CHAPTER 2
LITERATURE REVIEW
2.1 INTRODUCTION
Nowadays, healthcare providers encounter many challenges. In this globalised age, people are more educated and exposed to sources of health information and their rights. Therefore, this forces many healthcare providers especially nurses and junior doctors to be more knowledgeable and prepared. Besides that, many nurses and junior doctors are required to be more alert with their environment specifically with the deteriorating condition of their patients. In this chapter, the researcher will be discussed regarding deteriorating patients, risk assessment, track and trigger, and critical care outreach. In addition, healthcare personnel knowledge, attitude and practice in assessing and responses towards deteriorating patients and emergency pharmacotherapy also will be elaborate.
2.2 SEARCH STRATEGIES
The literature review was conducted as a systematic process beginning in September 2014 and completing in January 2016, allowing the identification of research published throughout the course of the study. Computer-based electronic searching was employed to access the library databases and search all online nursing and medical journals and books published between 1998 and 2016. 1998
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Ward-based clinical pharmacists prospectively documented prescribing errors at the point of clinically checking admission or discharge prescriptions. The rate of error was not significantly different between newly qualified doctors compared with junior, middle grade or senior doctors. High rate of error from medication omission, particularly among patients admitted acutely into hospital. Electronic prescribing systems could potentially have prevented up to a quarter of errors. This was a large study across nine diverse hospital settings. Did not evaluate the impact of electronic prescribing on the prevalence and type of prescribing
Deadlines are not met, a cynical or resentful attitude develops, a persistent sense of fatigue pervades both are the nurse’s personal and professional’s life. Today the proportion of acute patients entering the health care system through emergency
Preventable medical mistakes cause approximately 200,000 deaths around the United States each year. (1) More than 1,000,000 Americans are negatively impacted by medication errors each year caused by inadvertent mistakes in the prescription filling process. With 4 out of 5 adults taking at least 1 medication daily and 1 out of 4 adults taking 5 or more medications daily nationwide, errors like these cost healthcare industry billions of dollars per year. Health information technology were developed to transform healthcare services, the way they are provided and compensated. Electronic prescribing (e-prescribing) becomes an internal part of that transformation process, which can be confirmed from annual Surescripts’ National Progress Report.
There are many things that nurses can do to monitor errors that may occur by means of medication administration. According to Leufer and Cleary-Holdforth (2013), a “[…] crucial role of continuing education in fundamental areas of nursing practice, of which medication management is one” (p.214). A possible solution could be that, just like CPR certification, there could be a certification for nurses based on the six rights of medication administration. In this training, each nurse would learn the basics of med-admin and ways that they could minimize errors. By completing this certification, the nurse would then be able to administer medicine as safely as possible to each of the patients that they care for.
I recommend that outpatient practices that still remain paper-based to transition to electronic prescribing. According to the article, most prescribing errors occur in community-based outpatient settings. Community-based practices also have the lowest rates of e-prescribing use. If more outpatient practices adopt e-prescribing, the number of prescribing errors would dramatically be reduced. Although the effects of e-prescribing seem promising, this was one of the only few studies that have been done to prove its effectiveness in outpatient setting.
