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Healthcare is complex. Often many individuals are involved in patients’ health. From doctors to nurses and pharmacists, healthcare professionals have a huge responsibility when it comes to medication administration, and the slightest misstep can lead to massive consequences.
Medication administration isn’t just about handing over pills or giving injections; it’s about delivering the right treatment, in the right dose, to the right patient, at the right time. Patient outcomes depend on it.
As UK life expectancy increases and the population ages, more and more individuals are living with long-term medical conditions that require medication. Medicines are prescribed to prevent, manage or treat many conditions or illnesses. According to statistics, the number of prescription items dispensed in pharmacies in England has grown steadily over the last two decades. In the year 2022-2023, 1.08 billion prescription items were dispensed. The condition with the highest number of items prescribed was cardiovascular diseases and the single leading drug was atorvastatin.
Medication Errors
Correct medication administration is hugely important to prevent medication errors. These aren’t just blips; they can seriously affect patient safety. Errors can range from simple miscalculations to complex misjudgements. They can have big consequences not just on the individual but also on the broader healthcare system.
Here are some of the potential consequences of medication errors:
Patient harm
Whether it’s a missed dose, an incorrect dosage or the administration of the wrong medication, the repercussions of medication errors can be dire. Patients can suffer from reactions, worsening of symptoms or life-threatening complications.
For those suffering from chronic conditions or fragile health, medication errors can have devastating effects. Besides the complications brought on by such errors, it can also erode trust in the healthcare system and cause emotional distress for both patients and their families.
Increased healthcare costs
The fallout from errors is also costly. It might require additional interventions, monitoring or even hospitalisations. This increases costs and places additional strains on already burdened healthcare budgets. Litigation arising from medication errors can also have financial repercussions.
According to a publication in the British Medical Journal, the NHS wastes £1bn a year on avoidable errors like medication errors, avoidable infections after surgery and other errors. Also, between 5% and 8% of unplanned hospital admissions are because of issues with medication.
Diminished quality of care
Medication errors erode trust in the healthcare system. They cast doubts on competence and reliability. They can also cause delays in treatment, compromised outcomes and prolonged hospital stays.
Systemic implications
Beyond the immediate consequences, medication errors also highlight systemic vulnerabilities. They show a need for:
- Robust medication safety protocols
- Enhanced training for professionals
- Technology-driven solutions to minimise the risk of errors.
To address systematic issues, the approach needs to be multifaceted. It requires education, regulation and quality assurance.
Patient Safety
Patient safety is at the centre of healthcare. Ensuring patients receive the right medication, in the right dose at the right time is crucial.
Each pill or injection incorrectly administered (or missed), can lead to worsening symptoms, adverse reactions or a mix-up in results.
The impact of medication errors on patients’ physical and mental well-being is huge. Physically, these errors can lead to a range of complications, ranging from mild discomfort to life-threatening emergencies. Patients may experience adverse drug reactions, allergic reactions or medication-induced organ damage. If conditions are left untreated or undertreated due to medication errors, it can result in disease progression, deterioration of health and increased morbidity and mortality rates.
Aside from the physical consequences, medication errors can also take a toll on patients’ mental and emotional health. When patients learn they’ve been given the wrong medication or dosage, they can be confused and anxious. Their trust in their healthcare providers may be replaced by uncertainty and fear. Patients may then be reluctant to adhere to future treatment in fear of further errors. This psychological impact can manifest itself as stress, depression or, in the worst cases, post-traumatic stress disorder (PTSD).
Correct medication administration, therefore, is not just about following protocols and guidelines—it’s about honouring the trust placed in healthcare professionals and upholding the fundamental principle of “do no harm”.
Specific risks and issues
The NHS is continuing to use remote consultations for many of its services. And while there are benefits to these, there are also potential pitfalls. One such issue is the higher risk of prescribing errors. Without seeing the patient face-to-face, there could be a wrong prescription issued or a missed diagnosis, for example. There might also be inadequate prescription monitoring.
Professional Responsibility
Healthcare professionals shoulder a huge responsibility in ensuring accurate medication administration. Those who prescribe, issue and administer the medication, shoulder the biggest responsibility.
Nurses
Nurses in hospitals and other healthcare settings are tasked with verifying medication orders, and ensuring accuracy in dosage, route and frequency. They are responsible for administering medications according to protocols and adhering to safety procedures. They’re also required to verify patient identity before each dose.
Nurses also play an important role in educating patients about their medications, including proper administration techniques and potential side effects. They monitor patients for responses and reactions to medications. And, when necessary, they intervene promptly and document their findings accurately.
Pharmacists
Pharmacists are tasked with the accurate dispensing of medications, verifying prescriptions and counselling patients on proper usage, dosage and potential drug interactions. They also conduct medication reviews to identify potential issues like contraindications and interactions, collaborating with other healthcare professionals to optimise treatment.
Pharmacists also oversee medication storage, handling and compounding processes. This ensures compliance with regulations and minimises the risks of errors. Pharmacists are also involved in implementing strategies to promote medication safety.
Legal and ethical obligations
Healthcare professionals have a legal duty to provide care that meets the accepted standards. Patients have the right to be informed about their treatment options, which include medications and their risks and benefits. They should also be told about alternatives so they can make informed decisions about their care.
Healthcare professionals must also maintain patient confidentiality regarding medication information. This ensures privacy and compliance with data protection regulations.
In terms of documentation, medication administration requires accurate documentation. This should include doses, times and patient responses. This is essential for both legal and clinical purposes as it provides a comprehensive record of the care provided to the patient.
Healthcare professionals of all levels have an ethical obligation to report medication errors, adverse events or near misses. This contributes to learning and the improvement of safety protocols.
