Reducing medication errors in nursing practice

CANCER NURSING PRACTICE February 2015 | Volume 14 | Number 1 29
Continuing professional development
Reducing medication errors
in nursing practice
Medication errors remain one of the most common causes of unintended harm to patients. They contribute
to adverse events that compromise patient safety and result in a large financial burden to the health service.
The prevention of medication errors, which can happen at every stage of the medication preparation and
distribution process, is essential to maintain a safe healthcare system. One third of the errors that harm patients
occur during the nurse administration phase: administering medication to patients is therefore a high-risk activity.
This article highlights factors that contribute to medication errors, including the safety culture of institutions.
It also discusses factors that relate specifically to nurses, such as patient acuity and nursing workload, the
distractions and interruptions that can occur during medication administration, the complexity of some medication
calculations and administration methods, and the failure of nurses to adhere to policies or guidelines.
[email protected]
Linda Cloete is a lecturer at the
faculty of nursing and health,
Avondale College of
Higher Education, Sydney,
Conflict of interest
None declared
Drug calculations, medication
errors, nursing systems,
patient safety
This article has been
subject to double-blind review
and checked using antiplagiarism
software. For related articles visit
our online archive and search
using the keywords
Author guidelines
This article was originally
published in Nursing Standard
(2015) 29, 20, 50-59.
CNP1178 Cloete L (2015) Reducing medication errors in nursing practice.
Cancer Nursing Practice. 14, 1, 29-36. Date of submission: August 19 2014.
Date of acceptance: October 13 2014.
Aims and intended learning outcomes
This article provides insight into factors that contribute
to medication administration errors and that can result
in poor patient safety outcomes. After reading this
article and completing the time out activities you should
be able to:
â– â–  List potential risks that contribute to
medication errors.
â– â–  Explain how a number of unrelated risks, when
allowed to coexist, may result in adverse events
in the delivery of health care.
â– â–  Discuss ways to limit risks of medication errors in
your practice team.
â– â–  Reflect on contributions that could be made towards
the development of a safe reporting environment
for fostering the growth of knowledge and
achieving strategies that minimise the potential for
medication errors.
â– â–  Create a list of resources that promote active
involvement in the prevention of medication errors
and contribute to safe practice.
Medication errors remain one of the most common
causes of harm to patients (Roughead et al 2013). A
medication error is defined as a preventable event related
to medication which results in ‘a failure in the treatment
process that leads to, or has the potential to lead to,
harm to the patient’ (Ferner and Aronson 2006). The
medication treatment process includes all aspects of
medication handling (Aronson 2009,
National Coordinating Council for Medication Error
Reporting and Prevention 2014).
A review of medication error incidents reported
between 2005 and 2010 to the National Reporting
and Learning Service indicated that 526,186 such
incidents had occurred in England and Wales over this
period (Cousins et al 2012) (Table 1, page 30). A
total of 86,821 (16%) of these incidents caused actual
patient harm, of which 822 (0.95%) resulted in death
or severe harm (Cousins et al 2012). The cost to the
NHS of hospital admissions related to medication errors
in 2007 was £770 million and between 1995 and
2007 £5 million was spent on litigation costs (Frontier
Economics 2014). In the UK, one third of medication
errors occurring in general medical practices related
to prescribing errors. Many of these were the result of
poor communication, particularly with regard to the
prescription of antibiotics to which patients are known
to be allergic (National Patient Safety Agency (NPSA)
2007). Medication errors contribute to adverse events
that compromise patient safety and place a large
financial burden on health systems (Roughead et al
2013). In addition to the financial costs, individual
30 February 2015 | Volume 14 | Number 1 CANCER NURSING PRACTICE
Continuing professional development
patients and their significant others are affected
physically, emotionally and psychologically when
errors occur (Deans 2005). Therefore, the prevention
of medication errors is essential to maintaining a safe
healthcare system (Roughead et al 2013).
Medication processes are complex in nature,
involving multiple interactions, and are high-risk
activities (Nursing and Midwifery Council (NMC) 2010).
Although errors occur at every stage of the medication
preparation and distribution process (Aspden et al 2006,
McBride-Henry and Foureur 2006, Maricle et al 2007,
Biron et al 2009), one third of those that harm patients
are attributed to the administration phase (Leape et al
1995). Most medication administrators are nurses and,
therefore, when errors occur, nurses are often deemed
accountable (Burke 2005). Medication administrators
can provide a safeguard against errors made at any
of the previous stages, however, and are thought to
intercept around 86% of errors made by prescribers
or pharmacists (Leape et al 1995). Therefore, nurses
provide a safety defence against medication errors but,
at the same time, have the potential to place patients at
risk (Pape et al 2005).
