Introduction Improving the quality of care and patient safety is the top priority of every hospital. Strategies and interventions are implemented often to improve quality and safety in the hospital settings. One approach is clinical risk management, it evaluates system failures and identifies what places patients at risk of harm and takes action to prevent or control such. Evaluating the processes in place allow for improvement continuance. Unfortunately, healthcare facilities still struggle to prevent errors. Clinical risk associated with adverse events include, falls, surgical events, medication errors, near misses, and diagnostic errors.
Many of this events can be attributed to system failures. One particular issue and is often ignored is nursing staffing. Adequate nurse to patient ratio can be a solution to decrease adverse events. Recent studies show that short staffing can lead to potential errors. A study commissioned by Kronos, “Nursing Staffing Strategy,” found that 69 percent of healthcare professionals surveyed said that fatigue had caused them to feel concern over their ability to perform during work hours. Additionally, nearly 65 percent of participants reported they had almost made an error at work resulting from fatigue (Bird, 2013).
Problem Statement There is an increases concern that inadequate nursing to patient ratio can jeopardize safety. This can be both to the nurse and the patient. A relationship between medication errors can be attributed to lack of adequate nursing staffing. Literature Review New research estimates up to 440,000 Americans are dying annually from preventable hospital errors (“Hospital Errors,” 2013, para. 1). Medical errors can be of different nature in this EFFECTS OF NURSING STAFFING AND MEDICATION ERRORS 4 particular study the focus would be medication errors.
Many strategies to prevent medication errors have been implemented. Medication barcoding, smart pumps, and computerized physicians ordering entry systems are among these. However, medication errors are still and issue today. The final barrier to preventing a medication error falls on the nurses’ hands. Medication errors can be attributed to different failures in the system. Particularly this problem can be attributed to nursing staffing issues. Not enough nurses are available to meet the needs of the patients. Understaffing causes nurses to take shortcuts, loose focus and skip steps.
Nurses are often forced to deviate from standard of practice to provide care, causing and increase risk for errors. Medication errors are the most common medical errors and can result in adverse events. The correlation between nurse to patient ratio and medication errors has been studied in the past. In one study conducted in Qazvin Medical University teaching hospital, 150 nurses were asked which contributing factors led to medication errors. One findings showed that heavy workloads were a factor that lead to medication errors.
It “Showed in their study that the shortage in nursing work force and consequently high workload and overtime working of nurses are common reasons for making errors” (Shahrokhi, Ebrahimpour, & Ghodousi, 2013, para. 10). As nurses are overworked their level of exhaustion increases. Burnout also occurs and when nurses practice under these conditions there is an increase risk to making medication errors. In a study comparing performance of nurses in a 12-hour shift showed that “fatigue and sleep deprivation are linked to decreases in vigilance, memory, information processing, reaction time, and decision making (Anderson & Townsend, 2010, p. 5). This can all hinder the nurses’ performance at the time of medication administration. Any small distraction or deviation from regular practice extremely increases the chances of making a medication error.
There is a need to find the EFFECTS OF NURSING STAFFING AND MEDICATION ERRORS 5 correlation between nursing staffing numbers and its connection with medication errors. Findings will help hospitals and top management understand that extra load of work to nurses hinders their ability to provide safe and effective care. “Higher staffing at all levels of nursing was associated with a 2- to 25-percent reduction in adverse outcomes, epending on the outcome” (Staton, 2004, p. 3). Criteria and Study Setting In order to participants in this study, hospitals must be located in South Florida. Hospitals willing to participate will give informed consent to participate. Data will need to be acquired from payroll records and medication record errors from medical-surgical units for the past three years. Access to this records should be facilitated to researchers at all times. Hospitals who agree to participate must use Pyxis and barcoding for medication administration. Research Design
A non-experimental approach will be taken in this study. Nonexperimental research is descriptive because there is no manipulation or control of variables, and the researcher can describe the phenomenon only as it exists (Nieswiadomy, 2011, Chapter 9). A retrospective correlational design which involves the review of medication error records from the past three years will be used to gather information. Four different hospitals will be chosen for the study, and will only include medical surgical units. Also a retrospective study of payroll records for the past three years will also be evaluated.
