BACHELOR OF NURSING SCIENCE WITH HONORS

SEMESTER MAY/2023

NBHS1314

PHARMACOLOGY FOR NURSES

NO. MATRIKULASI : 920616075652001

NO. KAD PENGENALAN : 920616075652
NO. TELEFON : 011-39447113
E-MEL : rubini1605@oum.edu.my
PUSAT PEMBELAJARAN : SEBERANG JAYA LEARNING
CENTRE

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CONTENTS NO. PAGES

1.0 Introduction 3

2.0 Medication Safety 4

3.0 Strategies 5-7

4.0 Responsibilities 8 - 10

5.0 Conclusion 11

6.0 Reference 12 - 14

7.0 Online participation 15 - 16

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1.0 Introduction

Maintaining people's health and giving them the right care are top priorities for health
administrations around the world. Primary care services, which emphasize safety
and health planning, are becoming more and more integrated into people-centered
healthcare systems. The therapeutic services framework, which depends on
innovations, expert and institutional collaboration, and risk assessment is
unpredictably structured. To guarantee the highest level of patient health, risks and
harm must be assessed. Reducing avoidable harm or possible harm associated with
therapeutic services is emphasized by the World Health Organization. The use of
various technologies in health institutions, particularly in intensive care units, can
challenge professionals and managers to maintain quality care processes. The
management of these technologies and care processes becomes a priority in health
care units, particularly in the ICU, where central vascular access is common. To
ensure patient safety, good practices must be implemented by practitioners. Low
adherence to preventive measures for adverse events compromises the quality of
care, especially regarding medication administration. Drug safety is crucial in
healthcare, as it prevents adverse events and increases healthcare costs. The
nursing team plays a crucial role in reducing adverse events, as they work
uninterruptedly and represent the highest percentage of workers in health services. A
safe health care involves obtaining greater benefits with low risks, analysing
resources and social values, and evaluating care practices. Medication errors pose a
serious risk to patients' health, which is why patient safety is given high priority in
healthcare settings. These mistakes lead to morbidity, mortality, and unfavourable
economic outcomes. Medication errors are utilized in clinics to evaluate patients'
quiet health, and patient safety is a major concern for social insurance and human
services providers.

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2.0 Medication Safety

Medication errors are a significant issue in healthcare systems worldwide, causing

injury and avoidable harm. These errors occur at various stages of the medication
use process, influenced by weak systems, human factors, fatigue, poor
environmental conditions, or staff shortages. These errors can lead to severe harm,
disability, and even death. Despite the development of interventions to address
medication errors, their implementation is varied. A wide mobilization of stakeholders
is needed for sustained actions. Medication safety is crucial for providing appropriate
treatments and is considered a practice policy in medical settings. Various methods
and strategies have been introduced to improve medication safety, such as Look
Alike Sound Alike Medications, High Alert Medications, and Drug Allergy Cards.
Healthcare providers are responsible for prescribing safe and effective drugs for their
patients, not only by prescribing the correct medication but also being aware of
potential drug interactions and adverse events. This responsibility extends beyond
prescribing correct medication.

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3.0 Strategies

The most common cause of medication errors is nurses failing to compare name
bands to administration records, which is against guidelines. These actions should
not be allowed, as they can propagate in cultures that allow moral flexibility. Safe
medication practices require a prioritization of medication safety within an
organization and department. This involves implementing a comprehensive program
with a medication safety leader, key elements for safe practices, and a strategic plan.
Key supporting elements include a culture of safety based on just culture, supported
at all levels, an event-reporting system, an interdisciplinary medication safety team, a
continuous improvement philosophy, and strong designs to assess and reduce
errors. If not well developed, the organization should address them through the
planning process to ensure patient safety. A just culture values safety, encourages
reporting of safety risks without penalty, and holds staff, leadership, and the board of
trustees accountable through a transparent process. This process separates events
arising from flawed system design or inadvertent human error from behavioural
choices that compromise safety. A culture environment should also include a support
system for second victims, healthcare providers involved in adverse patient events,
medical errors, or patient-related injuries. Programs should be established to support
second victims and educate healthcare professionals about the second-victim effect.
A medication safety system is crucial for enhancing patient safety and preventing
harm. Errors and close calls should be reported and analysed using methods like
root cause analysis (RCA) to identify causes and develop preventative measures.
Other methods, such as trigger tools, chart review, technology data, and direct
observation, can complement error-reporting efforts. Commercially available
software systems can be used for online reporting and analysis of medication errors.
A multidisciplinary team is essential for addressing safety issues and proactively
assessing risk. A medication safety leader, preferably a pharmacist, should lead
efforts throughout the organization. A nurse position dedicated to medication safety
should be developed to ensure nurses are key safety leaders. The organization must
also evaluate and adopt technologies to reduce medication errors and prevent harm.

