Medication Errors in Psychiatric Hospitals Internationally, medications errors (MEs) and adverse drug events (ADEs) are understood to be critical public health issues that can harm patients who are hospitalized, including those in psychiatric hospitals. A systematic review of eight studies from the U.S., U.K., New Zealand, Australia, and Canada revealed that ADEs accounted for more than 15% of general hospital adverse events. Additional research revealed that the occurrence of prescribing errors (PEs), dispensing errors (DEs), and medication administration errors (MAEs) made up a median percentage of 7% of all medication dispensing transactions. Moreover, researchers have sought to understand the prevalence and nature of medication errors in psychiatric hospitals, where specific vulnerabilities of patients can create unique medication safety issues, concluding that medication errors, primarily psychotropic medications, cause patient harm in these psychiatric settings. Patients hospitalized for psychiatric treatment can have cognitive impairments that may result in nonadherence with psychopharmacological treatment and limited reporting of medication-related problems. These same issues can also be compromised by erratic or aggressive behavior by patients who are undergoing intense affective experiences, including psychotic process, while hospitalized (Alshehri et al., 2017). Antidepressants, benzodiazepines, and antipsychotics are commonly prescribed in these settings. These medications can often have drug-on-drug or drug-on-disease problems that manifest in physical and psychological side effects that can put patients at risk, with data revealing that atypical antipsychotics are the medication involved with the most adverse events. In reviewing 20 studies that examined the issue of medication safety, Alshehri and colleagues (2017) found that only a few recent studies have examined the question of how to intervene effectively and reduce medication errors. One such practice involves the use of an information technology intervention, namely a standalone device referred to as automated dispensing cabinet. This type of computerized machine offers a combination of security, reporting, and data collection for use in inpatient psychiatric units. Studies have been limited; however, some research demonstrates that the automated dispensing cabinet system can reduce medication errors. Another study examined how a personal digital assistant device could be used to reduce medication errors that occur during the patient discharge process from a psychiatric unit. Previously, discharge medication lists were a handwritten transcription of a psychiatrist’s medication order, a process that often resulted in human error. The study revealed that automating the medication discharge list via the personal digital assistant resulted in fewer medication errors. Another study, one of the largest recent efforts to investigate this phenomenon, was conducted over a five-year period and involved more than 65,000 patient days of hospitalization. It revealed that another information technology (IT) solution reduced medication errors in psychiatric settings. The twofold solution provided a dedicated medication error portal for reporting, along with a dedicated provider prescribing system. Together, the solutions demonstrated a meaningful reduction in medication errors (Alshehri et al., 2017; Jayaram et al., 2011). Psychiatric Inpatient Safety: The Larger Picture Patient safety remains a persistent problem in psychiatric acute care hospitalization. Researchers have pointed to the generally slower adoption of patient safety protocols by the behavioral health field generally, and within inpatient psychiatry specifically. Citing a 2018 study of 14 general hospital psychiatric units, data revealed an adverse patient
event frequency of 14.5% of all hospitalizations. Shields and colleagues (2018) also describe the broader milieu that ultimately affects patient safety efforts within inpatient psychiatry, namely unaddressed public concern about safety; understaffing; inappropriate seclusion and restraint practices; imperfect regulatory mechanisms; and sparse research, including a marked lack of necessary funding for such research. Additionally, the issue of staff burnout combined with a lack of professional training in trauma- informed care, researchers argue, critically contribute to this complex environment that can result in too many adverse events for patients. Invalidation of the Patient Acute psychiatric hospitalization is a stressful life event for patients, even if hospitalization is the intervention they need. Professional clinical experience and reviews from former patients greatly inform the perception of psychiatric care: A litany of problems combine to create an unhelpful and stressful hospitalization. Experts such as Shields and colleagues (2018) argue that the impersonal nature of acute care can lead patients to experience depersonalization, an intensely negative affective state. Other research (Frueh et al., 2005) has identified the differences in perceptions between staff and patients, namely that staff assign incidents of aggression as being solely caused by a patient’s mental illness and not associated with the behaviors or attitudes of staff. Naturally, research reveals that patients often report significant negative experiences while hospitalized. Additionally, staff attitudes and behaviors can be professionally inappropriate, leading to patients feeling intimidated or humiliated, which can often occur with the use of containment measures, chiefly chemical or physical restraint (Beckett et al., 2017). Psychiatric Staff Training: Trauma-Informed Care A growing corpus of research and clinical evidence has identified trauma as one of the leading experiences that cause individuals to seek behavioral treatment. However, despite this finding, critics have argued that behavioral health organizations have been slow to incorporate trauma- informed care principles within their treatment training and delivery. Research has demonstrated that the utilization of trauma-informed care practices reduces the rate of use of seclusion and restraint practices. Since the year 2000, trauma-informed care models have increasingly emerged within the behavioral community; however, the inclusion of this form of care is not yet ubiquitous in psychiatric hospitalization settings. Paradoxically, however, it is common for significant numbers of patients admitted onto psychiatric units to suffer from problems related to complex trauma, defined as the personal experience of multiple or extended trauma events. Researchers point out that trauma-informed practice has the potential to improve an organization’s context, creating a more informed, empathetic-driven ethic of care for patients. This in contrast to what psychiatric nursing staff and patients have negatively identified as treatment that is largely focused on only medical approaches (Beckett et al., 2017). Shields and colleagues (2018) maintain that trauma- informed care can reinforce principles of patient safety and quality care, reporting that “providing care that is psychologically safe requires that patients feel safe, have a sense of control over their lives, and have a sense of connection to staff members who are perceived to be available and who see their needs as legitimate” (p. 1854). An interesting study conducted in Australia uncovered positive results associated with trauma-informed education for psychiatric nursing staff. Through a series of ongoing
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