Table 1 Patient safety incident and medication incident reports (2005-2010)*
Healthcare sector Total number of
incident reports
Number of
incident reports
Medication incidents
as a percentage of
total incident reports
Acute/general hospital 3,921,212 394,951 10.07
Mental health service 754,812 48,951 6.49
Community nursing, medical and therapy
service, including community hospital
542,323 48,594 8.96
Learning disabilities service 155,914 8,154 5.23
General practice 22,587 5,358 23.72
Community pharmacy 19,696 19,245 97.71
Ambulance service 18,415 712 3.87
Community and general dental service 2,560 133 5.20
Community optometry/optician service 82 4 4.88
Not stated 398 84 21.11
Total 5,437,999 526,186 9.68
*Recorded by the National Reporting Learning Service for each healthcare sector in England and Wales. Cousins et al 2012)
This article discusses types of medication errors and
the contributing factors that occur in clinical practice.
It then concentrates on specific problems that nurses
can encounter in the administration process.
Errors and contributing factors
The types of errors that can occur are listed in Box 1
(Lassetter and Warnick 2003, McBride-Henry and Foureur
2006, Biron et al 2009). The two most common
medication errors are incorrect time of administration and
medication omission for no acceptable clinical reason
(Barker et al 2002).
Now do time out 1.
1 Medication delay Time outA patient’s intravenous antibiotic is delayed
by two hours because the patient was away
from the ward undergoing an investigative
procedure. Would this delay constitute
a medication error? Discuss this with a
colleague or describe strategies that could
be employed to prevent such an occurrence.
CANCER NURSING PRACTICE February 2015 | Volume 14 | Number 1 31
2 Patient factors Time outReflecting on your practice, can you
remember a circumstance where any of the
patient factors given in Box 2 could have
contributed to a medication error? Consider
the strategies that could be used to minimise
the risk of an incident for each factor.
Various studies have identified factors that contribute
to medication errors; these are broadly classified as
patient, system and personal factors (Grandell-Niemi et al
2003, Greenfield 2007, Mrayyan et al 2007, Wright
2007). Patient factors relate to the characteristics
or attributes of patients that place them at risk
of experiencing a medication error (World Health
Organization (WHO) 2009a) (Box 2).
Now do time out 2.
System and personal factors, respectively, relate to
institutional and individual practitioner characteristics that
contribute to the relative risk of medication errors. System
factors include the safety culture of an organisation,
management and leadership, workplace communication
and workplace policies and procedures. Examples include
addressing the educational needs of staff (including
agency nurses) and having accessible, succinct, stepby-step guidelines and protocols for the operation of
equipment. Personal factors include the cognitive ability
and skill, situational awareness, decision-making ability
and personal resources (including responses to stress and
fatigue) of individual practitioners (WHO 2009b).
The system approach, while acknowledging the
individual practitioner’s role in, and responsibility for,
errors, recognises that many medication errors could
be prevented by greater attention being placed on the
system and less on apportioning blame to individuals
(Reason 1990, Biron et al 2009). Nurses, however,
should continue to reflect critically on the potential for
improving their own practice. The following sections will
discuss the system and personal factors that may result in
medication errors.
Organisational safety culture
A safety culture in healthcare systems comprises
enlightened leadership, teamwork and a patient-centred
approach to care (Sammer et al 2010). Organisations
involved in highly complex, technological processes
demand a failure-free operational standard from their staff.
Frankel et al (2006) summarise the attributes necessary
to achieve this as ‘mindfulness’. Such attributes include:
â– â–  An awareness of the possibility of failure.
â– â–  Respect for all colleagues.
â– â–  An ability to adjust and remodel plans in
unforeseen circumstances.
â– â–  An ability to accommodate the bigger picture, while
maintaining focus on an isolated task.
While a culture of safety is partially determined by
organisational structure and leadership, the unit manager
plays a significant role in the effective implementation of
the safety culture in a nursing team (Mayo and Duncan
2004, Ulanimo et al 2007, Valentin et al 2009).
Until recently, nurses have focused on their individual
actions in efforts to promote safety and prevent harm to
patients (Mayo and Duncan 2004, Ulanimo et al 2007,
Valentin et al 2009). While this remains good practice,
nurses should also evaluate the way they function
in teams to ensure that the collective systems and
processes of practice are safe and to support and educate
inexperienced colleagues (Mayo and Duncan 2004,
Ulanimo et al 2007, Valentin et al 2009).
An emotionally unsafe environment (that is, one
led by managers who believe in demonstrating power
and control over employees, who do not recognise
individual needs or who are intimidating), along with
fear of discipline, can inhibit the reporting of errors by
nurses (Mayo and Duncan 2004, Ulanimo et al 2007,
Valentin et al 2009). In a study of 983 nurses, 76.9%
Box 2 Patient factors that increase the risk of medication errors
Box 1 Types of medication error
â– â–  Wrong time of administration or delayed
â– â–  Medication omission without acceptable
clinical reason.
â– â–  Unauthorised medication administration.
â– â–  Wrong dose administered.
â– â–  Extra unauthorised dose administered.
â– â–  Medication administered via incorrect route.
â– â–  Medication administered at the incorrect rate.
