JOURNAL THEME

Improving Safety on High-Alert

Medication

For an efficient healthcare system, ensuring patient safety during healthcare is essential.
Medication errors are preventable. Building safeguards and recognizing errors in healthcare
practices are the solutions to providing safe and efficient health services.
“Stay alert, be alert,
give meds without
hurt.”
Introduction

In a world where advancements in medicine are constant, ensuring the safety of high-
alert medications stands as a paramount concern for healthcare professionals. Imagine that
every year, thousands of lives are at stake due to preventable medication errors. As we
navigate the intricate landscape of healthcare, it is imperative to understand the multifaceted
nature of high-alert medications and their potential repercussions. From potent chemotherapy
drugs to high-dose opioids, the inherent risks demand a meticulous approach to
administration. The World Health Organization (WHO), in its global patient safety initiative,
emphasizes the need for robust systems that minimize medication errors and enhance patient
well-being (WHO, 2017).

This exploration into the realm of high-alert medications will unravel the complexities
surrounding their administration, examining existing protocols, shedding light on empirical
studies, and proposing strategies to fortify safety measures. As we embark on this journey,
the overarching goal is clear: to transform the landscape of healthcare, making it a safer
haven for patients in need.
Journal 1
Summary

The study titled "Effect of an Educational Program for Nurses about High Alert Medications
on their Competence" addresses the critical issue of patient safety concerning high-alert
medications (HAMs) in the medical profession, particularly in emergency and critical care
settings. The significance of the study is underscored by the substantial morbidity and
mortality associated with adverse effects of HAMs, contributing to a significant proportion of
deaths from medication errors. The study recognizes that nurses play a pivotal role in
medication administration but often lack the necessary knowledge and competence,
emphasizing the need for ongoing education to enhance their skills.

The study aims to evaluate the impact of an educational program on nurses' competence in
handling HAMs. The research hypothesizes that implementing such a program will lead to a
significant improvement in nurses' knowledge and practice, consequently positively affecting
their overall competence. The study unfolds in several phases, including assessing nurses'
knowledge, practice, and competence regarding HAMs, designing and implementing an
educational program, and determining the program's effectiveness.

The study employs a quasi-experimental design conducted at the Emergency Department of

Benha University Hospital, involving 34 nurses. Three tools are utilized for data collection: a
knowledge questionnaire, an observational checklist, and a competence scale. The knowledge
questionnaire covers various dimensions related to HAMs, while the observational checklist
assesses nurses' performance in pre-administration, during administration, and post-
administration phases. The competence scale evaluates nurses across 13 dimensions related to
medication principles, patient assessment, and other critical aspects.

The results of the study indicate a noteworthy improvement in nurses' knowledge,

performance, and competence regarding HAMs immediately after the educational program
and during follow-up after three months. The majority of nurses demonstrated satisfactory
knowledge, high performance, and high competence levels. The study concludes that the
educational program was effective in enhancing nurses' understanding and skills related to
HAMs.

The research suggests recommendations at the hospital level to enhance the management of
HAMs, including establishing lists of HAMs in different departments, creating clinical
pharmacy services, designing instructional guidelines, and implementing reward systems.
The study emphasizes the need for ongoing support, observation, and education to ensure
nurses maintain high levels of competence in handling high-alert medications.
Journal 2
Summary

The study investigated nurses' perceptions regarding the safety of administering critical
medications in hospital settings. To gather insights, interviews were conducted with eighteen
registered nurses from two distinct hospitals, aiming to capture their experiences in handling
these medications. The study identified three primary themes: Organizational Culture of
Safety, Collaboration and RN Competence, and Engagement. These themes elucidate the
impact of the hospital environment, teamwork, and nursing skills on the safety of
administering critical medications.

The first theme area, Organizational Culture of Safety, underscored the pivotal role of the
hospital's atmosphere in ensuring safety. Nurses emphasized the significance of reporting
errors without fear of reprisal and having access to essential resources such as computers and
smart pumps for secure medication administration. Despite established protocols, the study
revealed instances where nurses circumvented these guidelines, emphasizing the imperative
of consistent adherence to safety protocols.

The second theme area, Collaboration, and RN Competence and Engagement emphasized the
importance of teamwork and the proficiency of nurses in maintaining medication safety. The
study highlighted the value of interdisciplinary collaboration, particularly with pharmacists,
to ensure safe medication practices. Nurse competence, defined as possessing the requisite
knowledge and judgment for safe practices, was underscored. The findings suggested that
ongoing education and vigilance are critical components of nursing practice for ensuring
medication safety.

The third theme area addressed challenges to medication safety, including distractions,
excessive workload, and patient acuity. Nurses articulated how high workloads and frequent
interruptions posed challenges to maintaining focus during critical medication administration,
raising concerns about patient safety. The study also drew attention to instances of non-
compliance with established procedures, such as the independent double-check process, and
the utilization of workarounds that could compromise safety.

