Processes of Managing Medications in Selected Health Facilities in Country X

Purpose:

The purpose of this presentation is to share preliminary findings on the processes of medication management. The presentation highlights the role played by each cadre of health care providers at each stage of medication management and structures and processes in place for preventing and managing medication errors.

Methods:

A descriptive cross-sectional mixed- methods design was used. The study was conducted in urban, peri-urban and rural health facilities in country X. The selected health facilities were a mix of referral, district and primary hospitals as well as clinics and health posts. A total of 12 sites were selected. Following selection of health facilities, study participants were categorized by their cadres before simple random selection was done. The number selected for each cadre was proportional to the total number of candidates in a given cadre at a given health facility. Descriptive statistics was used to analyze the preliminary findings.

Results:

The sample consisted of 53 participants with an uneven distribution of gender as there were 22 males and 31 females. The age ranged between 24 to 63 years. The descriptive data shows that prescription is mostly done by doctors (88.6%) and nurses (53.8%) while transcription and administration was mainly done by nurses (Randolph, 2013). Dispensing of medications was done by pharmacist/technician, nurses and doctors. It was noted that both nurses and doctors in primary health care settings were involved in prescription while in acute care settings prescription was limited to doctors except for nurse anesthetists. However in the private facilities prescription was done by doctors only.

Most respondents (88.7%) were certain that their curricula covered medication errors. In-service and workshops addressing medication errors were reported but were uncommon. Medication counselling was most prevalent at dispensing and was rarely done during prescription and administration. It makes sense that counselling is more frequently provided at the dispensary (Al-Khani, Moharram & Aljadhey, 2014) than other areas because at prescription for instance, the health care provider may want to spend less time with the patient hoping counselling will be done at dispensing and administration.

Supervision and self-checking was common at dispensing and uncommon during prescription, administration and transcription. Peer checking was reported at all stages. Health care providers did not take medication self-checking as a routine. Mixing of medications was mostly done in the wards but few stated that mixing was also done at the pharmacy. Those involved in mixing were nurses, pharmacists and at times doctors. Participants stated that protocols for mixing injectable medications were available, and these included medication leaflets. It was also reported that new staff members were trained on mixing injectable medications. Some new staff were not offered on the job training on mixing injectable drugs; however protocols were available to guide them.

Public facilities reported that most medical and medication errors made by staff were not reported, the same observation was made on medication errors staff discovered. Medication errors were therefore not reported in public facilities. This was different with the private health facilities where all medical errors including medication errors were reported. The public sector participants disagreed that there was a written protocol for prevention, detection, reporting and tracking of medication errors. However the private sector respondents agreed to the availability of a tool for reporting medication errors but only 50% have used it.

Conclusion:

The findings on who prescribes are in line with the Drug and Related Substance Act of country X which provides for prescriptive authority to doctors and nurses. Transcription included telephone orders, transfer of medication orders to new drug sheet and writing a refill prescription. The report shows that transcription is done by nurses. Nurses spend most of the time with patients and receive orders when necessary. Medication administration was mostly done by nurses, and doctors also do in some situations. Dispensing was primarily done by pharmacy personnel, but nurses also dispensed probably because there is still shortage of pharmacists and pharmacy technicians in the country. Untrained staff was not engaged in medication management except in administration of dressing ointments and creams.

It is evident that none of the facilities had a room dedicated for mixing of medications, which poses a risk for medication errors due to distractions. Gaps identified in medication management were; limited counselling during prescription and administration, absence of a room dedicated for mixing intravenous medications and solutions, absence of protocols on mixing and preparing injectable medications in some situations, lack of training of new staff on mixing of intravenous medications in some situations and instances of failure to report medical errors including medication errors in public facilities.