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A well-designed formulary system helps clinicians prescribe safe and cost-effective
agents for specific diseases. It limits the selection of medications and standardizes
content in medical places, pharmacy information systems, and infusion pump
settings. Formularies should enhance safe medication use, not just cost-saving
measures. Nurses should assess potential safety issues, use a standard checklist,
and consider strategies to prevent medication errors. Organizations should design
and implement strategies to reduce errors to prevent patient harm. High-risk
populations, processes, high-alert medications, and easily confused drug names are
areas to focus on. Risk-reduction strategies should prevent errors, make errors
visible, and mitigate harm if an error occurs. Successful strategies address the
underlying cause of error and impact multiple steps of the medication-use process.
Safety strategies in healthcare include using non-connected oral syringes, epidural
tubing without ports, smart infusion pumps, electronic prescribing systems, barcode
technology, evidence-based standard order sets, standardizing concentrations,
diluents, and container sizes, using commercially available products instead of
compounding, dispensed medications in the most ready-to-administer form, using
oral measuring devices in metric scale, performing independent double checks on
dosing, infusion pump programming, and concentrations, using auxiliary labels when
appropriate, and improving the readability of labels. These strategies aim to ensure
the safety and effectiveness of medication administration in the healthcare system.
Medications often confused due to similarities in name, dosage form, or packaging
should be proactively addressed. These medications can be identified by reviewing
local data on errors and the list of confused drug names published by ISMP.
Strategies for handling medications include differentiation, improved access to
information, reminders, limiting access or use, and redundancies. Strategies for
handling medications include using both brand and generic names, tall-man lettering,
colour, or font to differentiate, including the indication for use on orders, limiting
verbal orders, using read-back processes, implementing barcode technology and or
radio frequency identification (RFID), and avoiding abbreviating drug names if
possible. Product packaging is another source of look-alike drug errors. Strategies to
minimize the risk of error include making items look different by purchasing products
from different manufacturers, purchasing different-size containers, storing drugs in
separate areas, and using alerts on the product and in the storage area.

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Independent double checks are widely promoted in healthcare to identify potential
errors before they reach patients. However, misuse and improper execution can
jeopardize medication safety. Independent double checks should be selectively
applied to certain medications after careful consideration, requiring two people to
conduct them independently. Nurses should be familiar with which medications are
managed via a risk evaluation and mitigation strategy (REMS), a FDA-mandated
program that seeks to manage the safe use of a medication with known or potential
serious risks. The process of prescribing, transcribing, dispensing, and administering
medication involves a multi-disciplinary team of healthcare professionals, with nurses
being a primary contributor. They spend a minimum of 16% of their time preparing or
administering medication, and can administer 50 or more during a shift. Nurses are
at high risk of medication administration errors due to their high frequency and
demanding role. Despite attempts to reduce medication errors in paediatric settings,
sustainable solutions are not evident. Strategies should be comprehensive, review
organizational systems, and be inclusive of key individuals like nurses.
Understanding nurses' perceptions of medication administration errors is crucial for
developing effective prevention strategies. The right equipment and a calm, efficient
work environment are essential for reducing medication error in nurses. When taking
medication, distractions can cause mistakes and stress. Multitasking or high work
pressure can impair focus and safety. Signage, checklists, staff and patient
education, and conspicuous symbols such as red vests are some of the interventions
used to reduce distractions. In order to perform safe medication tasks, nurses should
also have reasonable workloads. A study by Jennings et al. (2011) explored nurses'
medication day strategies to minimize errors. Nurses prioritized intravenous
antibiotics first, then moved on to the next administration. Patients on crushed oral
medications were placed at the end of the round. They multitasked during MA, and
used individualized techniques for managing temporal load. The study found
interruptions to be a positive action, and the MA itself inherently entails interruption.
The '5 Rights', a fundamental aspect of nursing education, are often insufficient in
preventing medication errors (MEs), despite their widespread application in clinical
practice.