The study asserted that existing strategies for ensuring medication safety are inconsistently
applied and recommended a comprehensive approach to improvement. This includes
fostering an organizational culture conducive to collaboration, providing education on safe
medication practices, implementing pragmatic policies, and leveraging technology.

The findings underscored the necessity for further research on nurse engagement, intra- and
interprofessional collaboration, and the involvement of patients in strategies to enhance
medication safety. The proposed model, "HAM Safety: Nursing, Collaborative, and
Organizational Influences," serves as a descriptive framework highlighting the interconnected
themes essential for secure medication administration. Overall, implementing the study's
recommendations has the potential to significantly reduce errors associated with critical
medication administration in hospital settings.
Journal 3
Summary

The study titled "Knowledge & Practice About Administration of High Alert Medication in
the Tertiary Care Hospital in Lahore" delves into the critical issue of medication errors within
the nursing profession. Focusing specifically on high-alert medications, which pose a greater
risk of harm if used incorrectly, the research explores the knowledge and practices of nurses
in administering, storing, and calculating doses of these medications. Given the potential for
significant harm, particularly in emergency and critical care settings, understanding and
improving nurses' proficiency in handling high-alert medications is of paramount importance.

The significance of the study lies in its potential to enhance knowledge and practices among
nurses, ultimately improving the standard of care. By addressing deficiencies in knowledge
and practice, the research aims to contribute to the development and implementation of
strategies that can effectively reduce medication errors. The study is positioned to support
hospital management in maintaining and enhancing existing protocols and procedures related
to medication safety, thereby reducing the risk of adverse events.

The study adopts a cross-sectional descriptive design, utilizing a self-administered

questionnaire distributed among staff nurses at Mayo Hospital in Lahore. The research
specifically targets 157 staff nurses, excluding students, trainees, and other health
professionals. Through convenient sampling techniques, 113 participants were selected for
the study. The results indicate a deficiency in nurses' knowledge of high-alert medications,
particularly in areas such as drug administration, regulations, and overcoming obstacles.
Conflicting views between nurses and doctors, along with a lack of established standard
operating procedures, emerged as significant obstacles during high-alert medication
administration.

The discussion emphasizes the need for ongoing assessment of nurses' awareness and
knowledge regarding high-alert medications to facilitate targeted education and training
programs. The study suggests that the outcomes can serve as a baseline for designing
appropriate educational initiatives, guiding nursing schools in curriculum development, and
aiding policymakers in shaping relevant courses. The study identifies specific gaps in
knowledge, such as the administration of calcium chloride and insulin, highlighting the
critical nature of addressing these gaps to avoid fatal outcomes. In addition, obstacles faced
by nurses, including conflicting opinions and confused prescriptions, underscore the
importance of standardized procedures and effective communication in preventing
medication errors.

The research reveals that a majority of participants demonstrated only moderate knowledge
about the administration of high-alert medications. The study emphasizes the pressing need to
address deficiencies in knowledge, as these were identified as significant obstacles during the
administration of high-alert medications. The findings provide valuable insights into the
challenges faced by nurses and advocate for comprehensive educational programs,
standardization of procedures, and improved communication to enhance medication safety
and reduce the likelihood of errors.
Analysis and Reaction

High-alert medications (HAMs) represent a critical concern in healthcare, demanding

comprehensive research for effective administration and patient safety. This essay provides a
comparative analysis of three nursing studies: "Effect of an Educational Program for Nurses
about High Alert Medications on their Competence," "Nurses' Perceptions of High-Alert
Medication Administration Safety: A Qualitative Descriptive Study," and "Knowledge &
Practice About Administration of High Alert Medication in the Tertiary Care Hospital in
Lahore."

The study "Effect of an Educational Program for Nurses about High Alert Medications on
their Competence" focuses on evaluating the impact of an educational intervention on nurses'
competence in handling HAMs. A quasi-experimental design involving 34 nurses from the
Emergency Department of Benha University Hospital is employed. The study employs
multiple tools, including a knowledge questionnaire, an observational checklist, and a
competence scale. Results indicate a significant improvement in knowledge, performance,
and competence after the educational program, emphasizing the effectiveness of targeted
education. This study places a spotlight on the necessity of continuous learning to enhance
nurses' proficiency.

In contrast, "Nurses' Perceptions of High-Alert Medication Administration Safety: A

Qualitative Descriptive Study" explores nurses' perspectives on factors influencing HAM
safety. Conducted with 18 registered nurses from two hospitals, the qualitative design
captures the intricacies of their experiences. Three main themes emerge: Organizational
Culture of Safety, Collaboration and RN Competence, and Engagement. The findings
emphasize the importance of organizational support, collaboration, and nurse engagement in
ensuring safe HAM administration. This qualitative approach provides a deeper
understanding of the nuanced factors shaping nurses' perceptions and practices.