Compared to paper or fax prescriptions, e-prescribing improves medication safety, better management of medications costs, improved prescribing accuracy and efficiency, increase practice efficiency while improving health care quality and reducing health care costs through the reduction of adverse drug events and increased prescribing of generic medications. The implementation of an e-prescribing system can potentially reduce the time spent on pharmacy callbacks, faxing prescriptions to pharmacies, and automating the prescription renewal request and authorization process. This can reduce the cost of prescribing for both physicians and pharmacies, by saving time and resources, and increasing patient convenience. Some patients may not fill new prescriptions and/or substitute an over-the-counter medication in place of a
In 2007, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) acknowledged that reconciliation errors compromise the safety of drug use and recommended hospitals to develop a system for obtaining patients’ complete pharmacotherapeutic records, to ensure they receive the necessary drugs for the new
While not sure why this was happening as most medical offices and hospitals I decided that I would like to find the real reason why most our peers have chosen to skip this step or even better yet completely ignore it. After many hours of research I realized that the value of e-prescribing alerts is more of an issue than most would acquire. According to the study of merits of e-prescribing drug alerts in primary care one concludes that although primary care prescribers recognize the patient safety value of drug prescribing alerts, they indicate to override these drug-drug interactions at least 40 percent of the time. One request made by the participant of this study that I found very attention-grabbing was that the physicians would like to address the sensitivity of alerts and its unnecessariness. Our physicians would like to see these drug alerts run only on active medications and there be a threshold set by the prescriber on its severity, not the electronic health record
recognizes patient safety and adverse drug events negatively corresponded to inaccurate medication reconciliation processes (2016). An improvement effort was established in Boston with a sample of, “148 Brigham and Women’s Hospital ambulatory specialty practices” (Keogh et al., 2016, p. 186). Brigham and Women’s ambulatory specialty sample involving a 148 practices, 63 practices followed a thorough medication reconciliation process, 71 practices less restrictive revised moderate medication reconciliation process, and lastly 14 practices followed a minimal accountability with medication reconciliation (Keogh et al., 2016, p. 186). The three divisions within this study are defined in vague terms. Pointedly, a sample size of 148 specialty practices is a large respective quantity, however no definition to how many providers cover a specialty or patient to provider
Medication errors can be very dangerous for the ones taking the wrong medicines or doses; therefore, safety measures must be in place. Administering them must be done with an understanding and focus. One missed check could have a staff member giving a resident the wrong set of pills. Some interventions to help prevent the medication error from occurring is to first report errors. When errors are reported, the main cause is to try and never let the error occur again.
Fisher Week Three Response to McConnelly Yvonne, your post was extremely intriguing to me as a community health department is not an environment I have had the privilege of experiencing. Interestingly, the utilization of computerized order entry does not prevent the prescriber from ordering an incorrect medication dose or the wrong drug (Lapane, Waring, Dube’, & Schneider, 2011). Do the facility employ process to assure nurses are checking the medication in order to avoid the administration of an incorrect drug or dosage? Distractions have been linked to medication errors, consequently, and the ability to care for a solitary patient at one time clearly minimizes the distractions and interruptions that a nurse may experience during medication
In the same way, Kinley (2004, cited in Courtney, 2006) and supported by Nuttall and Rutt-Howard (2011) who acknowledged that it has been a big hindrance to agree CMP with GPs as an implementation of supplementary prescribing is requiring more time which is greater than the advantages of Supplementary prescribing. Furthermore, Courtney (2006) states that for successful implementation of supplementary prescribing, good interprofessional relationships and team working is necessary. In the author’s opinion that Supplementary Prescribing is not that expanded this can be either because of GP are reluctant or because many supplementary prescribers have chosen their role as a non medical prescriber to take the independent
This is important evidence because it gives us conditions and results of what can happen if patients get lower quality care. Patients’ are not having enough time getting checked up by a nurse, and nurses would miss some diagnostics. Patients are getting sick because of the poor care they are receiving from nurses. The care patients can get is affected by a nurse shortage, “Nursing workload definitely affects the time that a nurse can allot to various tasks. Under a heavy workload, nurses may not have sufficient time to perform tasks that can have a direct effect on patient safety.
Medication use is potentially dangerous. Polypharmacy is increasing, and makes it harder to keep track of side effects and interactions and of potentially inappropriate drug combinations. “The risk of serious consequences, hospitalization, and death due to medication errors increases with patients’ age and number of medications (Scand J Prim Health Care, 2012)”. For example, the GP is supposed to monitor the patient's regular medication, but does not always do so. Lack of monitoring and keeping track of patients’ medication use is a main cause when a patient is given inappropriate drugs.
Communication can be a big factor in medication errors. Miscommunication by the members of the healthcare team can lead to deadly consequences, so orders should be repeated back and verified (Anderson, 2010.) Sometimes
Health practitioners possess distinctive scope of practice standards based upon distinctive skills, education and qualification levels. RNs are accountable to assess patients’ health problems and needs, develop and implement nursing care plans, maintain medical records and supervise ENs and AINs practice. Excepting the ENs’ abilities to assist intervene and evaluate patients health and functional status and administer prescribed medicines or maintain intravenous fluid, ENs and AINs are both have responsibilities to observe patients health status and report changes to the RNs, maintain ongoing communication with RNs regarding the patients’ health and functional status, assist patients with ADL and emotional support, and understand health information technology. Successive healthcare treatment is always associated with collaborated teamwork.