This will allow for gathering of information in regards to number of nurses working on a particular shift and correlated with those days where medication mistakes were found. EFFECTS OF NURSING STAFFING AND MEDICATION ERRORS 6 Population and Sampling Plan Four different hospitals will be chosen for the study, out of these hospitals only the medical surgical units will be accounted for. Medication errors committed only by nurses will be evaluated. Risk management departments and hospitals must agree to participate and allow for the revision of records containing this information.
Records on medication errors cannot be older than three years. Staffing will be evaluated during the day’s errors were committed by using payroll records. Data collection and Procedure Plan Using a retrospective approach medication error records would be reviewed, the errors will be divided in categories based on kind and in what part of the process they occurred. During administration, documentation, transcribing, dispensing or while monitoring. The nurse to patient ratio during the time the error occurred will be evaluated.
How many nurses where present, how many patients where present and the nurse to patient ratio. Independent and Dependent Variables In this particular study the researcher will use independent and dependent variables. This study takes on a nonexperimental approach and thus the independent variable will not be manipulated. The independent variable in this study would be the nurse to patient ratio. The dependent variables would be that, which is under investigation in these case the medication errors. Data Analysis Hospital data records were the major sources of data for this study.
The analysis of the records pertaining to medication errors will give enough data to conclude if medication errors can be attributed to nurse patient ratio. The data would be summarized using tables, medication EFFECTS OF NURSING STAFFING AND MEDICATION ERRORS 7 errors would be categorized per phase in the medication administration process using percentages. The staffing for those particular nights will be explored and correlated with the errors committed. A table will also be included to reveal how many nurses were staffed and how many patients they were assigned during the particular shift when the error was made.
The relationship between staffing and errors will be concluded by evaluating the statistical results. Findings After data collection and analysis has concluded. The effects of the staffing will be assessed and a relationship between medication errors and nurse to patient ratio will be concluded. The results from the number of medication errors committed and the nurse to patient ratio during the time of error will show the correlation of these two variables. The possibility of the finding includes a relationship between short staffing and medication errors.
The alternative would be that there is no correlation between the variables. Enough data should be sufficient to demonstrate that when nurses are forced to take on extra work of load safety is jeopardized. Discussion This study is set out to evaluate the relationship of nurse to patient ratios and medication errors. Adequate staffing is necessary so that quality care is delivered and most importantly to keep nurses and patients safe. This study will serve to demonstrate to hospitals and quality improvement initiatives that the nurse to patient ratio is imperative in avoiding medication errors.
Administering medication takes a vast amount of knowledge and requires extensive concentration. Any small interruption during any phase of the medication administration process can jeopardize the safety of nurses and patients. When nurses are forced to take on extra load of work they are forced to take short cuts and often time ignore protocols to get the work done. This EFFECTS OF NURSING STAFFING AND MEDICATION ERRORS 8 study will provide evidence that as nurses staffing decreases medication errors increase and vice versa. Conclusion
In an effort to help reduce medication errors, hospitals have adopted many strategies, including physician order entry systems, bar coding and medication dispensing systems such as Pyxis. This are great strategies and have proved to reduce mistakes, however medication errors are still on the rise. It is evident that technology has helped this issue but it is also necessary to invest in enough staff, needless to say human capital. Nurses are the last barrier in preventing medication errors. Mental exhaustion, burnout, tiredness, and extra workload can have detrimental effects on the nurses’ ability to perform.
Approximately 39% of medication errors occur during the ordering process; 12% occur during the order verification process; 11% occur during the preparation and dispensing process; and 38% occur at administration” (Patient Safety Facts, p. 1). It is imperative for hospitals to understand the correlation between medication errors and nursing staffing. As the Institute of Medicine stated in their famous article “To Err is Human, at least 44,000 people, and perhaps as many as 98,000 people, die in hospitals each year as a result of medical errors that could have been prevented (“To Err is Human,” 1999, p. 1).
