Better Environments for Nurses Mean Fewer Medication Errors

Interdisciplinary Study Affirms Vital Role of Nurses in Ensuring Patient Safety; Focuses on Work Environment Factors That Improve Health and Fiscal Outcomes

    • August 28, 2012

Medication errors can compound a medical crisis, sometimes with tragic results. On average, a U.S. hospital patient is subjected to at least one medication error per day, and medication errors contribute to more than 7,000 inpatient deaths per year in the United States. This ever-present threat to patient safety can originate at the prescribing, transcribing, dispensing or administration stage, but it’s registered nurses (RNs) who are most likely to identify and intercept inpatient medication errors before they reach the patient.

Yet, despite studies illuminating the critical role of nurses in the interception of medication errors, little is known regarding organizational factors that facilitate nurses’ efforts in performing this vital safety function. A substantial body of research indicates that characteristics of the nursing practice environment are an important organizational determinant of quality nursing care and patient outcomes, but there has been little research investigating the impact of the practice environment on nurses’ error interception practices.

In response, a recent study funded by the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative (INQRI) has taken a closer look at acute care hospitals to determine the relationships among characteristics of the nursing practice environment, nurse staffing levels, nurses’ error interception practices, and rates of nonintercepted medication errors. The study, “Nurses’ Practice Environments, Error Interception Practices, and Inpatient Medication Errors,” is published in the June issue of the Journal of Nursing Scholarship.

The study finds that nurses’ error interception practices­—including independent comparisons between the medication administration record and patient record at the beginning of a nurse’s shift; determining the rationale for each ordered medication; requesting that physicians rewrite orders when improper abbreviations are used; and ensuring that patients and families are knowledgeable regarding the medication regimen so that they can question unexplained variances—are associated with lower rates of nonintercepted medication errors, further quantifying the important role of nurses in enhancing patient safety.

The findings also add to a growing body of evidence indicating that a supportive practice environment—reflected in factors such as teamwork between physicians and nurses; nurses’ opportunities to participate in hospital- and unit-level decisions; continuity of patient care assignments; continuing education opportunities; and the retention of nurse administrators who are visible and accessible, who listen to nurses’ concerns, and who have high expectations of their nurses—is associated with a higher quality of nursing care.

The research team behind the study consists of Linda Flynn, PhD, RN, FAAN, professor and associate dean, Rutgers University, College of Nursing, Newark, N.J.; Yulan Liang, PhD, University of Maryland, School of Nursing, Baltimore; Geri L. Dickson, PhD, RN, consultant, New Jersey Collaborating Center for Nursing, Rutgers University, College of Nursing, Newark, N.J.; Minge Xie, PhD, professor and director, Rutgers University, Office of Statistical Consulting, New Brunswick, N.J.; and Dong-Churl Suh, PhD, professor, Chung-Ang University, College of Pharmacy, Seoul, South Korea.

“Nursing practices that identify and intercept medication errors not only benefit patients, they benefit a hospital’s bottom line,” said Flynn, one of the study’s principal investigators. “Health care administrators should carefully consider available strategies to ensure supportive work environments for nurses.”

Researchers found that nurses’ interception practices have a significant effect on the rate of medication errors. More frequent engagement by nurses in interception practices was associated with fewer documented medication errors per 1,000 patient days; for example, for 100 units of interception practice for 1,000 patient days, medication errors decreased by an average of 19.

The decrease not only enhances patient safety but has fiscal implications, as well. The study points out that medication errors are costly, frequently resulting in longer lengths of stay and an estimated $4 million per hospital in additional annual patient care costs.

The study was conducted in a sample of 82 medical-surgical units recruited from 14 U.S. acute care hospitals in New Jersey. RNs on the 82 units were surveyed, producing a sample of 686 staff nurses. Data collected for the eight-month study period included the number of medication errors per 1,000 patient days and the number of RN hours per patient day. Nurse survey data included the Practice Environment Scale of the Nursing Work Index as a measure of environmental characteristics, and a metric of nurses’ interception practices was developed for the study.

The Interdisciplinary Nursing Quality Research Initiative is funded by the Robert Wood Johnson Foundation. To learn more, visit www.inqri.org and follow @INQRIProgram on Twitter.

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About the Robert Wood Johnson Foundation 

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation’s largest philanthropy devoted exclusively to health and health care, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, measurable, and timely change. For 40 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime. Follow the Foundation on Twitter (www.rwjf.org/twitter) or Facebook (www.rwjf.org/facebook).