By Susan L. Montminy, EdD, MPA, BSN, RN, CPHRM, CPPS
For over two decades, nurses have been ranked as the most trusted professionals nationwide. It’s clear that people appreciate the skill, dedication, and compassion they bring to patient care. Their genuine concern for patients’ safety and well-being is unmistakable.
Adverse events pose risks to patients and can heighten feelings of stress nurses already face. A recent study of nurse-related malpractice claims indicated that 47% involved a patient death or a high level of injury and accounted for 77% of the nursing indemnity paid. Overall, nursing events were 13% more costly than non-nursing events.
Despite remarkable technological innovations over the past few decades, nurses and their patients remain susceptible to error. Healthcare organizations must continue embracing opportunities to support nurses, examine delivery systems, create a culture of safety, and provide continuing education to reduce risk. A deep dive into the medical malpractice claims data offers valuable insights into one common area of risk: medication administration.
Medication errors: A statistical picture
Before electronic prescribing, illegible handwriting was often the culprit in medication errors. Today, providers’ handwriting has largely been replaced with easy-to-read type—yet medication errors remain a cause of preventable patient harm.
One study estimates medication errors result in 7,000–9,000 deaths annually, with hundreds of thousands of additional, unreported adverse reactions. Malpractice claims research suggests that between 2018 and 2021, medication administration and management accounted for 18% of nurse-related claims, 39% of which resulted in death. The most common medications implicated were opioids, anticoagulants, and antibiotics.
Equally revealing is the fact that 75% of the patients in the analyzed claims had at least one serious comorbidity—most frequently cardiovascular disease, hypertension, chronic pulmonary disease, or diabetes. These comorbidities typically require polypharmacy, increasing the odds of drug interactions and potential for error.
The signals from the claims data underscore several strategies healthcare organizations can deploy to reduce the risk of medication errors.
Strategies to support nurses and safeguard patients
Alerts and other safety features built into EHRs and medication dispensing systems can help reduce the risk of medication errors. The question is: How effective are those safeguards within daily nursing workflows?
Nurses risk missing vital safety information when EHRs and dispensing systems aren’t attuned to their needs. For example: Are drug allergy alerts displayed prominently, or do nurses need to search for them on multiple screens? Organizational leaders are encouraged to “walk a mile in their shoes” and watch the administration process from start to finish to identify opportunities to make the process streamlined and intuitive.
Here are four strategies to strengthen nurses’ medication administration workflows:
- Optimize technology use by safeguarding against vulnerabilities. Healthcare organizations should consider tasking a multidisciplinary team to review nurses’ medication management and administration concerns and evaluate EHR and dispensing system processes to optimize the technologies’ safety features. Take alerts as an example. If alerts are bypassed, the team should evaluate the data to understand why. Nurse education should include the rationale for the alerts and the risks associated with bypassing them. It’s also vital to ensure that traveling and temporary staff receive the same training on the alerts, the organization’s EHR documentation, and the medication dispensing system as staff nurses.
- Empower nurses with “no interruption” zones. Medication administration requires complete focus and concentration. In fact, research establishes that errors can be reduced when interruptions are minimized.
- Strengthen medication reconciliation processes. A medication safety plan should require a robust medication reconciliation process at admission and at all transitions in care. Nurses should be trained to document medication histories that include current medications/dosages, route/time of last dose, over-the-counter medications, supplements, alternative medications, cannabis products, illicit drug use, and allergies. Organizations would benefit by ensuring the accompanying documentation process is easy for the nurses to use.
- Create a culture of shared accountability. Organizational leaders must encourage nurses to speak up about medication safety issues by viewing them as opportunities to identify systemic problems. Quality and patient safety committees can show support by swiftly addressing the issues nurses bring to their attention and thanking them for their report. By being willing to hear and fix problems, healthcare organizations can build an environment of trust, respect, and commitment to patient safety.
Seize the opportunities
While statistics suggest that medication errors remain a problem, healthcare organizations that heed these signals and look inward at their own processes will see that they also reveal many opportunities for improvement. Underlying these opportunities is the realization that a culture built on respecting and collaborating with nurses is crucial. Empowering nurses with thoughtfully designed tools, processes, and shared responsibility enables safe and compassionate care—the kind of care patients trust their nurses to deliver.
Susan L. Montminy, EdD, MPA, BSN, RN, CPHRM, CPPS, is the director of risk management for Coverys and a passionate advocate for patient safety. She brings an abundance of clinical experience and healthcare leadership positions to the table, including working as a registered nurse and holding director-level leadership positions in nursing, risk management, and quality.