Medication errors from shortfalls in staffing and technology

The impact of inappropriate staffing and lack of technology on patient care from the perspective of the National Institute of Cardiovascular Diseases

One nurse attending to four patients is what’s ideal in healthcare. Fewer than four is even better. But these are usually not the case in hospitals today, especially in a pandemic situation. The impact of this problem is larger than just human resource management.

Improper patient to nurse ratio prevents hospitals from providing optimal clinical and patient outcomes. At the National Institute of Cardiovascular Diseases (NICVD), this insufficiency in staffing is the main factor associated with medication errors.

Azra Masqood, COO, NICVD

The first tertiary cardiac care institute in South Asia and the flagship facility for cardiology in Pakistan, NICVD sees more than 2 million patients annually. An overwhelming number of patients would ideally require a sufficient number of nursing staff. With a patient to nurse ratio of 6:1, chances of medication errors happening under their watch become higher, says Azra Maqsood, Chief Operating Officer at NICVD.

Yet, NICVD’s plight is not an isolated case. Reports have shown how a lack of nurses can lead to inefficient patient care. Because nurses have to attend to a lot of patients, they are oftentimes in a hurry or distracted. Hence, a number of nurses have missed patient vital signs, made mistakes in delivering medications, and failed to provide psychological and social support to their patients.

COVID-19 magnified the issue even more. Each nurse in one hospital is assigned an exhausting workload from attending to seriously ill patients while staying vigilant with infection control measures. Confusions and overcrowding, therefore, mess with the staff’s fulfilment of duties.

Looking at the ideal scenario where appropriate nurse staffing is in place in a hospital, patient care is better. According to several studies, a proper nurse to patient ratio enhances patient satisfaction and reduces medication errors. When nurses aren’t fatigued, they stay on top of their game and are able to concentrate on their responsibilities as care providers.

Nonetheless, staffing is just one of several factors related to medication errors at NICVD. Masqood recognises how the lack of technological support can be resolved to prevent prescription, dispensing, and administration mistakes.

“NICVD is still young on technology,” she highlights, thus, the hospital still uses handwritten prescriptions, which are sometimes illegible and therefore subject to misinterpretation. Other hospitals are fortunate enough to have an electronic medical records system running, so prescriptions are transmitted in electronic format, thereby, reducing the chance of misinterpretations and mistakes. Realising this hurdle, NICVD has implemented a system wherein prescriptions are read out by the postgraduates, fellows, or residents in each shift.

NICVD is looking at developing its very own digital footprint toward this same cause. Providing medication to the wards on a daily rather than a weekly basis will be one lane in this path, and the other will be implementing “simple barcode reading provided on an in-patient bracelet to be able to provide the right medicine along with the right dosage,” shares Masqood.

While plans are still polished, the present demands a response whenever medication errors happen. AT NICVD, the response primarily concentrates on reviewing and counselling. First, the management needs to identify if it is an “innocent human error.” Is it because of an illegible prescription chart that nurses find difficult to comprehend? If so, the management does counselling for the involved personnel. The same goes if it is a case in the outpatient department and the medication error happened at the side of the pharmacy.

Blaming has no space at NICVD’s response, knowing how punishments and retributions would not solve the problem. At the same time, the problem has several layers under it, like improper staffing and inadequate technological support.

Rather, steps to prevent medication errors are put in place. These include providing standard operating procedures (SOPs) on drug administration to the patient care team, which consists of consultants, physicians, and nurses. Involved with the process are the pharmacy and therapeutic committee that conducts a review on the SOPs. Drug guides are also made available for each shift and a hotline is available for drug guidance in general wards.

Medication errors are preventable, but it won’t be easy if nurse to patient volume is inappropriate and if opportunities to digitise aren’t optimised towards this end.

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