â– â–  Medication administered in incompatible fluid or in
conjunction with another incompatible medication.
â– â–  Medication calculation error.
â– â–  Medication administered to the incorrect patient.
â– â–  Allergy-related error.
(Lassetter and Warnick 2003, McBride-Henry and
Foureur 2006, Biron et al 2009)
Multiple medication use:
â– â–  Complex disease process.
â– â–  Multiple medical problems.
â– â–  More than one prescribing doctor.
Poor communication:
â– â–  Children and babies.
â– â–  Confused or unconscious state.
â– â–  Language difficulties.
Passive involvement:
â– â–  Culturally determined passive
relationship with health professionals.
â– â–  Lack of interest in being informed
about health and medications.
Complicated drug calculation
â– â–  Titrated medications.
â– â–  Weight-based medications
(children and babies). (World Health Organization 2009a)
32 February 2015 | Volume 14 | Number 1 CANCER NURSING PRACTICE
Continuing professional development
thought that medication errors were unreported because
of fear of a negative reaction from the unit manager
(Mayo and Duncan 2004). Organisations that aim to
understand fully the factors, systems and processes
that lead to medication errors and to identify error
minimisation strategies need staff to feel free to voice
concerns in a safe environment, and admit to errors and
the need for development (Frankel et al 2006).
Effective communication is a key element of the safety
culture in an organisation, particularly the communication
between and within multidisciplinary teams in relation
to medication processes (Savvato and Efstratios 2014).
Nurses are directly involved in preventing errors at
administration level and are often integral to prompting
prescriptions, advising on dosages during the prescription
writing phase, informing pharmacy about incorrectly
dispensed medication, detecting errors and taking
corrective action in medication preparation before
administration (Popescu et al 2011).
Inexperienced nurses are particularly vulnerable to
errors associated with miscommunication, because
of low levels of anticipation or awareness of the
potential for error. They are therefore less likely than
their experienced colleagues to seek clarification either
through verbal communication with colleagues or from
written information (Kazaoka et al 2007, Savvato and
Efstratios 2014). Experience promotes anticipation and
early detection of errors (Seki and Yamazaki 2006).
Therefore, ensuring an adequate skill mix on shifts may
help prevent medication errors (Tang et al 2007).
Communicating with and educating patients about
their medications during the administration process can
result in individuals being better informed about and
more involved with their medicines, thereby improving
the quality and safety of medication administration
(Popescu et al 2011). This may be particularly the case
in community settings, such as in a patient’s home,
where the most common reason for medication errors
relates to administration. Therefore, helping patients to
understand and manage medication administration safely
can contribute to reducing errors (NPSA 2007).
Now do time out 3.
Interruptions and distractions
Higher medication error rates are associated with greater
levels of interruptions during medication administration
(Westbrook et al 2010). Indeed, interruptions at this
stage are one of the main contributing factors to errors
(Mayo and Duncan 2004, Deans 2005, Hopp et al 2005,
Ulanimo et al 2007, Westbrook et al 2010, Ozkan et al
2011). In this context, interruptions are defined as a
halt in the primary activity being performed – medicine
administration – to carry out a secondary task, resulting in
nurses having to manage a number of tasks simultaneously
(Mrayyan et al 2007, Petrova 2010, Ozkan et al 2011).
Distractions, such as noise, can be ignored or processed
concurrently with the primary task; however, they may
also contribute to errors and act as a precursor to an
interruption (McFarlane and Latorella 2002).
Medication administration includes components of
both skill-based and knowledge-based task requirements.
Skill-based tasks require attention to be focused on the
activity being performed, to ensure successful completion
(Reason 1990). Interruptions that divert attention can
hamper skill-based performance (Reason 1990),
while knowledge-based tasks rely on conscious analytical
processes that can be disturbed by competing demands
for cognitive resources, fatigue and distractions such as
noise (Wickens and Hollands 2000).
When a number of patient activities occur
simultaneously, nurses are involved in complex
decision making to prioritise activities. Many competing
activities have the potential to result in distractions and
interruptions that can interfere with a primary task and
may contribute to errors. Nurses are often required to
choose between attending to, ignoring and delaying
attending to distractions when undertaking medication
administration, which may result in the nurse anticipating
potential distractions, prioritising one task over another or
delegating a secondary task (Popescu et al 2011).
The most common source of interruption is from
another nurse requiring face-to-face communication
(Hedberg and Larsson 2004, Spencer et al 2004,
Alvarez and Coiera 2005, Popescu et al 2011). Such
interruptions frequently occur during direct patient care
activities, and the activity interrupted most often is that
of medication administration (Hedberg and Larsson
2004). Common locations for interruptions to occur
are medication rooms and open spaces where nurses
may be viewed as being more accessible (Hedberg and
Larsson 2004, Bennett et al 2006). Areas that allow
for conversation result in higher levels of distraction and
interruption (Popescu et al 2011).
