NUR 2407 Cultural Factors and Their Influence on Medications

NUR 2407 Cultural Factors and Their Influence on Medications

NUR 2407 Cultural Factors and Their Influence on Medications

 

In this written assignment, select one cultural factor such as health beliefs, language, perception of time, environment control, etc. (see textbook reading) and apply it to a selected ethnic group. The paper will include the following:

One impact on medication preparation. Explain.

Two impacts on medication administration. Explain.

Two potential adverse reactions. Explain with rationale.

One possible issue in adherence to medication regimen. Explain how this can be overcome.

The paper should be no more than 3 pages. Use APA Editorial Format for all citations and references used.

NUR 2407 Cultural Factors and Their Influence on Medications
NUR 2407 Cultural Factors and Their Influence on Medications

The Institute of Medicine’s (IOM) first Quality Chasm report, To Err Is Human: Building a Safer Health System, stated that medication-related errors (a subset of medical error) were a significant cause of morbidity and mortality; they accounted “for one out of every 131 outpatient deaths, and one out of 854 inpatient deaths” (p. 27). Medication errors were estimated to account for more than 7,000 deaths annually. Building on this work and previous IOM reports, the IOM put forth a report in 2007 on medication safety, Preventing Medication Errors. This report emphasized the importance of severely reducing medication errors, improving communication with patients, continually monitoring for errors, providing clinicians with decision-support and information tools, and improving and standardizing medication labeling and drug-related information.

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With the growing reliance on medication therapy as the primary intervention for most illnesses, patients receiving medication interventions are exposed to potential harm as well as benefits. Benefits are effective management of the illness/disease, slowed progression of the disease, and improved patient outcomes with few if any errors. Harm from medications can arise from unintended consequences as well as medication error (wrong medication, wrong time, wrong dose, etc.). With inadequate nursing education about patient safety and quality, excessive workloads, staffing inadequacies, fatigue, illegible provider handwriting, flawed dispensing systems, and problems with the labeling of drugs, nurses are continually challenged to ensure that their patients receive the right medication at the right time. The purpose of this chapter is to review the research regarding medication safety in relation to nursing care. We will show that while we have an adequate and consistent knowledge base of medication error reporting and distribution across phases of the medication process, the knowledge base to inform interventions is very weak.

Defining Medication Errors

Shared definitions of several key terms are important to understanding this chapter. Drugs are defined as “a substance intended for use in the diagnosis, cure, mitigation, treatment or prevention of disease; a substance (other than food) intended to affect the structure or any function of the body; and a substance intended for use as a component of a medicine but not a device or a component, part or accessory of a device.” Medications include, but are not limited to, any product considered a drug by the Food and Drug Administration (FDA). Given the number and variety of definitions for medication errors, the IOM has recommended that international definitions be adopted for medication error, adverse drug events, and near misses.

Medication Errors

One commonly used definition for a medication error is:

Any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. Such events may be related to professional practice, health care products, procedures, and systems, including prescribing; order communication; product labeling, packaging, and nomenclature; compounding; dispensing; distribution; administration; education; monitoring; and use.

Some of the factors associated with medication errors include the following:

  • Medications with similar names or similar packaging
  • Medications that are not commonly used or prescribed
  • Commonly used medications to which many patients are allergic (e.g., antibiotics, opiates, and nonsteroidal anti-inflammatory drugs)
  • Medications that require testing to ensure proper (i.e., nontoxic) therapeutic levels are maintained (e.g., lithium, warfarin, theophylline, and digoxin)

Look-alike/sound-alike medication names can result in medication errors. Misreading medication names that look similar is a common mistake. These look-alike medication names may also sound alike and can lead to errors associated with verbal prescriptions. The Joint Commission publishes a list of look-alike/sound-alike drugs that are considered the most problematic medication names across settings. (This list is available at www.jointcommission.org/NR/rdonlyres/C92AAB3F-A9BD-431C-8628-11DD2D1D53CC/0/lasa.pdf.)

Medication errors occur in all settings and may or may not cause an adverse drug event (ADE). Medications with complex dosing regimens and those given in specialty areas (e.g., intensive care units, emergency departments, and diagnostic and interventional areas) are associated with increased risk of ADEs. Phillips and colleagues found that deaths (the most severe ADE) associated with medication errors involved central nervous system agents, antineoplastics, and cardiovascular drugs. Most of the common types of errors resulting in patient death involved the wrong dose (40.9 percent), the wrong drug (16 percent), and the wrong route of administration (9.5 percent). The causes of these deaths were categorized as oral and written miscommunication, name confusion (e.g., names that look or sound alike), similar or misleading container labeling, performance or knowledge deficits, and inappropriate packaging or device design.

