Need help with paper!!

[emilyy220]

Hi, In one of my classes I have to write a 10 page paper. I have started reading through articles and am submitting an annotates bibliography and then an outline for the paper in the next few weeks. I have read through at least 50 different peer reviewed articles but I'm just not sure what me thesis for the paper should be and how to formulate it. Once I have a thesis with my subtopics I can form an outline and that will really help me. This is my topic "Medication errors are an ongoing threat to patient safety and quality health care. Are the standards of practice adequate to stem the vast number of med errors that occur in practice". I am going to argue that the standards of practice are not good enough to prevent med errors because so many med errors are still made. Obviously pyxis machines and barcode scanning has decreased med errors greatly but there are still issues. I just don't know what exactly to write in the paper. Please help me with ideas on what to put in my thesis. The main issues I have found that cause med errors are nurses being distracted. I was thinking about using that as one of my subtopics in my thesis and there are a lot of studies on how disstractions affect medication administration. But I don't know what else to talk about. Maybe the fact that there are many different syringes used when giving injections? For example, if someone used a regular syringe instead of an insulin syringe the patient could get way too much insulin, so maybe there's a way nurses could have to scan the syringe they are using so that they know they are using the right one before administering a med. I don't know though if that makes sense. And I don't know what I would use as my third control. Please give me ideas! I will be heading to my university's writing center for help but I feel as if a lot of you could help me as well.

[angeloublue22, BSN, RN]

I did a paper similar to this and I used the other reasons that cause med errors. Like pharmacy mess ups, limited times, frequent interruptions, low staffing etc. Preventing medication error should not only be the nurses responsibility since many hands are the process. There was an interest article that I read that focused on the rights of nurses to have the ability to perform safe administration.

[Here.I.Stand, BSN, RN]

I haven't researched this much, but have you found any evidence of grabbing the wrong syringe? I don't know, but I can definitely tell when I have a 12 ml vs 3 ml vs insulin syringe in my hand... plus I can see when drawing up a med if the syringe is metered in ml vs units. PLUS, most places require insulin to be double checked.

Have you found any info on hours/shifts? Does mandatory OT and ensuing fatigue affect nurses' attention/cognition? What about working 5, 6, 7 12-hr shifts in a row (either due to choice or poor management's staffing practices)? 8-hr vs 12-hr vs 16-hr shifts?

What about excessive focus on the customer-is-always-right, hotel mentality of pt satisfaction? Does the nurse feel supported to say to a pt, "I need to focus on your meds right now," when a pt is griping about the TV and food?

What about discussing measures that have already been implemented? Things like tall-man lettering for look alike/sound alike drugs, e.g. DOPamine and doBUTamine; a standard concentration for heparin; dual-nurse signoff for high risk drugs like insulin or a vasoactive drip, or for lab-based titrations such as a heparin drip. How effective has the evidence shown these practices?

What about the non-punitive approach to reporting and investigating med errors? As far as I'm aware, the research is pretty clear on that... yet every so often on here, I read about nurses getting disciplined or "reported."

I like angeloublue's suggestion about non-nursing factors as well. Unless nurses do EVERYTHING from ordering to administration, we are not 100% responsible... and of course, we are not. A provider orders, a pharmacist verifies, they may compound the med or dispense a pre-cut partial tablet.... or note that the nurse is to give half a tab, and s/he has to cut it... a pharmacy tech double checks, they enter the med into the Pyxis/Omnicell or deliver it to the unit. Once on the unit, the pharm tech stowes it in a cubby or the fridge or the locked narc box. Sometimes they even just set it on the counter in a pile -- so the nurse misses it when s/he looks for it in the pt's med cubby where it was SUPPOSED to be. Or if they use a pneumatic tube system, and they accidentally send the med to station # 543 instead of 534, then the med will be delayed. What about PHARMACY staffing levels?? My hospital recently laid off pharmacy staff, and it really seems to have impacted the promptness of their duties!**

What about relying TOO heavily on barcode scanning? I once did receive a prefilled oral syringe with double the ordered amount of med -- but the *label* read that the syringe contained the proper amount. Based on the concentration and ordered dose, pt should get 10 ml; the syringe had 20 ml in it. Had I ONLY scanned and not done my 5 rights the old fashioned way, the pt would have received incorrect medication.

What about unlicensed med aides as are frequently used in LTC and assissted living situations? Is there research on med safety with UAP vs licensed RN/LPNs?

**ETA: Of course accuracy is more important than speed, so yes if they need that extra time they should take it. Technically though, the extra time HAS contributed to wrong time med errors.