What Causes Medication Administration Errors in a Mental Health Hospital?

Patients with mental health issues are a large group of patients who deserve special attention and attitude from the medical staff. Since the beginning of the XXI century, people with mental health problems are seeing doctors more and more often. They rely on medical workers to get the right diagnoses and receive effective treatment. This paper aims to summarize two qualitative research studies on mental health nursing practices, explain how these findings might be applied, and address ethical issues associated with the conduct of the studies.

Just like all humans, nurses quite often make mistakes while treating patients with mental health issues. Scientists conducted a study to analyze the causes of medication administration errors (MAE) in the mental health National Health Service (NHS) hospital in the North West of England (Keers et al., 2018). The study was based on data collected from 20 nurses working in a hospital, who shared their experiences of making MAE in the interviews.

These were interns and nurses with experience less than one year, 1-5 years’ experience and more than five years’ experience, and they all made mistakes. The 26 described incidents of MAE were of the following character:

  • “wrong drug”,
  • “wrong dose”,
  • “wrong patient”,
  • “extra dose”,
  • “omitted dose”,
  • “wrong time”,
  • “wrong formulation”,
  • “wrong preparation”,
  • “wrong documentation”,
  • “unordered drug” (Keers et al., 2018, p. 7).

To establish the causes of errors, scientists analyzed the error and violation-provoking conditions. These included working environment factors, individual nurse factors, wider organizational context, health care team factors, medicines administration task factors, and patient factors (Keers et al., 2018). Scientists also presented a comprehensive discussion and made recommendations for improving the situation.

Another disturbing trend in mental health nursing practices attracted the attention of Australian scientists. Beks, Healey, and Schlicht (2018) conducted a study to examine the working conditions of generalist nurses working in rural EDs (Emergency Departments) and UCCs (Urgent Care Centers). They discovered a mismatch between the number of patients with mental health problems and the number of mental health care providers in Australian urban and rural areas. Even though more medical practitioners provide care in large cities, a higher number of patients with mental health issues live in rural areas (Beks et al., 2018). Therefore, generalist nurses work with these patients, providing them telephone assistance.

The study was based on semi-structured interviews with 13 generalist nurses working in one rural ED and two rural UCCs located in south-west Victoria. It was concluded that “generalist nurses working in rural EDs and UCCs encounter multiple challenges in providing care to mental health consumers” (Beks et al., 2018, p. 10). These challenges were linked to the “lack of skills and confidence,” “limited onsite support from community mental health teams,” and “reliance on telephone triage” (Beks et al., 2018, p. 10). After a detailed analysis of the nurses’ interviews, scientists recommended establishing closer cooperation between the generalist nurses and community mental health nursing practitioners, while also questioning the efficiency of telephone-only consultations.

The findings of the first study should be widely applied in nursing practices. Recommendations given by Keers et al. (2018) include advice on reducing MAE made by the medical staff in mental health and general hospitals. Scholars recommend focusing on the main MAE provoking conditions, namely “low staffing, inadequate skill mix, challenging ward environments (including patient factors), interruptions and distractions, and communication problems” (Keers et al., 2018, p. 15). They also emphasize that a complex approach will be most beneficial since most often, MAE occurred under the simultaneous influence of conditions listed above.

Besides, scientists pointed out that conditions like low staffing, interruptions, high workload, and task management restrictions were common for both mental health and general hospitals across areas. Whereas “the impact of lone working and some patient-related needs and behaviors like specific demands, aggression or lack of engagement,” mainly characterized the mental health hospitals (Keers et al., 2018, p. 13). Scientists believe that the results of their research will be most beneficial for improving ward-based medication administration management (Keers et al., 2018). They also mentioned that interns and nurses with less than one year experience are the most vulnerable group who makes MAE. That is why this group may need support to provide health care services more confidently.

The findings regarding the work of the generalist nurses in rural areas could be widely applied in nursing practices as well. The lack of onsite inpatient facilities in rural areas is a highly relevant issue for many countries with state-funded medicine, as well as the issue of providing telephone-only medical care instead of personal consultations. Inadequate collaboration between nursing teams working in different departments and the difficulties associated with staff development are also widespread.

Severely problematic patients’ transportation to inpatient facilities reported by several generalist nurses is another issue clinicians are facing more and more frequently (Beks et al., 2018). Nursing practitioners who work in rural areas should familiarize themselves with the results of the study and discuss it with superiors and colleagues. It will surely help them to develop more effective ways of providing health care services.

As for the ethical issues associated with the conduct of the studies, they were observed in both studies. Beks et al. (2018) obtained ethics approval from Alfred Health and Deakin University. Scientists also indicate that “the familiarity with potential participants at one of the study sites was disclosed to the reviewing human research ethics committees” (Beks et al., 2018, p. 4). The study of Keers et al. (2018) was approved by the University of Manchester Research Ethics Committee and by the NHS research and development department. Scientists claim responsibility for the non-disclosure of information obtained from the interviews.

That is why the interviews were not published in full as the originality of some incidents could reveal the participants’ personalities (Keers et al., 2018). University of Manchester research team, the NHS representatives, and regulatory authorities are the only institutions that have access to the interviews. Participants also have access to their transcribed interviews privately or to cooperate with regulatory authorities.

Thus, two qualitative research studies on mental health nursing practices were summarized, and further application of its findings was described. One study aimed to discover the key factors that contributed to MAE in the English mental health hospital and was based on interviews with 20 nursing practitioners. The recommendations for the application of findings included focusing efforts on multi-purposed elimination of error provoking conditions.

Another study aimed to discuss the provision of mental health care services in Australian rural areas and was based on interviews with 13 nurses. Scientists questioned the effectiveness of providing mental health care services by telephone while also addressing the issue of poor communication between generalist nurses and community mental health teams. Ethical issues associated with the conduct of the studies were discussed as well.

References

Beks, H., Healey, C., & Schlicht, K. (2018). ‘When you’re it’: A qualitative study exploring the rural nurse experience of managing acute mental health presentations. Rural and Remote Health, 18(3), 1-11.

Keers, R. N., Placido, M., Bennett, K., Clayton, K., Brown, P., & Ashcroft, D. M. (2018). What causes medication administration errors in a mental health hospital? A qualitative study with nursing staff. PloS One, 13(10), 1-18.