Other sources of distraction and interruption include
patients (Hedberg and Larsson 2004, Lyons et al
2007), technical sources (for example, alarms) and
operational failure (for example, the unavailability of
a medication or infusion device required for medicine
administration) (Hedberg and Larsson 2004, Tucker
and Spear 2006). Operational failure regularly results in
drugs being omitted or administered late (Popescu et al
2011). Minimising the frequency of interruptions may
3 Safe reporting environment Time outList any strategies that foster a safe
reporting environment in your workplace.
How could you personally contribute towards
implementing them?
CANCER NURSING PRACTICE February 2015 | Volume 14 | Number 1 33
limit the number of medication errors. The NPSA (2012)
recommends that institutions develop policies and
procedures to minimise interruptions during administration
of medicines. Solutions to minimising interruptions
include: the creation of interruption-free zones of work
– thus limiting casual conversations in certain work
areas, wearing ‘Do not disturb’ safety vests or armbands
and using ‘Do not disturb’ signs to indicate the need
for interruption-free work (Pape et al 2005, Biron et al
2009). Other suggestions include the allocation of specific
times during shifts when nurses can administer medication
free from clerical interruptions and postponing non-urgent
patient care tasks (Savvato and Efstratios 2014).
Any intervention that leads to fewer distractions
could ultimately enable nurses to focus more on the
task that they are performing, complete the task in good
time and create less work-related stress and greater job
satisfaction (Pape et al 2005).
Therefore, nurses should learn to recognise
the potential for making errors during medication
administration and take active steps to avoid distractions
and interruptions (Palese et al 2009). They should learn
to recognise when it is appropriate to be interrupted – for
example, to attend to a patient alarm or a patient whose
condition is deteriorating – and when it is preferable
to defer the interruption – for example, responding to
clerical enquiries. This requires exercising critical thinking
and making appropriate clinical judgements, which are
fundamental responsibilities of the professional nurse
(Jones and Treiber 2010). Nurses should also be made
aware of their potential to distract and interrupt other
nurses and work towards minimising such occurrences.
Now do time out 4.
Shift length, patient acuity and workload
Research suggests that the number of hours nurses
work, length of shifts, patient acuity and high workloads
result in nurse fatigue (Suzuki et al 2005, Ulanimo et al
2007). Nurses who engage frequently in competing
activities as a result of high workloads and the acute
nature of patients’ conditions are more likely to
experience distractions and interruptions, focus poorly on
work-related activities and potentially make more errors
(Tang et al 2007, Hewitt 2010).
The likelihood of errors has been found to be
three times higher when staff work 12.5 or more hours
in a shift (Rogers et al 2004), and nurses are two and
a half times more likely to suffer burnout and job
dissatisfaction when regularly working shifts of ten hours
or longer (Stimpfel et al 2012).
While employers are bound by statutory requirements
and organisational policies to limit shift length and
hours of work per week, it remains the responsibility
of individual practitioners to practise within these
boundaries to remain safe (NMC 2010, Fair Work
Ombudsman 2014, Royal College of Nursing 2014).
Compared with day workers working regular
hours, those working shifts, especially at night, have
a significantly higher risk of accidents and near-miss
events. This is the result of lower alertness and a greater
tendency to experience drowsiness, both of which affect
cognitive function (Barger et al 2009). Staff sleeping
during the daytime can optimise sleep time by avoiding
exposure to bright light and stimulants, keeping the
room dark and using earplugs. Before starting a night
shift, staff can increase their wakefulness by exposing
themselves to bright light; they can also make use
of short occasional nap periods when on breaks
(Barger et al 2009, Rajaratnam et al 2013).
Access to information and guidelines
A number of international studies have found that nurses
prefer to approach colleagues for information to aid
decision making rather than to access evidence-based
resources from reliable databases (Thompson et al
2001, Estabrooks et al 2003, Pravikoff et al 2005,
Kosteniuk et al 2006). Reasons for this include
convenience and time efficiency, a perceived lack of
computer skills and low confidence levels when using
online records that require search word and phrase
selection (Thompson et al 2004, Dee and Stanley 2005).
A lack of convenient access to policies and guidelines
for medication administration is likely to result in poor
information-seeking habits, which may contribute in turn
to medication errors (O’Leary and Mhaolrúnaigh 2012).
A lack of information, training and preparation with
regard to using infusion devices can contribute to errors
(Mayo and Duncan 2004, Ulanimo et al 2007, Jones
and Treiber 2010).
Environmental factors
Environmental characteristics that can lead to problems
during administration of medications include poor lighting,
high noise levels, restricted storage space resulting in
cluttered work surfaces, poor layout of medication rooms,
a lack of space for preparing and charting medications,
and in particular a lack of privacy in medication rooms.
Each of these factors can be associated with a higher
incidence of fatigue, stress, distraction and interruptions
(Mahmood et al 2011, Savvato and Efstratios 2014).
