Patient safety is a relatively new research trend; it nonetheless arouses great interest of researchers. The World Health Organization (WHO) for nearly a decade has undertaken numerous actions to promote patient safety, including the promotion of medication without harm. In 2020, WHO declared their Flagship Initiative “A Decade of Patient Safety 2020-2030”. All the more so, the research area explored by the authors of this article proves immensely important taking into account the scarcity of publications on the detailed analysis of risk factors in the pharmacotherapy process. The tools that could be used for this purpose are also scarce.
Undoubtedly, in contemporary healthcare systems, there is a multitude of negative stressors that affect the safety of the pharmacotherapy process. They are related to such factors as nurse understaffing, population aging and the change of patient profile, patients with multiple morbidities and state-of-the-art medical technologies, not infrequently with complex interfaces. These stressors place the frontline medical staff, such as nurses, in a situation in which they can fall short of their standards and be unable to provide the highest quality of care .
Authors’ own study has revealed that contemporary nurses are working under substantial time pressure (item 3). This could result from the said shortages of personnel and excessive workloads. The consequences could affect the ability to ensure patient safety. Performing work under considerable pressure can be conducive to errors which might entail serious consequences in the pharmacotherapy process. Both Polish and Slovak nurses paid attention to this fact and most of them, in both groups, considered working under time pressure as “very significant risk (5)”.
El-Bannaat et al. emphasize in their work that nurses should be supported in their provision of patient safety and also in their belief that errors in this process are predisposed by a great number of internal factors, such as shift pattern, and external ones, such as demographic or epidemiologic situation, and they should not, in the long run, entail the liability of nurses for incorrect pharmacotherapy .
A majority of both Polish and Slovak nurses assessed inappropriate work organization (item 4) as a factor characterized by “very significant risk (5)”. In many medical facilities, the nurse who prepares medications for patients also performs other tasks, such as answering phone calls in the meantime, talking to another person who enters the room in which medications are prepared, etc. The pharmacotherapy process requires intense concentration, and the above-mentioned situations conduce to medical errors. Moreover, it is rarely that separate rooms are assigned for medication preparation with access exclusively for the nurse appointed for that specific task. As demonstrated by research results, both in Poland and Slovakia, medicine preparation rooms serve many purposes. Preparation of personalized sheets with the name and dosage of the medicine on the drug tray poses an additional problem which has been assessed by Polish nurses as “very significant risk (5)”, and by Slovak nurses as “significant risk (3)”.
Studies conducted in Iran on errors in the pharmacotherapy process in teaching hospitals have revealed that the majority of factors are related to the work of nurses, for example, insufficient care of patient medical records, dissatisfaction with work and errors in the calculation of medication doses . These studies are noteworthy, as in 2007 the frequency of errors in pharmacotherapy in Iran was around 2.4–5.6 times higher than in the United States .
Polish nurses also paid attention to the legibility of medical documentation as far as medical orders are concerned (item 1). They assessed this factor as “very significant risk (5)”. In Slovakia, in turn, it was assessed as “significant risk (3)”. This might result, among other reasons, from the fact that medical documents in Slovakia is already in the electronic format, while in Poland, not all medical institutions have implemented this solution by the time of conducting this study. Legibility of documentation (especially of medical orders) and medical order deficiencies are other factors that play a significant role in ensuring patient safety. Not infrequently, medical orders fail to provide information on the specific solvent for a particular medicine (item 6). Polish nurses consider it as “very significant risk (5)”, and Slovak nurses - as “significant risk (3)”.
Bryant R. et al. emphasize that the education of nurses by pharmacists/ clinical pharmacologists on the use of some groups of medications, in particular of those from the high-risk group, i.e. narcotics, medications used in cancer treatment, medications for heart diseases, etc., could contribute to reducing errors in the pharmacotherapy process .
Unfortunately, the authors’ own research has demonstrated that neither in Poland nor in Slovakia, is there any possibility for nurses to consult a hospital pharmacist/ clinical pharmacologist. What is more, nurses from Poland draw attention to the fact that they are not familiar with the list of generic medications and assess this factor (item 5) as“very significant risk (5)”, and Slovak nurses assess it as “significant risk (3)”. Knowledge deficiencies in safe pharmacotherapy could be eliminated by staff training courses. At the same time, nurses from Poland and Slovakia state that they are not trained on a regular basis, and most of them assess the factor of the availability of training (item 8) as “significant risk (4)”.
The absence of consultation possibilities is a symptom of lacking communication. Communication in a therapeutic team, as emphasized by Soodabeh et al., is of crucial importance . Both Polish and Slovak nurses stated that inappropriate communication in the therapeutic team is a significant risk factor (item 2).
Keers R.N. et al. in their systematic review of literature on medication administration errors (MAEs) in hospital note that many system-related factors contribute to errors in the pharmacotherapy process. It is important not only to differentiate between the types of these factors but also to analyze how they are generated and how they combine to ultimately result in harm to patients. It is therefore of special importance that research on the safety of pharmacotherapy is conducted at both national and international scales with regard to particular healthcare systems .
The research project aimed at determining the safety level of the pharmacotherapy process in two neighboring European countries revealed substantial differences between them. It was found that in the Polish healthcare system, the safety level of pharmacotherapy, as assessed by nurses, is lower than that in Slovakia. It constitutes an important impulse for continuing research in this area and providing staff training on an ongoing basis.
Ensuring patient safety is an immensely difficult task, as demonstrated both by the authors’ own study and studies conducted by other researchers. Nevertheless, it is an important task not only for medical staff but also for healthcare managers.
Based on the survey and the analysis of the results, the method of data collection should be approached critically. The use of electronic survey available at the link is undoubtedly a very convenient solution – on the one hand, it allows us to quickly reach people who live on the other side of the country and quickly aggregates collected data, which saves time spent on entering data and reduces the risk of error during this process. On the other hand, this solution raises some concerns among the respondents, namely whether this method is entirely anonymous. It was found that a significant proportion of the respondents did not complete their investigation, i.e. did not send a reply to the server because they were afraid that it could be identified.
Implications for nursing management
Based on the results of this study, it should be noted that the proprietary NURIPH tool can be used to identify risk factors in the pharmacotherapy process in hospitals worldwide. A diagnosis based on the results obtained can contribute to the development of new procedures, to the improvement of their quality and safety of the patient, and preventive action. It should be concluded, taking into account the conclusions of the literature review, that the NURIPH tool can be a universal tool for the rapid diagnosis of risks in inpatient medicine worldwide. Moreover, medical and management staff should be trained on patient safety.