The study "Knowledge & Practice About Administration of High Alert Medication in the
Tertiary Care Hospital in Lahore" addresses deficiencies in nurses' knowledge and practices
related to high-alert medications. A cross-sectional descriptive design involves 157 staff
nurses at Mayo Hospital in Lahore. The study identifies obstacles, including conflicting
views and a lack of standard operating procedures, contributing to medication errors.
Recommendations include establishing lists of HAMs, creating clinical pharmacy services,
and designing instructional guidelines. This study bridges the gap between knowledge and
real-world application, uncovering challenges and recommending practical interventions for
improvement.
Conclusion

In conclusion, the synthesis of insights from these three nursing studies on High-Alert
Medications (HAMs) not only deepens our understanding of the challenges but also paves the
way for critical advancements in nursing practices. The strengths derived from each study
offer valuable guidance for nurses, nurse educators, and healthcare institutions, underscoring
the pivotal role of continuous learning, organizational support, and practical interventions in
ensuring the safe and proficient administration of high-alert medications.

The first study, "Effect of an Educational Program for Nurses about High Alert Medications
on their Competence," powerfully advocates for the incorporation of targeted educational
programs in nursing curricula. The quantitative evidence of improved knowledge,
performance, and competence post-educational intervention establishes a strong foundation
for nursing educators. It underscores the indispensable nature of ongoing learning initiatives
to equip nurses with the necessary skills for navigating the complexities of high-alert
medication administration.

Complementing this, the qualitative richness of the second study, "Nurses' Perceptions of
High-Alert Medication Administration Safety: A Qualitative Descriptive Study," provides a
profound understanding of the human elements influencing HAM safety. Nurses' perspectives
on organizational culture, collaboration, and engagement illuminate the emotional and
interpersonal dimensions of nursing practices. This qualitative depth is a call for healthcare
institutions to foster environments that prioritize a culture of safety, collaboration, and nurse
engagement, recognizing these as crucial components of ensuring the well-being of both
nurses and patients.

In tandem, the third study, "Knowledge & Practice About Administration of High Alert
Medication in the Tertiary Care Hospital in Lahore," brings the real-world challenges faced
by nurses to the forefront. Its identification of deficiencies and proposed practical
interventions serve as a pragmatic guide for frontline nurses and healthcare administrators
alike. The implementation of recommendations, such as creating clinical pharmacy services
and establishing lists of HAMs, is a tangible step towards bridging the gap between
theoretical knowledge and its application in the dynamic and fast-paced nursing environment.

Together, these strengths weave a narrative that resonates deeply with nursing professionals.
The call for continuous learning aligns with the essence of nursing as a lifelong journey of
acquiring, applying, and adapting knowledge. Recognizing the significance of organizational
culture, collaboration, and practical strategies in nursing practices, these studies elevate the
discourse on patient safety. They advocate for a nursing environment that nurtures
competence, fosters collaboration, and empowers nurses with the tools and support needed to
navigate the intricate landscape of high-alert medication administration.

In essence, the synthesis of these studies is a testament to the transformative potential within
nursing. As guardians of patient safety, nurses are not only the recipients of educational
initiatives but also active contributors to shaping organizational cultures and influencing the
design of practical interventions. By embracing the strengths highlighted in these studies, the
nursing profession can stride confidently towards a future where high-alert medication
administration is synonymous with unwavering competence, compassionate care, and a
commitment to patient safety.
Recommendation

1. Comprehensive Training, Seminars, and Simulation Integration:

To enhance the competency and preparedness of healthcare professionals involved in
the administration of High-Alert Medications (HAMs), it is recommended to
implement an integrated approach. This involves conducting regular and
comprehensive training programs and seminars, addressing the latest guidelines, best
practices, and case studies. This multifaceted approach aims to augment knowledge,
skills, and confidence. Additionally, the integration of simulation-based training into
educational programs and professional development sessions offers a hands-on
experience, allowing healthcare professionals to practice critical decision-making and
procedural skills in a controlled environment, further fortifying their competence in
the safe administration of HAMs.

2. Enhance Safety Protocols and Technology Integration: To bolster the safety of High-
Alert Medication administration, it is recommended to strengthen safety protocols and
integrate technological solutions. This encompasses the implementation of barcode
scanning systems, automated dispensing cabinets, and other advanced technologies
aimed at preventing errors in dosage, administration, and documentation. Such
technological interventions contribute significantly to enhancing overall patient safety
in medication management.

3. Emphasize Proper Labeling Practices: Implement and reinforce standardized and clear
labeling practices for High-Alert Medications (HAMs) across all healthcare settings.
This involves ensuring that labels provide essential information such as medication
name, concentration, dosage, and expiration date. Promoting consistent and legible
labeling practices is a proactive measure to minimize the risk of errors during
medication preparation and administration, thereby contributing to an overall
improvement in patient safety.
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