Environmental factors, therefore, should be considered
4 Interruption Time outConsider what activities can be sources
of interruption during medication
administration. Describe strategies that could
be used to reduce the frequency of such
interruptions. Outline a number of strategies
that could result in fewer distractions.
34 February 2015 | Volume 14 | Number 1 CANCER NURSING PRACTICE
Continuing professional development
when planning strategies to minimise medication errors
(Savvato and Efstratios 2014).
Drug calculation and administration
Studies have shown that nurses have poor drug
calculation skills, which could account for 10-20% of
medication errors (Wright 2004, 2005). In addition,
it has been reported for more than four decades that
nursing students have difficulty with mathematical tasks
such as unit conversions, dosage calculations and fluid
monitoring (Bindler and Bayne 1984, Worrell
and Hodson 1989, Sandwell and Carson 2005).
Two skills have been identified as necessary for
accurate drug calculation: basic mathematical and
computational aptitude, and, the ability to understand
clinical information well enough to formulate correctly a
suitable mathematical problem to calculate drug dosage
(Wright 2007). According to Vagliardo and Schmittau
(2008), it is important for practitioners to be able to
estimate, to correctly interpret graphs, proportions, ratios
and tables, and to be resourceful in problem solving; good
mathematical understanding means not being dependent
on a calculator.
There appears to be a significant correlation between
a positive attitude towards mathematics, self-efficacy
(the belief in one’s own ability to complete tasks and
reach goals) and performance, with feelings of selfefficacy being a stronger predictor of performance than
attitude to mathematics (Hackett and Betz 1989, Ma
and Kishor 1997, Nicolaidou and Philippou 2003).
Mathematical-related anxiety is correlated inversely to
self-efficacy for complex mathematical tasks, where drug
calculations are perceived as difficult (Walsh 2008).
Therefore, nurses may be likely to perform less well on
complex drug calculations as a result not only of the
complexity of a task but also the level of their perceived
self-efficacy in relation to undertaking the calculation.
Levels of confidence and self-efficacy in completing
basic and complex tasks can improve with mathematical
practice (Walsh 2008).
Now do time out 5.
Understanding and reporting errors
It is important to ascertain how errors occur, and
this is primarily achieved through adequate reporting
(Hewitt 2010). The first step in planning strategies to
reduce errors is to obtain a clear understanding of what
constitutes an error (McBride-Henry and Foureur 2006).
A mixed-methods study on medication errors in a district
general hospital in south west England found that there
was confusion among nurses as to what constituted a
medication error and which incidents should be reported
to a physician or nurse manager (Gladstone 1995).
For example, less than 20% of the 81 nurses who
responded to a questionnaire identified the following as
medication errors:
â– â–  A patient having missed an antibiotic dose due to the
fact that he was away from the ward for three hours.
â– â–  A dose of medication delayed by 45-60 minutes.
â– â–  A dose of nebulised medication at 2am omitted
because the patient was sleeping.
Raising awareness by disseminating information about
factors that are likely to increase the possibility of errors
and what constitutes an error may be useful in improving
nurse vigilance (Savvato and Efstratios 2014).
Failure to follow policy or guidelines
One of the more common personal contributors to
medication error is a failure to adhere to professional
and institutional policies or guidelines (NMC 2010),
in particular a failure to check the ‘five rights’ (right
patient, right medication, right dose, right route, right
time) (Tang et al 2007, Ulanimo et al 2007). Neglecting
these checks has been shown to contribute to medication
errors (Pape et al 2005, Fogarty and McKeon 2006).
Failure to check identity bands was found by
Westbrook et al (2010) to be the most common deviation
from procedural policy. Failure to watch patients take
medication and signing charts before medication was
consumed were also common. Reasons given for
deviations from policy were mostly to save time. Such
findings show a lack of insight into the necessity to check
a medication chart against a patient’s identity band. It has
been suggested that nurses may not value the practice of
checking name bands or that the practice loses importance
when the nurse is no longer being supervised (Hewitt
2010, Jones and Treiber 2010). It could be argued that
nurses, having worked previous shifts and having attended
to the same patients, would correctly identify a patient by
sight. However, not implementing the process of checking
identity bands prevents nurses ensuring that a medication
chart belongs to the correct patient.
Nurse managers must ensure that guidelines and
policies are available and accessible, and encourage
their implementation. Creating suitable additional
defence barriers (for example, double checks for highrisk situations such as paediatric medications, unusual
prescriptions, similar names or packaging) could minimise
errors; however, it has also been noted that single checks
can result in fewer nurse interactions and thus fewer
distractions (Biron et al 2009, Popescu et al 2011,
Savvato and Efstratios 2014).
5 Mathematical ability Time outOn a scale of one to ten, rate your
mathematical ability. Find a good source
(online or paper) of drug calculation practice
questions to assess your calculation skills.