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4.0 Responsibilities

Medication safety leaders collaborate with healthcare professionals, support staff,

and management to improve medication safety in various healthcare settings. Their
role includes leadership, expertise, influencing practice change, research, and
education, considering all components of the medication-use process. The role
involves creating a vision for a safe medication-use system, leading the planning,
creation, review, and refinement of a medication safety plan, and implementing error
prevention strategies based on practice standards, best practices, literature review,
external error reports, and medication safety tools. Medication management and
patient safety are core components of overall organizational quality and outcomes
initiatives. Participation in planning, design, and implementation of medication-use
technology and automation systems is essential. A culture of safety is built through
"lesson learned" education and communication. Information on medication errors
and system failures is collected and barriers to reporting are addressed. Compliance
with regulatory and legal requirements is ensured, and a second victim/care-for-the-
caregiver program is supported. The role of a medication safety leader involves
providing authoritative information on medication safety, contributing to technology
initiatives, and assisting in emergency preparedness planning. They also serve as an
internal consultant, investigating safety events and developing recommendations.
The chair of the committee, they set agendas, review error reports, and examine
project progress. They are knowledgeable in quality-improvement methodologies
and tools, and collect and analyse data on medication use, errors, and adverse drug
reactions. They can predict and prepare for medication safety issues caused by
potential or actual shortages. They maintain knowledge of patient safety trends
through professional development, participating in local and national patient safety
organizations and initiatives, and seeking and sharing best practices with other
regional safety leaders and practice sites. The medication safety leader is
responsible for collaborating with various departments, hospital or health system
senior leadership, frontline staff, and nursing and medical staff to identify and
prioritize safety issues and develop risk-reduction strategies. They manage changes
in the medication-use system to enhance safety and ensure that hospital staff and
faculty are supported in providing safe care. They work closely with other

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departments to integrate medication safety into the overall patient safety plan and
coordinate initiatives with organizational patient safety initiatives. They participate in
multidisciplinary committees to identify risk points and prioritize system
improvements. They also advise clinical teams and the hospital on opportunities and
strategies to improve patient care. They encourage organization-wide medication
error reporting and develop effective methods for spreading best medication-use
practices. They also share information about medication errors with safety
organizations, conduct research, contribute to literature, and integrate medication
safety into orientation and training for all healthcare providers. RNs perform bedside
nursing care, and they must communicate with staff about patients' drug treatments
orally and in writing. They seek out staff on wards and hold meetings, and staff
members are required to read nurses' documentation. However, nurses perceive
gaps in communication, particularly in staff’s, which they perceive as a barrier to safe
medication monitoring. They also feel unlisten to when physicians make decisions
contradicting their suggestions about patients' drug treatments, or when physicians
act solely on nurses' opinions, which they find frightening. Nurses often assume
expanded responsibilities in medication management to prevent patients from
suffering or to ensure their formal competence. They express uncertainty about the
division of responsibilities between themselves and physicians, who are ultimately
accountable for patients' drug treatments. Nurses plan and prioritize physicians'
work, monitoring and evaluating treatments, and requesting specific medicines
based on assessments. They feel responsible for the actions of physicians, which
results in constant checking and reminding them of what must be done. However,
when several physicians are linked to the same long-term care settings, their sense
of responsibility decreases. Nurses feel they need control for their own sake, mainly
to prevent patients from suffering, which can result in exceeding their responsibilities
as nurses. They feel that they must take on a great responsibility, which they do not
have the authority to take, as it is the simplest solution for everyone involved. Nurses
play a crucial role in patient safety, providing quality care and preventing errors. They
spend a significant amount of time in the treatment process, making raising
awareness, education, and attitudes towards patients essential. Nursing education is
crucial for developing necessary thinking skills and competence. Higher education
programs foster critical thinking and knowledge, while experience helps nurses
analyse patient cases and make informed decisions. Continuing nursing education is
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essential for raising and deepening the qualification and knowledge of practicing
nurses. Although most nurses are graduates of professional education, continuing
education plays a vital role in the ever-evolving field of nursing. It ensures
competence, adaptability, and critical thinking skills. As demands on nurse’s
increase, it is essential for them to actively pursue ongoing professional
development. By understanding the benefits of continuing education, nurses can feel
more confident in their practice and improve their professional competence. The
study highlights the importance of following guidelines, responsibility, and a positive
attitude towards work in preventing medication errors. Nurses are highly responsible
for medication administration, but also play a crucial role in patient assessment.
Reporters acknowledge both physician and patient responsibility for safe medication
management.

