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Medication errors are a significant issue affecting patient safety and costs
in hospitals often posing dangerous consequences for patients. It is important to
understand that an analysis of medication errors can help healthcare professionals
and managers identify why medication errors occur and provide insight into how
to make improvements to prevent or reduce them.There are several types of medication
errors such as wrong dosage, wrong patient, wrong route, wrong time, or
wrong medication.The causes are also varied such as inexperienced or insufficient
staff, or perhaps procedure or protocol not being followed.This study explored the
relationship between the number of medication errors and level of education and
the relationship between the number of medication errors and years of nursing
experience. In researching the relationship between these possible contributing
factors and medication errors, the safety of patients could be greatly enhanced and
costs of healthcare can be reduced.
Medication errors are a significant issue affecting patient safety in
United States hospitals and pose dangerous consequences for patients. Every step
in patient care for a nursing professional involves a potential for error and some
degree of risk to patient safety. However, this is especially true in regards to
medication errors. A proper understanding of the contributing factors that
increase medication errors is the first step toward preventing them.There are
many factors, such as training deficiencies, undue time pressure, and nursing
shortages that may have contribute to medication errors.The amount of nursing
education and the years of nursing experience are two factors that may have a
relationship to medication errors. Due to the fact that nursing staff is a large
cost to hospitals, these organizations are constantly trying to manage expenses.
This is supported by Yang (2003) who states “nursing professionals typically represent
the largest employee group in hospitals, and have become a primary target
for redesign measures”. Consequently, medication errors are costly and seem to
be proportional to the staffing of nurses. Since nurses make up such a large portion
of the staff population, it is important to understand the factors behind
these medication errors.With a better understanding of the relationship between
education level and medication errors, along with years of nursing experience, it
is believed that healthcare will improve and become more efficient.
Medication Errors In Relation To Education & Medication
Errors In Relation To Years of Nursing Experience
CHRIS G. BAILEY, BRYAN S. ENGEL, JILLIAN N. LUESCHER, MAEGAN L.TAYLOR
This paper was written for Dr. Maranah Sauter’s Nursing Resarch course.
These issues of medication errors were present even at the time when
Benjamin Franklin founded America’s first hospital and he stated that patients
ultimately suffer and die without good nursing care (Clarke, 2003).The framework
for this study is the belief that relationship that less education and less
experience lead to increased medication errors.This is supported by the evidence
that there is a rise in medication errors resulting in deaths (Stetina,
Groves, & Pafford, 2005). Based upon this, it is important to evaluate nurses’
medication errors including why they make them, how they are made, and what
preventive measures can be taken to decrease the risk of making additional mistakes.
There is a limited amount of published research correlating nursing experience
and/or education with the number of medication administration errors.
Although there are many layers involved in medication administration,
it is the nurse now who is generally held accountable for medication errors. Jill
Gladstone reports “advancements in medical science have led to the increase in
both the numbers and potency of medications that are prescribed” (Gladstone,
1995, p. 628). Gladstone (1995) did a study over a twelve month period in
England, which looked at self administered questionnaires about medication
errors and incident reports. The sample size was a total of seventy-nine. The
study showed that over half the medication errors were dosage related and
involved intravenous medications.
Pamela Stetina, Michael Groves, and Leslie Pafford(2005) stated “medications
errors accounted for 7,931 deaths in 1993, compared to 2,876 deaths in
1983” (p. 174). In this particular study the researchers wanted to obtain a better
understanding of how nursing experience related to medication errors. In order
to acquire a better understanding, researchers used the Heideggerian phenomenological
method to discover how nurses’ handled medication errors.The
researchers interviewed twelve nurses in Texas.The data revealed three key concepts.
These included medication errors involving violation of the “five rights”,
context of medication administration, and dependence on medication administration
systems such as medication administration report sheets and computers.
The “five rights” of medication safety refer to the right patient, right drug, right
dose, right time and right route.The data from this study showed that “nurses
viewed the system as infallible and a relief from the duty of systematic checking
against error” (Stetina, 2005, p. 177). It is important to understand that an
analysis of medication errors can help healthcare professionals and managers to
identify why medication errors can occur and make improvements to prevent or
BAILEY, ENGEL, LUESCHER,TAYLOR
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Table 1:Types of Medication Errors
(From: “Legal Issues in Critical Care,” by R. M. Kleinpell, 2001, Nursing Spectrum, 2, 39).
The purpose of this study was to determine the relationship between
level of education and medication errors and years of work experience and medication
errors.With a better understanding of these relationships, nursing professionals
can learn what characteristics tend to make a nurse prone to medication
errors and can develop methods and procedures to reduce incidence.