CANCER NURSING PRACTICE February 2015 | Volume 14 | Number 1 35
Preventing confusion
Confusion relating to poor prescriber handwriting on
medication charts can lead to administration and
pharmacy errors (Mayo and Duncan 2004, Fry and
Dacey 2007, Ulanimo et al 2007). The Care Quality
Commission has expressed concern about the illegibility
of doctors’ handwriting, stating that staff find some
handwriting difficult to decipher, posing a high risk to
patient safety (Evenstad 2014).
Several studies in hospitals have shown that medication
error rates are substantially reduced with computer order
entry programs – the process of entering medication or
physician orders electronically instead of on paper charts
(Potts et al 2004, Holdsworth et al 2007, Radley et al
2013). While using computer-based systems may not
be possible in all institutions, it remains incumbent on
prescribers to ensure their prescriptions are legible and on
nurses not to administer medication from an illegible or
confusing chart. Similarly, by ensuring medication charts
are clearly legible, and performing adequate checks, errors
resulting from confusion relating to similar drug names and
packages, as well as the misinterpretation of abbreviations,
letters and numerals, may be prevented (Lassetter and
Warnick 2003, Mayo and Duncan 2004, Fry and Dacey
2007, Ulanimo et al 2007).
Now do time out 6.
Medication errors result from a combination of factors
that often appear trivial or insignificant in isolation, but
when compounded may lead to adverse events.
To improve nurses’ knowledge of how individual factors
6 Institutional practices Time outRead the scenario described in the case study
above. Outline what steps Paige should take
to ensure her patients receive the required
intravenous medication correctly. Describe
some institutional practices that could help
prevent medication errors in the scenario.
contribute to errors and help them develop effective
strategies to prevent errors occurring, it is important
that institutions reward and encourage leaders who
demonstrate characteristics of mindfulness on all levels.
A safe reporting environment that encourages staff
engagement to identify contributory factors as well as
possible solutions must also be fostered. Extensive
organisational resources are required to enhance
communication, to reduce confusion, to improve
knowledge, skill and compliance with policies, guidelines
and standards, and to ensure that staff members are
less pressurised. Nurses and other healthcare providers
can contribute individually to patient safety by accessing
available resources that will improve their awareness
and knowledge of medication errors, encourage them to
engage in effective communication with one another and
their patients, and foster a safe reporting environment that
will enable all staff to learn from safety incidents if and
when they occur.
Now do time out 7.
7 Reflective account Time outNow that you have completed the article,
you might like to write a reflective account.
Guidelines to help you are on page 37.
Case study
Paige is a newly qualified nurse who has been seconded to a surgical ward
that is short staffed. When reviewing patients’ charts, she realises that
there are a number of intravenous (IV) antibiotic infusions to administer.
She is unfamiliar with the operation of the IV pumps used on the ward so
she tries to find someone who can show her how they are set. Everyone
seems occupied, but she eventually finds a registered nurse who is willing
to help her. The nurse hands her a manual and, then, in a rushed manner,
briefly explains how the pump is operated. Paige is still unsure about how
the pump is set, but the nurse just suggests that Paige just reads the manual.
Alvarez G, Coiera E (2005) Interruptive
communication patterns in the intensive care
unit ward round. International Journal of
Medical Informatics. 74, 10, 791-796.
Aronson J (2009) Medication errors: definitions
and classification. British Journal of Clinical
Pharmacology. 67, 6, 599-604.
Aspden P, Wolcott J, Bootman J et al (Eds)
(2006) Preventing Medication Errors. First edition.
The National Academies Press, Washington DC.
Barger LK, Lockley SW, Rajaratnam SM et al
(2009) Neurobehavioural, health, and safety
consequences associated with shift work in
safety-sensitive professions. Current Neurology
and Neuroscience Reports. 9, 2, 155-164.
Barker K, Flynn E, Pepper G (2002) Observation
method of detecting medication errors.
American Journal of Health-System Pharmacy.
59, 23, 2314-2316.
Bennett J, Harper-Femson L, Tone J et al
(2006) Improving medication administration
systems: an evaluation study. Canadian Nurse.
102, 8, 35-39.
Bindler R, Bayne T (1984) Do baccalaureate
students possess basic mathematics proficiency?
Journal of Nursing Education. 23, 5, 192-197.
Biron A, Loiselle C, Lavoie-Tremblay M (2009)
Work interruptions and their contribution to
medication administration errors. Worldviews
on Evidence-Based Nursing. 6, 2, 70-86.
Alvarez G, Coiera E (2005) Interruptive
communication patterns in the intensive care
unit ward round. International Journal of
Medical Informatics. 74, 10, 791-796.
Aronson J (2009) Medication errors: definitions
and classification. British Journal of Clinical
Pharmacology. 67, 6, 599-604.
Aspden P, Wolcott J, Bootman J et al (Eds)
(2006) Preventing Medication Errors. First edition.
National Academies Press, Washington DC.
Barger LK, Lockley SW, Rajaratnam SM et al
(2009) Neurobehavioural, health, and safety
consequences associated with shift work in
safety-sensitive professions. Current Neurology
and Neuroscience Reports. 9, 2, 155-164.
