Vanessa: Why medication errors happen in aged care
Vanessa Muir is a Registered Nurse who works in aged care in Queensland. When she read an article about the high rate of medication errors in nursing homes, Vanessa was not surprised.
Here Vanessa outlines some of the factors she thinks lead to errors.
As a Registered Nurse working in a residential aged care facility, I have encountered numerous factors that contribute to and make medication errors unfortunately inevitable. This shouldn’t be the case as our elderly deserve only the best care. I love working as an aged care nurse but there is much room for improvement in the industry.
- Patient/resident identification: In hospitals, adhering to the Rights of Medication Administration eliminates the possibility of error. However in aged care facilities, the basic necessity of identifying that you indeed have the Right Patient (resident) isn’t always easy. Residents aren’t wearing identification bands on their wrists replete with a UR number and date of birth. Residents might not have a photo/name at their door due to the red tape of privacy issues (plus residents aren’t confined to their rooms anyway). If you are not familiar with the residents, this leaves you with asking residents what their names are (fingers crossed they don’t have advanced dementia), checking their clothes for labels (fingers crossed they don’t have another resident’s clothing on on that particular day- which does happen!) and asking other staff for direction. I’m not suggesting that people be branded or tattooed with identification but an attractive stainless steel bracelet or dog-tag necklace (similar to the med-alert bracelets) would definitely go a long way. Especially when agency nurses are so highly utilised in nursing homes in light of staffing shortages. This issue desperately needs to be addressed.
2. Unsafe nurse-to-resident ratios: On day/afternoon shift, I am responsible for administering medications to over 40 residents on one medication round. When you have to work at breakneck speed to get medication to all 40 of these people in timely manner, it is a mad rush. You are not simply handing over a cup of pills and walking away. You are expected to watch the resident swallow every last pill before signing the medication sheet. Even if there are 20 pills in that cup that are taken one at a time and very slowly. Swallowing difficulties (dysphagia) are a common occurrence with age which can make taking oral medications a laborious, time-consuming task. And in addition to the pills there are liquid medications, multiple eye drops and ointments, nebulisers, inhalers, topical creams, nasal sprays, ear drops, suppositories, patches, etc. This is a recipe for error. Residents understandably get upset when they don’t receive their medication on time but it is just not humanly possible as things currently stand. Unions are lobbying for the introduction of nurse-to-resident ratios in aged care. This is long overdue. Quality and safety will continue to be compromised until the government steps in and does something.
3. Multiple distractions: In hospitals, nurses on med rounds have the option of wearing a ‘Do Not Disturb’ vest. In aged care, we are doling out dangerous drugs such as insulin, warfarin and Schedule 8s yet we have no such provisions. On my med rounds I have assistant nurses approaching me with concerns. I have residents approaching me often just for a chat. I have emergency buzzers going off that I have to drop everything to respond to. I have family members of residents coming up to me and asking why their husband/wife/mother/father is sitting in a particular chair (for example). And on top of all that, I have to field phone calls from hospitals who have multiple questions about residents who have been recently discharged that I often can’t answer and from family members with non-urgent requests. Preparation and dispensing of drugs requires our full attention. We want to ensure that we are not giving someone something that they are allergic to. We need to check that we are giving the right dose at the right time. We need to check that the medication hasn’t expired. We need to consider and foresee any negative drug interactions or side effects and make a mental note to monitor for these. If we injected the wrong resident with the insulin that we have prepared, the consequences could be fatal. Eliminating some of the multiple distractions could be as simple as not expecting RNs to answer phone calls during their med rounds but diverting these to reception. Assistant Nurses cannot be expected to distract and entertain residents and keep them away from the RN whilst they are on their med round as they are simply flat-out with endless toileting requests, etc.
The propensity for error in the area of medication administration in nursing homes is huge. Registered nurses cannot alone improve the current situation but need to lobby those higher up (ie. government and nursing management) to instigate positive change. With the ageing population, hopefully there will be more impetus for change. Aged care nurses certainly shouldn’t beat themselves up for making the odd medication error in the current environment.
We’d love to hear from other aged care nurses about this.
Previously on Nurse Uncut: