Article Critique on "Willingness of Nurse to Report Medication Administration Errors in Southern Taiwan a Cross Sectional Survey"

Article Critique 10 pages (2768 words) Sources: 3

[EXCERPT] . . . .

authors, Y.H. Lin and S.M. Ma (2009), selected the title, "Willingness of nurses to report medication administration errors in southern Taiwan. A cross-Sectional survey," which was considered to be a concise and descriptive title for this study.

The authors also present a solid and concise description of their study following traditional guidelines for this purpose, including a description of the study sample, the research purpose and a summary of their findings. For instance, the authors preface their abstract by providing a background of the problem. In this regard, Lin and Ma (2009) report that medication administering errors (MAEs) represent an ongoing threat to the quality of delivered nursing services, but the causes of such errors are multifaceted and differ from individual to individual as well as from healthcare facility to healthcare facility. The purpose of the cross-sectional study involving a survey of a convenience sample of 605 respondents from 14 tertiary healthcare facilities in southern Taiwan by Lin and Ma (2009) was to examine the prevalence of MAEs and the willingness of nurses to report them. As their data collection instruments, these researchers used a modified structured questionnaire, MAEs Unwillingness to Report Scale, Medication Errors Etiology Questionnaire, and the Personal Features Questionnaire for this purpose. The researchers determined that more than two-thirds (66.9%) of the nurse respondents had personal experiences with MAEs during their professional careers, and the majority of these respondents reported a willingness to report the MAEs they encountered (Lin & Ma, 2009). According to Lin and Ma, "The key factor contributing to the nurses' willingness to report MAEs was working in a private or nonprofit hospital" (2009, p. 244). Based on the results of their study, Lin and Ma conclude in their abstract that MAE reporting should be anonymous and there should not be any corresponding adverse consequences associated with MAE reporting to help ensure that the process is properly overseen, administered in a meaningful fashion and results in improvements to patient outcomes. In sum, the abstract was regarded as a good one.

3.

Research Credentials

The authors cite their own professional experience in the study and include their credentials for conducting the study which appear satisfactory for the research purpose: Lin is employed in the Nursing Department, I-Shou University and is a PhD candidate at the College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan; her collaborator, Ma is the Section Coordinator at the Cancer Center, Chi Mei Medical Center, Liou Ying Branch, Tainan, Taiwan. The study also notes that Lin in an RN and MSN and Ma is an RN.

4.

Purpose

The authors also provide a concise description of the study's purpose, which was to generally explore the prevalence of MAEs and the willingness of nurses to report them.

5.

Problem statement

The problem statement presented by the researchers adequately codified the issues under consideration. In this regard, the problem considered by the Lin and Ma study concerned the need to reduce medication errors in general and medication administration errors in particular being made by nursing professionals working in southern Taiwan. According to Lin and Ma (2009), current levels of medication administration errors are inordinately high ("MAEs made by nurses in Taiwan are not unusual," p. 243), with correspondingly high social and economic costs. For instance, Lin and Ma report that, "In the United States, medication errors account for an estimated 7,000 deaths per year. In addition, an average of 400,000 preventable drug-related injuries occur each year in hospitals, 800,000 occur in long-term care settings and 530,000 occur in outpatient clinics in the United States. These incidents account for extra medical costs amounting to $3.5 billion annually" (p. 237).

It is axiomatic that in order to improve something, it must first be measured. Therefore, improving the reporting of medication administration errors represents the first step towards addressing the problem. As Wakefield, Uden-Holman, and Wakefield (2005) point out, "Analysis of medication errors can lead to system improvement and reduced risk only if the errors are detected, reported, and used to design better patient-care practices and systems" (p. 37). Indeed, this same point is emphasized by Lin and Ma (2009) who report, "Reporting medication errors is fundamental to gathering information on such incidents, helps health professionals learn how to improve the medication-use process, and prevents or minimizes future incidents" (p. 238).

Although virtually anyone, including patients and families, are in a position to report medication errors (Gebhart, 2008), clinicians are on the front line of delivery and are therefore primarily responsible for identifying and reporting medication errors of all types. In order for effective and timely changes and remedial actions to be taken, though, clinicians must be willing to report medication errors irrespective of their severity or origin. In this regard, Wakefield et al. emphasize that, "Voluntary medication error reporting systems rely on the ability and willingness of individual physicians, pharmacists, and nurses to detect and report errors as part of their routine practice. Because of the central role nurses play in medication administration, it is important to understand their perceptions of the medication error reporting process" (2005, p. 37), and it was this problem that the study by Lin and Ma (2009) examined in detail as described further below.

6.

Scope and delimitation

The researchers describe the scope and delimitations of their study, but do not describe them in these terms. Lin and Ma, though, do report that the scope of this study was delimited to the selection samples of respondents and healthcare facilities located in southern Taiwan. The authors conclude that, "The results could be generalized to a larger Taiwanese population" (Ma & Lin, 2009, p. 244), but do not suggest that the results can be delimited any further beyond this scope.

7.

Literature Review

To their credit, Lin and Ma (2009) present a comprehensive review of the relevant literature, including peer-reviewed studies, scholarly sources, online resources from accrediting organizations such as the Joint Commission on the Accreditation of Healthcare Organizations and governmental resources, with about a third of the resources used being from the last 5 years or so, notwithstanding the gap cited at the end of this section.

The literature review delivered by Lin and Ma was used to provide the background and an overview of the problems under consideration from a wider perspective, including the different types of medication administration errors that are most common as well as how these errors are typically made by nursing professionals. According to Lin and Ma, among the most common types of medication errors is the medication administration error, and these can be either an act of omission or an act of commission. With respect to the latter type of error, these types of medication administration errors occur when one or more of the so-called "six Rs" or "six rights" (i.e., giving the right medication in the right dose at the right time via the right route to the right patient with the right documentation) are violated; by contrast, omission errors take place in those instances where prescribed medications are not administered at all (Lin & Ma, 2009).

With respect to medication administration error reporting regimens, Lin and Ma suggest that the procedures that are in place in Taiwan are comparable to those being used elsewhere, differing only in the reporting medium which is still paper-based. According to Lin and Ma, "In

Taiwan, most hospitals' medication administration errors are reported on a standard paper form. On this form, the reporting nurse describes the error and any contributing factors" (2009, p. 239). Completed medication error reports are then typically sent to the unit head nurse, then to the supervisor and ultimately to the nursing department director who is responsible for acting on the report (Lin & Ma, 2009). The type of action that is taken by the nursing department director, of course, depends on the type of error and its severity, but disciplinary measures generally include the following:

A. Some type of punishment (i.e., lost opportunity for promotion or pay cut),

B. Assigning official responsibility,

C. Requiring the nurse who is responsible for the error to undertake additional training; or,

D. Correcting faults inherent in the environment (Lin & May, 2009, p. 239).

Clearly, the identity of the responsible clinician is required for the majority of these types of corrections actions to be taken but the researchers either failed or avoided to incorporate a balanced view of this need in their literature review.

8.

Conceptual framework

The conceptual framework used by Lin and Ma (2009) was appropriate for the study. The conceptual framework used by these researchers maintained that in order to properly identify opportunities for improving medication administration errors, they must first be reported and then trended in order to determine the types of errors being experienced and where they are being generated. To achieve this level of pervasive and consistent reporting requires a framework in which healthcare practitioners can report such errors without fear of recriminations, either personally or professionally. The researchers report that this conceptual framework had some limitations, though, including the following:

A.… READ MORE

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