Barker K, Flynn E, Pepper G (2002) Observation
method of detecting medication errors.
American Journal of Health-System Pharmacy.
59, 23, 2314-2316.
Bennett J, Harper-Femson L, Tone J et al
(2006) Improving medication administration
systems: an evaluation study. Canadian Nurse.
102, 8, 35-39.
36 February 2015 | Volume 14 | Number 1 CANCER NURSING PRACTICE
Continuing professional development
Bindler R, Bayne T (1984) Do baccalaureate
students possess basic mathematics
proficiency? Journal of Nursing Education.
23, 5, 192-197.
Biron A, Loiselle C, Lavoie-Tremblay M (2009)
Work interruptions and their contribution to
medication administration errors. Worldviews on
Evidence-Based Nursing. 6, 2, 70-86.
Burke K (2005) Executive summary: the State of
the Science on Safe Medication Administration
symposium. American Journal of Nursing. 105,
3 Suppl, 4-9.
Cousins D, Gerrett D, Warner B (2012) A review
of medication incidents reported to the National
Reporting and Learning System in England and
Wales over 6 years (2005–2010). British Journal
of Clinical Pharmacology. 74, 4, 597-604.
Deans C (2005) Medication errors and
professional practice of registered nurses.
Collegian. 12, 1, 29-33.
Dee C, Stanley E (2005) Information-seeking
behavior of nursing students and clinical nurses:
implications for health sciences librarians.
Journal of the Medical Library Association.
93, 2, 213-222.
Estabrooks C, O’Leary K, Ricker K et al (2003)
The internet and access to evidence: how are
nurses positioned? Journal of Advanced Nursing.
42, 1, 73-81.
Evenstad L (2014) CQC Highlights Doctors’ Poor
Handwriting. tinyurl. com/mkg2zss
(Last accessed: December 29 2014.)
Fair Work Ombudsman (2014) Hours of Work. (Last accessed: December
29 2014.)
Ferner R, Aronson J (2006) Clarification of
terminology in medication errors: definitions and
classification. Drug Safety. 29, 11, 1011-1022.
Fogarty G, McKeon C (2006) Patient safety
during medication administration: the influence
of organizational and individual variables on
unsafe work practices and medication errors.
Ergonomics. 49, 5–6, 444-456.
Frankel AS, Leonard MW, Denham CR (2006)
Fair and just culture, team behavior, and
leadership engagement. Health Services Research.
41, 4 Pt 2, 1690-1709.
Frontier Economics (2014) Exploring the Costs
of Unsafe Care in the NHS. Frontier Economics,
Fry M, Dacey C (2007) Factors contributing to
incidents in medication administration. Part 2.
British Journal of Nursing. 16, 11, 676-681.
Gladstone J (1995) Drug administration errors: a
study into the factors underlying the occurrence
and reporting of drug errors in a district
general hospital. Journal of Advanced Nursing.
22, 4, 628-637.
Grandell-Niemi H, Hupli M, Leino-Kilpi H et al
(2003) Medication calculation skills of nurses
in Finland. Journal of Clinical Nursing.
12, 4, 519-528.
Greenfield S (2007) Medication error reduction
and the use of PDA technology. Journal of
Nursing Education. 46, 3, 127-131.
Hackett G, Betz N (1989) An exploration
of mathematics self-efficacy/mathematics
performance correspondence. Journal
for Research in Mathematics Education.
20, 3, 261-273.
Hedberg B, Larsson U (2004) Environmental
elements affecting the decision-making process
in nursing practice. Journal of Clinical Nursing.
13, 3, 316-324.
Hewitt P (2010) Nurses’ perceptions of the
causes of medication errors: an integrative
literature review. MEDSURG Nursing.
19, 3, 159-167.
Holdsworth M, Fichtl R, Raisch D et al (2007)
Impact of computerized prescriber order entry on
the incidence of adverse drug events in pediatric
inpatients. Pediatrics. 120, 5, 1058-1066.
Hopp P, Smith C, Clegg B et al (2005)
Interruption management: the use of attentiondirecting tactile cues. Human Factors. 47, 1, 1-11.
Jones J, Treiber L (2010) When the 5 rights
go wrong: medication errors from the nursing
perspective. Journal of Nursing Care Quality.
25, 3, 240-247.
Kazaoka T, Ohtsuka K, Ueno K et al (2007) Why
nurses make medication errors: a simulation
study. Nursing Education Today. 27, 4, 312-317.
Kosteniuk J, D’Arcy C, Stewart N et al (2006)
Central and peripheral information source use
among rural and remote registered nurses.
Journal of Advanced Nursing. 55, 1, 100-114.
Lassetter J, Warnick M (2003) Medication
errors, drug-related problems and medication
errors: a literature review on quality of care and
cost issues. Journal of Nursing Care Quality.
18, 3, 175-181.
