Medication errors contribute significantly to patient illness and mortality and are costly to the healthcare system. This is especially true for elderly patients in long-term care facilities. While the specific definition of medication error often varies from study to study, these errors typically occur when a physician's orders, the manufacturer's guidelines, or professional best practices in drug, dose, route, or timing are not properly followed. They can arise during ordering, dispensing, or administering medication. Elderly patients are particularly susceptible to negative outcomes from such errors due to the fact that they are often in a more fragile physical state, and typically take more medications than younger people. In the United States, data suggest that long-term care facilities spend more than $3 billion annually on the treatment of preventable medication errors, yet research that specifically addresses this population is scarce. The work environment of nurses in physically and psychologically intense places such as long-term care facilities has been the focus on a number of studies focused on how the work environment, staff stress might contribute to or reduce medication errors. In this review, the authors note that only a very limited number of quality studies have examined the effects of environmental factors on nursing staff health, effectiveness, errors, and job satisfaction in long-term care environments. This paper synthesizes the key environmental and organizational factors that can influence medication errors, drawing primarily on research from acute care settings, and discusses their relevance to long-term care environments.
The purpose of this study was to review and synthesize findings from empirical and non-empirical literature reporting on the physical and organizational factors influencing medication and nursing errors, and assess their applicability to long-term care environments.
Literature review. A keyword search in relevant databases (e.g., Academic Search Premier, Web of Science, TOC Premier, Webline, PsycInfo, Google Scholar, AARP Ageline, Medline, PubMed, EMBASE and ABI/Inform) was conducted along with a review of citations from relevant articles to identify additional potential articles for inclusion in the review. Because of the paucity of literature on this topic in long-term care, evidence from acute care and the relevance for long-term care environments was added. The reviewed articles were subdivided into empirical and non-empirical categories and summarized.
The majority of the research on environment and medication error comes from acute care settings and as such should be considered in light of care processes specific to long-term care.