The researchers in this study were nursing students who had obtained
approval from the hospital where the study was to be conducted and the
College’s Institutional Review Board where they were enrolled to execute a
study on factors that might affect the number of medication errors.The data for
this study was collected through anonymous self reported surveys distributed to
nursing staff members throughout the selected hospital.The surveys consisted of
six questions that were a combination of short answer and multiple choice. On
Types Contributing Factors Causes
extra dose distractions performance deficit
improper dose/quantity workload increase procedure/protocal not
omission error inexperienced staff knowledge deficit
prescribing error shift change inaccurate or lack of
unauthorized drug agency /temporary staff confusing communication
wrong administration no 24 hour pharmacy inaccurate or omitted
technique insufficient staffing computer entry
wrong dosage form emergency situation drug distribution system
wrong drug prepartaion cross coverage inadequate system
wrong patient code situation illegible or unclear handwriting
wrong route no access to patient
wrong time information
BAILEY, ENGEL, LUESCHER,TAYLOR
the front side of each survey was an informed consent sheet explaining the study
and policies related to it.The surveys were placed on each floor of the hospital in
the nurses’ stations in a labeled manila envelope with instructions concerning
participation in the study. Additionally, there was another envelop for the subjects
to place the completed surveys.The researchers collected the completed
surveys on the Friday of each week for a two week period. Upon completion of
the two week period, all the surveys were compiled and analyzed. Microsoft
Excel was used in calculations and presentation of the results.The statistics were
added and averaged per nurse per level of education and also added and averaged
per nurse per years of experience. All original surveys were shredded.
The subjects of this study were Bachelor of Science in Nursing
Registered Nurses, Associate Degree Registered Nurses, and Licensed Practical
Nurses from a rural hospital in west Georgia.The convenience sample was
obtained through distribution of surveys to nurses on each floor of the selected
hospital. Participation was voluntary and surveys were completely anonymous.
The study consisted of 47 completed surveys, two of which were discarded due
to lack of inclusion criteria (see figure 1). Of the 45 remaining surveys, 23 were
from Registered Nurses with Associate Degrees in nursing.This group comprised
51% percent of the returned surveys.The second group in this study was fifteen
nurses who had completed a Bachelor of Science degree in nursing.This group
comprised 33% of the returned surveys.The third group that participated was
made up of seven Licensed Practical Nurses who comprised 16% of surveys
This study used a quantitative non-experimental correlation design to
examine the relationship between medication errors and level of education in
addition to the relationship between medication errors and years of nursing
experience.A survey consisting of six questions regarding medication administration
experience was used for data collection. Microsoft Excel was used in calculations
and presentation of the results.
The results of the study suggested that there is a direct relationship
between education and medication errors, rather than an inverse relationship,
wherein as education increased number of errors decreased.The study showed
that Licensed Practical Nurses (LPN) made the least number of medications
errors followed by Registered Nurses with Associate Degrees, with BSN
Registered Nurses having the highest incidence of medication errors.The LPNs
in this study had made an average of 1.1 medication errors within the last twelve
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months (see Figure 2).The RNs in this study had made an average of 1.4 medication
errors within the last twelve months.The BSN RNs who participated in this
study had made an average of 2.3 medication errors within the last twelve
months.The results indicate that as the education level increased so did the number
of medication errors.The study showed that nurses made the most medication
errors either in their first five years of nursing experience or after twenty
years of nursing (see Figure 3).The results showed that nurses within the first
five years of work experience had an average of 2.2 errors within the last twelve
months. The nurses with more than 20 years of nursing experience made an
average of 2 errors per nurse within the last twelve months.The three other
work experience groups with 6-20 years of experience, varied within .5 errors
of each other.This study also indicated that giving medication at the wrong time
was the most common type of medication error made by the participants (see
Figure 4).The shift that reported having the most medication errors was 7am-
7pm, when most medications are administered (see Figure 5). The most common
route for medications errors was PO or “by mouth” (see Figure 6).
Due to the limited size of the sample population and the fact that the
scope was limited to one hospital, the results of this study cannot be generalized.
However, the results do provide insight into the probable impact of education
and experience on medication error rates.The study suggests there is a relationship
between the number of medication errors and nurses with varying education
levels.The study indicates that a BSN RN generally makes the most errors,
which could be useful information in structuring future BSN programs to
increase clinical focus in the preparation of their students. This study indicates
little difference between the number or medication errors and work experience.
Since nurses make up such a large portion of the hospital staff population,
it is important to understand this relationship and possible contributing factors
leading to medication errors.With a better understanding of the relationship
between education level and medications errors, along with years of nursing
experience and medications errors, it is believed that healthcare will improve
and costs would be decreased. The scarcity of published literature on this particular
topic supports the need for further research.
Clarke, S. (2003). Balancing staffing and safety. Nursing Management, 34, 44-48.
Gladstone, J. (1995). Drug administration errors: a study into the factors underlying
the occurrences and reporting of drug errors in a district general
hospital. Journal of Advanced Nursing, 22, 628-637.
Kleinpell, R.M. (2001), Legal issues in critical care. Nursing Spectrum, 2. p.39.
Stetina, P., Groves, M. Pafford, L.,(June 2005). Managing medication errors- a
qualitative study. MedSURG Nursing Journal, 14(3), 174-178.
Yang, K. (2003). Relationships between nurse staffing and patient outcomes.
Journal of Nursing Research, 11, 149- 157
(Figure 1) Number of Responses as a Function of Years of Experience
(Figure 2) Number of Medication Errors as a Function of Nursing Level of Education
BAILEY, ENGEL, LUESCHER,TAYLOR
(Figure 3) Number of Medication Errors as a Function of Years of Nursing Experience
(Figure 4) Number of Medication Errors as a Function of Error Types
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(Figure 5) Number of Medication Errors as a Function of Working Shift
(Figure 6) Number of Medication Errors as a Function of Medication Route
BAILEY, ENGEL, LUESCHER,TAYLOR
Compare the measurements in the study with the standard normal distribution, what does this tell you about the data?