Nurses' Clinical Reasoning

Processes and Practices of Medication Safety

Nurses use clinical reasoning to detect errors with their patients’ medications.

Nurses are the first line of defense against medication errors, which may account for up to 7,000 hospital deaths per year. Lucian Leap, the patient safety advocate, found that nurses account for most instances when medication errors are prevented.

This Lead Article from Qualitative Health Research reports a grounded theory study, (prior to this research, there was little, if any, information available about how a hospital’s structure and processes cause fatal errors in patients’ medications), that asked how nurses are able to catch medication errors. The authors interviewed veteran nurses from hospitals in 10 mid-Atlantic states and asked about medication safety practices. In their answers to open-ended questions, nurses described the causes of medication errors; the responses also recounted how nurses intercepted errors before patients were harmed.

The authors used constant comparative data analysis to categorize interview responses. After first coding and highlighting interview transcripts, they systematically classified phrases that revealed nurses’ thoughts and actions upon perceiving medication error.

Key Findings:

  • Medical-surgical nurses identified six categories of practices that maintain the safe provision of medication: (1) educating patients; (2) taking everything into consideration; (3) advocating for patients with pharmacy; (4) coordinating care with physicians; (5) conducting independent medication reconciliation; and (6) verifying with colleagues.
  • Nurses work in an environment defined by four basic categories: (1) coping with interruptions; (2) interpreting physician orders; (3) documenting near misses; and (4) encouraging open communications.

By preventing medication errors, nurses can save lives and increase the efficiency of the health care system. Health care professionals must acknowledge the role of nurses in preventing medication errors.

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