Technology and Automation
Technology and automation are becoming powerful allies in the prevention of medication errors. There are innovative solutions that enhance safety, efficiency and accuracy in medication administration. These include:
Electronic Health Records (EHRs):
It was only in 2005 that the National Health Service began introducing electronic health record systems in the UK. However, this was considered one of the most expensive healthcare IT failures after it cost £12 billion of taxpayers’ money but ultimately failed.
EHRs provide a centralised platform for healthcare providers to access patient medication history, allergies and current prescriptions. This reduces the risk of errors that are down to incomplete documentation or illegible handwriting.
Computerised Physician Order Entry (CPOE):
Computerised provider or physician order entry (CPOE) or ePrescribing systems allow healthcare providers to prescribe medications electronically. This minimises transcription errors, dosage discrepancies and delays in processing.
Barcode Medication Administration (BCMA):
BCMA systems use barcodes to verify patient identity, medication and dosage at the point of administration. This reduces the risk of medication errors due to misidentification or incorrect medication selection.
Automated Dispensing Cabinets (ADCs):
These streamline medication distribution in healthcare settings. They allow for medications to be stored securely and dispensed automatically depending on patient-specific orders and authorised access. This enhances efficiency and reduces medication retrieval errors.
Smart Infusion Pumps:
These incorporate safety features like dose error reduction software and alerts. They help to prevent adverse drug events related to infusion therapy.
Education and Training
With frequent updates and new systems, continuous education and training are needed. Here are some of the reasons why this is so crucial:
Keeping up to date with advances:
There are often new medications and treatments as well as new technologies in the healthcare industry. This means continuous education is needed to ensure professionals stay abreast of developments. This means they can provide the most up-to-date and evidence-based care to patients.
Enhancing skills and competence:
Ongoing training helps healthcare professionals refine their knowledge, skills and competencies. This may include mastering techniques for safe medication preparation, administration, monitoring and documentation. It is also important to develop critical thinking and decision-making skills in complex clinical scenarios.
Minimising errors in medication administration:
Education and training programmes reinforce best practices in medication safety, error prevention and risk management. Healthcare professionals can minimise the occurrence of medication errors and adverse drug events, thereby safeguarding patient safety.
Promoting interdisciplinary collaboration:
Education and training promote healthcare professionals coming together from various disciplines to learn from each other’s perspectives and experiences. This approach fosters a culture of teamwork, communication and mutual respect. These are essential for delivering high-quality patient-centred care.
Adapting to regulatory changes:
Healthcare regulations and standards are subject to frequent updates and revisions. Continuous education ensures that healthcare professionals remain compliant with legal and regulatory requirements. This reduces the risk of non-compliance and liabilities.
Useful resources
Healthcare professionals have a range of courses and training available. The National Institute for Health and Care Research (NIHR) offers a range of Good Clinical Practice (GCP) courses and programmes, for example. The NHS also provides online mandatory training.
Regulatory Framework
In the United Kingdom, medication administration is governed by a robust regulatory framework to ensure patient safety, quality of care and adherence to professional standards. This is shaped by various legislative Acts, regulatory bodies and professional organisations that set guidelines and standards for medication management practices. Here are the main elements and bodies of this regulation:
Medicines Act 1968
The Medicines Act 1968 is the primary legislation governing the regulation of medicines in the UK. It establishes the legal framework for the licensing, manufacture, supply and distribution of medicinal products, including prescription and over-the-counter medications.
Medicines and Healthcare products Regulatory Agency (MHRA):
The MHRA is the executive agency responsible for regulating medicines, medical devices and blood components for transfusion in the UK. It oversees the safety, quality and efficacy of medicinal products.
Nursing and Midwifery Council (NMC):
The NMC is the regulatory body for nurses, midwives and nursing associates in the UK. It sets standards for nursing practice, education and conduct, including guidelines related to medication administration, record-keeping and professional accountability.
General Pharmaceutical Council (GPhC):
The GPhC is the regulatory body for pharmacists and pharmacy technicians in the UK. It regulates pharmacy practice, ensures the quality and safety of pharmacy services and sets standards for the safe and effective dispensing and administration of medications.
The General Medical Council (GMC):
The GMC works with doctors, patients and stakeholders to support good, safe patient care across the UK. They set the standards of patient care and professional behaviours that doctors need to meet.
National Institute for Health and Care Excellence (NICE):
NICE provides evidence-based guidance and recommendations to support healthcare professionals and organisations in delivering high-quality care. It produces clinical guidelines and quality standards related to medication management, prescribing practices and patient safety.
The Misuse of Drugs Act 1971 and the Misuse of Drugs Regulations 2001:
The Misuse of Drugs Act 1971 and the Misuse of Drugs Regulations 2001 are about the licensing and production as well as the possession and supply of substances classified as controlled drugs. Common prescribed drugs that are classed as controlled drugs include:
- Codeine – Class B (an opioid painkiller)
- Diamorphine – Class A (a strong opioid painkiller)
- Diazepam – Class C (a benzodiazepine used for anxiety, panic attacks, alcohol withdrawal, convulsions and muscle spasms)
- Methylphenidate – Class B (a stimulant used for ADHD)
- Morphine – Class A (a strong opioid painkiller)
These regulations consolidate UK law surrounding medicinal products.
The Human Medicines Regulations 2012:
Final Thoughts
Precision in medication administration is paramount. From doctors to pharmacists, healthcare professionals bear immense responsibility. The slightest error can have huge consequences.
Patient safety is crucial when it comes to medication administration as each dose can heal or harm. Education, training and adherence to regulatory frameworks are essential in ensuring quality care and upholding safety standards.