are to be written

Running Head: Conflicts with Medical Administration

on a paper medication chart. Errors detected by chart review are to be reported on an incident
form. 369 errors were made out of 1423 doses, some were detected on a chart review that had a
total of 148 errors with incident reports on none. Haw, C., & Stubbs, J., & Dickens, G, (2007).
Another common problem with med administration is when some nurses feel they can go around
the system such as failure to scan the medicine and patients name band. There is evidence that
BCMA systems can reduce pharmacy dispensing errors, and there are reports that BCMA
systems can reduce administration errors, although the latter claims have not been clearly
demonstrated. What has been demonstrated is that some users deviate from written BCMA-use
protocols. These deviations, called violations or workarounds, are staff actions that do not follow
explicit or implicit rules, assumptions, workow regulations, or intentions of system designers.
They are nonstandard procedures typically used because of deciencies in system or workow
design. Although several BCMA workarounds have been documented, no systematic evaluation
of BCMA workarounds causes and possible outcomes has been previously reported (Koppel, &
Wetterneck, &Telles, & Karsh. (2008)). When working around the system nurses tend to have an
error in the medication because they have failed to do the 2nd checkoff for med administration.
Sometimes if a nurse cannot scan the barcode correctly on either the patient name or the
medicine they feel that they can just skip the step and type in on the medical records the
information, but because they didnt scan it there are administration errors. BCMAs record the
number and types of alerts presented to users, the alert overrides, and the users stated
explanation for overriding the alert (from a standard list or free text). These explanations, both
those mentioned frequently (such as medication label smudged or torn, patient wristband
missing, and dose differing in some way from that ordered) and those mentioned infrequently
(such as patient combative, or too agitated to scan) were used to identify categories (types) and

Running Head: Conflicts with Medical Administration

causes of workarounds. BCMA alert overrides occur when a user documents medication
administration without a conrming barcode scan. This can be precipitated by an alert indicating
that the scan does not match the medication order or the patient identication (ID), or when the
user does not or cannot scan the barcode. (Koppel, & Wetterneck, &Telles, & Karsh. (2008)).
Scope
Geographically in America medical administration is a very serious issue. One nurse that
I have spoken with that works with UAMS has said that medical administration is necessary for
the progress of the populations health. Both in the hospital and community. The focus should be
on disease prevention and maintenance with the least financial cost and the greatest patient
outcomes. Our geographical area suffered greatly because of chronic disease brought on by
obesity, causing diabetes and heart disease. Chronic disease is a huge financial burden on todays
healthcare system (T. Carey, personal communication, October 25, 2016). According to Haw,
C., & Stubbs, J., & Dickens, G, (2007) there are nine nurses administering medication with a
routine medication rounds, but in every four doses were common errors. With what Carey from
UAMS said about diseases prevention and maintenance hold be the focus, the most common
mistake of error according to Haw, C., & Stubbs, J., & Dickens, is the unauthorized crushing of
tablets or opening capsules and failing to sign for medication. Disease prevention is not going to
be fixed with mistakes such as these. In hospitals, the medication administration stage accounts
for 26% to 32% of adult patient medication errors 2, 3 and 4% to 60% of pediatric patient
medication errors. Errors in this latter stage of the medication process are far less likely to be
intercepted and far more likely to reach patients than in any previous stage (Koppel, &
Wetterneck, &Telles, & Karsh. (2008)). this shows how big of an issue medical administration
errors is, and why there needs to be an end to it.

Running Head: Conflicts with Medical Administration

According to Pamela Anderson (2010) she writes that Critical care nurse is in the process
of catching up on her morning medications for her patient who has had condition changes and
was given several procedures. The patient is intubated and the nurse then decides to crush the
pills and put them in his nasogastric tube. With her giving the late medications she does not
notice the Do not crush warning on the mediation administration record. The nurse crushes the
calcium channel blocker and administers it. With this an hour goes by and the patients ends up in
asystole and he dies. This could have easily been avoided if the nurse just would have taken her
job a little more seriously. She failed to do the three checkoffs before administering the
medication, if she would have done the check offs then she would have noticed the warning on
the medication administration records. This has a question wondering in my head. If nurses dont
want to be the reason for the death of someone then why dont they just do what is required of
them in a hospital? Why dont they recheck the labels on the patients band and on the
medication? Why dont they ask for another nurse to check off that they have the right
medication to give to a patient? I know the nurse from Anderson article was in a haste when
administering the meds to the intubated patient, but wouldnt that want her to get a second nurses
opinion to make sure the labels are right? Another story from Anderson article writes A
physician writes an order for primidone (Mysoline) for a 12-year old boy with a seizure disorder.
Misreading the physicians handwriting, the pharmacist mistakenly fills the order with
prednisone. For 4 months, the boy receives prednisone along with his seizure medications,
causing steroid-induced diabetes. The diabetes goes unrecognized, and he dies from diabetic
ketoacidosis (Anderson, P. (2010)). Distractions and interruptions can disrupt the clinicians
focus, leading to serious mistakes. To reduce interruptions, Sentara Leigh Hospital in Norfolk,
Virginia has instituted a no interruption zone around the automated medication dispensing

Running Head: Conflicts with Medical Administration

machines; coworkers know not to interrupt a nurse whos obtaining medication from the
machine (Anderson, P. (2010)). Norfolk hospital has the right idea of how to reduce medical
administration errors.
A suggestion that I think would help with reduced medical errors is that check offs for
medical administration should always be a requirement in all hospitals and other institutions.
Upon my discussion with the Carey from UAMS she suggested that electronic ordering and
medication scanning such as scanning both the med and the patient ID band be done, and
pharmacy and managers run reports to monitor scanning over rides. Hospitals use disciplinary
action on providers not following the policy. She states Its the only way to provide safe patient
care (T. Carey, personal communication, October 25, 2016). I agree with her but I also think
that all hospitals should require that upon preparing the medication the nurse preparing should
get the eyes of another nurse to check off the medication records of the patient too. This will
ensure not only the correct medication but will assure that there is not a medical error. If upon
not following these actions, the nurse who does a medical error should be punished in an
appropriate manner fit to the hospital policies.

Running Head: Conflicts with Medical Administration

References
Anderson, P. (2010) Medication errors: Dont let them happen to you (web) American Nurse
Today.
Ghenadenik, A., & Rochais, E., & Atkinson, S., & Bussieres, J.F. (2012). Potential Risks
Associated with Medication Administration, as Identified by Simple Tools and
Observations (web), US National Library of Medicine National Institutes of Health.
Koppel, & Wetterneck, &Telles, & Karsh. (2008). Workarounds to Barcode Medication
Administration Systems: their Occurrences, Causes, and Threats to Patient Safety
(Journal), Journal of the American Medical Informatics Association Volume 15 Number 4
July / August 2008.
Haw, C., & Stubbs, J., & Dickens, G, (2007). An Observational Study of Medication
Administration Errors in Old-Aged Psychiatric Inpatients (journal), International Journal
for Quality in Health Care; Volume 19, Number 4: pp. 210 216.
Berman, Snyder, and Frandsen (P. 773). Kozier & Erbs Fundamentals of Nursing concepts,
process, and practice (textbook), Pearson Pg. 769.
T. Carey, personal communication, October 25, 2016