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5.0 Conclusion

Health professionals should try to focus on the task at hand and administer
medication with a high moral awareness. However, in order to support the safe
administration of medication, the system should support health professionals by
offering a reasonable work environment and fostering collaboration among the
providers. Medication safety practices in clinical nursing involve nurses'
characteristics, skills, competencies, clinical processes, and environment. Each
practice contributes to the medication safety chain, with each having its own value.
These practices are practical, simple, effective, and contribute to the improvement of
safety culture and constructive learning outcomes for all clinical teams. They can be
implemented by frontline clinical nurses, nurse leadership, senior management, and
policy-makers. Senior nurses can strengthen team learning through staff meetings,
setting ground rules, and engaging staff in discussions. Further research studies are
needed to understand the nature of each practice, their relation to medication errors
(ME), their long-term impact, safety behaviours, best practices, well-designed tools,
and the role of education in medication safety.

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6.0 Reference

Alrabadi, N., Shawagfeh, S., Haddad, R., Mukattash, T. L., Abuhammad, S., Al-

Rabadi, D., Farha, R. A., AlRabadi, S., & Al‐Faouri, I. (2021). Medication

errors: a focus on nursing practice. Journal of Pharmaceutical Health

Services Research, 12(1), 78–86. https://doi.org/10.1093/jphsr/rmaa025

Billstein-Leber, M., Carrillo, J. D., Cassano, A. T., Moline, K., & Robertson,
J. J. (2018). ASHP Guidelines on Preventing Medication Errors in
Hospitals. American Journal of Health-System Pharmacy, 75(19),
1493–1517. https://doi.org/10.2146/ajhp170811

‌Alomari, A., Wilson, V., Solman, A., Bajorek, B., & Tinsley, P. (2017). Pediatric

Nurses’ Perceptions of medication safety and Medication error: A Mixed

Methods study. Comprehensive Child and Adolescent Nursing, 41(2), 94–110.

https://doi.org/10.1080/24694193.2017.1323977

American Hospital Association, Health Research & Education Trust, and the Institute
for Safe Medication Practices. Pathways for Medication Safety: Leading a
Strategic Planning Effort. 2002.
http://www.ismp.org/tools/PathwaySection1.pdf

Commentary on Drug safety: importance, issues and role in healthcare. (n.d.).

https://www.longdom.org/open-access/commentary-on-drug-safety-

importance-issues-and-role-in-healthcare.pdf

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Härkänen, R. M., Saano, S., & Vehviläinen-Julkunen, R. K. (2017). Using incident

reports to inform the prevention of medication administration errors. Journal of

Clinical Nursing, 26(21–22), 3486–3499. https://doi.org/10.1111/jocn.13713

Johansson-Pajala, R., Blomgren, K. J., Bastholm‐Rahmner, P., Fastbom, J., &

Martin, L. (2016). Nurses in municipal care of the elderly act as

pharmacovigilant intermediaries: a qualitative study of medication

management. Scandinavian Journal of Primary Health Care, 34(1), 37–45.

https://doi.org/10.3109/02813432.2015.1132891

Manana Machitidze, Medea Chitashvili, Maia Gogashvili and Nato Durglishvili.

Assessment of Nurses Education and Attitudes Toward Patient Safe

Medication Administration in Georgia. Am J Biomed Sci & Res. 2023 20(2)

AJBSR.MS.ID.002693,

Shepherd M. & Shepherd E. (2020) Medicines administration 1: understanding

routes of administration. Nursing Times [online] 116:42-44.

Athanasakis E. (2019) A meta‐synthesis of how registered nurses make sense of

their lived experiences of medication errors. J. Clin. Nurs. 28:3077-3095

Athanasakis, E. (2021). Medication Safety Practices in Clinical Nursing: Nurses’

Characteristics, Skills, Competencies, Clinical Processes, and

Environment. International Journal of Caring Sciences, 13, 3–2019.

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GUIDELINE ON MEDICATION SAFETY 2021 PHARMACY DEPARTMENT

HOSPITAL ENCHE’ BESAR HAJJAH KHALSOM, KLUANG MINISTRY OF

HEALTH MALAYSIA. (n.d.).

https://jknjohor.moh.gov.my/hebhk/file/sh/Guideline-Medication-Safety-

2021.pdf

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7.0 Online participation

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