Adverse Drug Events and Adverse Drug Reactions

Adverse drug events are defined as injuries that result from medication use, although the causality of this relationship may not be proven. Some ADEs are caused by preventable errors. ADEs that are not preventable are often the result of adverse drug reactions (ADRs), which are defined as “any response to a drug which is noxious and unintended and which occurs at doses normally used for prophylaxis, diagnosis or therapy of disease, or the modification of physiological function, given that this noxious response is not due to medication error.” Potential ADEs or near misses/close calls are medication errors that do not cause any harm to the patient because they are intercepted before they reach the patient or because the patient is able to physiologically absorb the error without any harm.

An adverse drug reaction is defined as “an undesirable response associated with use of a drug that either compromises therapeutic efficacy, enhances toxicity, or both.” ADRs can be manifested as diarrhea or constipation, rash, headache, or other nonspecific symptoms. One of the challenges presented by ADRs is that prescribers may attribute the adverse effects to the patient’s underlying condition and fail to recognize the patient’s age or number of medications as a contributing factor. According to Bates and colleagues, more attention needs to be directed to ADEs—including both ADRs and preventable ADEs—which range in severity from insignificant to fatal.

Black Box Warnings and High-Alert Medications

In 1995, the FDA established the black box warning (BBW) system to alert prescribers to drugs with increased risks for patients. These warnings are intended to be the strongest labeling requirement for drugs or drug products that can have serious adverse reactions or potential safety hazards, especially those that may result in death or serious injury. While the FDA does not issue a comprehensive list of drugs with BBWs, some of the BBW drugs are celecoxib (Celebrex), warfarin, rosiglitazone (Avandia), methylphenidate (Ritalin), estrogen-containing contraceptives, and most antidepressants. One study funded by the Agency for Healthcare Research and Quality found 40 percent of patients were taking a medication with a BBW and that many of those patients did not receive the recommended laboratory monitoring. The authors concluded that BBWs did not prevent the inappropriate use of high-risk medications.

Medication errors can be considered a sentinel event when they are associated with high-alert medications. According to the Institute for Safe Medication Practices (ISMP), “High-alert medications are those likely to cause significant harm when used in error.” The top five high-alert medications are “insulin, opiates and narcotics, injectable potassium chloride (or phosphate) concentrate, intravenous anticoagulants (heparin), and sodium chloride solutions above 0.9 percent” (p. 339). ISMP’s list of high-alert medications is available at: www.ismp.org/tools/highalertmedications.pdf.

The Prevalence and Impact of Medication Errors

In the Harvard Medical Practice Study, Leape and colleagues,  examined more than 30,000 hospital discharges selected at random from 51 hospitals in the State of New York in 1984. The researchers found that 3.7 percent of hospitalizations involved adverse events that prolonged hospital stay or were manifested as a new disability at the time of discharge. About one in four of these adverse events were judged to be attributable to negligence, and 58 percent were judged to be preventable.

It is difficult to reduce or eliminate medication errors when information on their prevalence is absent, inaccurate, or contradictory. Bates put forth the notion that for every medication error that harms a patient, there are 100, mostly undetected, errors that do not. Most medication errors cause no patient harm or remain undetected by the clinician.,  The low rate of detected errors makes assessing the effectiveness of strategies to prevent medication errors challenging.

Rates of medication errors vary, depending on the detection method used. For example, among hospitalized patients, studies have shown that errors may be occurring as frequently as one per patient per day.,  In pediatric intensive care unit (ICU) studies, reported medication error rates have ranged from 5.7 and 14.6 per 100 orders to as high as 26 per 100 orders.

The impact of medication errors on morbidity and mortality were assessed in a case-control analysis of ADEs in hospitalized patients during a 3-year period. The investigators found significant increases in (a) the cost of hospitalization from increased length of stay, ranging from $677 to $9,022; (b) patient mortality (odds ratio = 1.88 with a 95% confidence interval); and (c) postdischarge disability. The impact was less in male patients, younger patients, and patients with less severe illnesses and in certain diagnosis-related groups.

Without an infrastructure to capture and assess all medication errors and near misses, the real number is not known. These rates could be expected to be higher once patient safety organizations begin to collect nationwide errors and health care clinicians become more comfortable and skilled in recognizing and reporting all medication errors. The concern raised in To Err Is Human about the potential prevalence and impact of ADEs—2 out of every 100 hospitalized patients—was just the beginning of our understanding of the potential magnitude of the rates of medication errors. The concern continues, as is seen in the most recent IOM report, Preventing Medication Errors, which states that “a hospital patient is subject to at least one medication error per day, with considerable variation in error rates across facilities” (pp. 1–2). Yet, despite numerous research findings, we cannot estimate the actual rates because they vary by site, organization, and clinician; because not all medication errors are detected; and because not all detected errors are reported.

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