¹mediMethode, Wadersloh, Germany

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Background: Due to the introduction of general nursing, the training of nursing professionals underwent fundamental changes in 2017 [1]. Since, from day one of learning in nursing schools the patient and his care setting are in focus. Basic subjects such as „medication in care“ are no longer taught. In outpatient facilities and geriatric care homes, specially trained nursing professionals, known as practice instructors, take over the practical part of the training using structured teaching situations.

Medication administration and medication management are among the tasks related to illness and therapy. Risk and error management is part of quality management. The handling of medication is part of the nursing process planning and is therefore a reserved task that may only be controlled by nursing professionals [2].

Practice instructors have to take part in 24-hours continuing education programmes every year. There is an effective space to discuss the role of nursing professionals in the medication process. Possible sources of medication errors are identified for each step. Frequent errors occur during storage, documentation or provision. As part of the overall concept of “Medication in Nursing Process Planning”, two working aids for error analysis and error management are introduced [3].

Materials and Methods: Groups of about 12 practice instructors come together to perform error analyses and discuss error management during the workshops. The error analysis questionnaire asks about the type of error, whether the patient was harmed on a scale from A to I, evaluates which factors contributed to the event, and finally analyses whether and how a similar event can be avoided in future.

The second step focuses on error management and the implementation and transfer of solution ideas. Regular discussions during team meetings of particularly frequent or particularly dangerous errors are encouraged. The benefits for nursing staff, geriatric care homes and their operators are discussed in detail. The benefits for elderly people are described in the areas known to nursing staff: cognition and communication, mobility and agility, care, nutrition, urinary continence, pain, skin integrity, and oral health, as well as “safe handling of medication”.

Results: Dosing errors and dispensing errors occur repeatedly in various workshop groups. Dispensing errors are related, for example, to delivery shortages, where 5 mg tablets are delivered instead of 10 mg tablets. Then, the correct labeling by the pharmacy is overlooked or misunderstood and therefor incorrectly implemented by the nursing staff. An example for a dosing error is resulting from a transcription error from the hospital discharge report to the family doctor’s prescription. Instead of Haloperidol 2 mg, Haloperidol 20 mg was prescribed and administered for 2 weeks. A third example: a resident with a urinary tract infection did not receive the antibiotic medicines in time.

The participants are very willing to engage in error analysis and error management. However, achieving zero percent medication errors seems unrealistic at present. Too many similar errors occur repeatedly. The topic of medication is not required by law in education, training, or continuing education. Training with medication is provided once a year in inpatient settings by the supplying pharmacists. Given the complexity of the topic, this is far too infrequent. A nursing-based plausibility check of the dosage is only possible with years of practical experience. The CIRS-NRW reporting platform for medical errors is virtually unknown in geriatric care.

Conclusion: Practice instructors are sensitised to recognise medication errors during workshops. In structured teaching situations, they analyse them with nurses in training. Possible solutions are implemented during team meetings. The aim is to prevent medication errors in advance or to identify them as early as possible and resolve them in an interdisciplinary team. Practical instructors play a key role in the facilities: as experienced nursing professionals with a special understanding of complex issues, they are very well suited to act as multipliers within the team. Many providers are improve the quality of their practical training. Hence, sufficient time to carry out the training is often available.

Literatur

[1] Bundesministerium der Justiz. Gesetz über die Pflegeberufe (Pflegeberufegesetz – PflBG). Available from: https://www.gesetze-im-internet.de/pflbg/BJNR258110017.html
[2] Hagedorn M. Sicherer Umgang mit Medikamenten. Das kompakte Know-how für Pflegefachkräfte in der Altenpflege. Hannover: Schlütersche Fachmedien GmbH; 2024.
[3] Kantelhardt P, Picksak G. Fehlermanagement in der Apotheke – Medikationsfehler erkennen und vermeiden. Deutscher Apotheker Verlag: Stuttgart; 2017.