Leape L, Bates D, Cullen D et al (1995) Systems
analysis of adverse drug events. ADE Prevention
Study Group. Journal of the American Medical
Association. 274, 1, 35-43.
Lyons M, Brown R, Wears R (2007) Factors
that affect the flow of patients through triage.
Emergency Medicine Journal. 24, 2, 78-85.
Ma X, Kishor N (1997) Assessing the relationship
between attitude toward mathematics and
achievement in mathematics: a meta-analysis.
Journal for Research in Mathematics Education.
28, 1, 26-47.
Mahmood A, Chaudhury H, Valente M (2011)
Nurses’ perceptions of how physical environment
affects medication errors in acute care settings.
Applied Nursing Research. 24, 4, 229-237.
Maricle K, Whitehead L, Rhodes M (2007)
Examining medication errors in a tertiary
hospital. Journal of Nursing Care Quality.
22, 1, 20-27.
Mayo A, Duncan D (2004) Nurse perceptions
of medication errors: what we need to know for
patient safety. Journal of Nursing Care Quality.
19, 3, 209-217.
McBride-Henry K, Foureur M (2006) Medication
administration errors: understanding the
issues. Australian Journal of Advanced Nursing.
23, 3, 33-41.
McFarlane D, Latorella K (2002) The scope and
importance of human interruption in human–
computer interaction design. Human-Computer
Interaction. 17, 1, 1-61.
Mrayyan M, Shishani K, Al-Faouri I (2007) Rate,
causes and reporting of medication errors in
Jordan: nurses’ perspectives. Journal of Nursing
Management. 15, 6, 659-670.
National Coordinating Council for Medication
Error Reporting and Prevention (2014) About
Medication Errors: What is a Medication Error?
tinyurl. com/pw76lwb (Last accessed: December
29 2014.)
National Patient Safety Agency (2007)
The Fourth Report From the Patient Safety
Observatory. NPSA, London.
National Patient Safety Agency (2012) Safe
Anaesthesia Liaison Group. Patient Safety Update.
NPSA, London.
Nicolaidou M, Philippou G (2003) Attitudes
towards mathematics, self-efficacy and
achievement in problem-solving. In Mariotti MA
(Ed) European Research in Mathematics III.
University of Pisa, Pisa.
Nursing and Midwifery Council (2010) Standards
for Medicines Management. NMC, London.
O’Leary D, Mhaolrúnaigh S (2012) Informationseeking behaviour of nurses? Journal of
Advanced Nursing. 68, 2, 379-390.
Ozkan S, Kocaman G, Ozturk C et al (2011)
Frequency of pediatric medication administration
errors and contributing factors. Journal of
Nursing Care Quality. 26, 2, 136-143.
Palese A, Sartor A, Costaperaria G et al (2009)
Interruptions during nurses’ rounds in surgical
wards: observational study. Journal of Nursing
Management. 17, 2, 185-192.
Pape T, Guerra D, Muzquiz M et al (2005)
Innovative approaches to reducing nurses’
distractions during medication administration.
Journal of Continuing Education in Nursing.
36, 3, 108-116.
Petrova E (2010) Nurses’ perceptions of
medication errors in Malta. Nursing Standard.
24, 33, 41-48.
Popescu A, Currey J, Botti M (2011)
Multifactorial influences on and deviations from
medication administration safety and quality in
the acute medical surgical context. Worldviews on
Evidence-Based Nursing. 8, 1, 15-24.
Potts A, Barr F, Gregory D et al (2004)
Computerized physician order entry and
medication errors in a pediatric critical care
unit. Pediatrics. 113, 1 Pt 1, 59-63.
Pravikoff D, Tanner A, Pierce S (2005)
Readiness of US nurses for evidence-based
practice. American Journal of Nursing.
105, 9, 40-51.
Radley D, Wasserman M, Olsho L et al (2013)
Reduction in medication errors in hospitals due
to adoption of computerized provider order
entry systems. Journal of the American Medical
Informatics Association. 20, 3, 470-476.
Rajaratnam SM, Howard ME, Grunstein RR
(2013) Sleep loss and circadian disruption in
shift work: health burden and management.
Medical Journal of Australia. 199, 8, S11-S15.
Reason JT (1990) Human Error. Cambridge
University Press, Cambridge.
Rogers AE, Hwang W, Scott LD et al (2004)
The working hours of hospital staff nurses and
patient safety. Health Affairs. 23, 4, 202-212.
Roughead L, Semple S, Rosenfeld E (2013)
Literature Review: Medication Safety in Australia.
Australian Commission, Sydney NSW.
Royal College of Nursing (2014) How Do Working
Time Regulations Affect Me? rcn-wtr
(Last accessed: December 29 2014.)
Sammer C, Lykens K, Singh K et al (2010)
What is patient safetyculture? A review of
the literature. Journal of Nursing Scholarship.
42, 2, 156-165.
Sandwell M, Carson P (2005) Developing
numeracy in child branch students.
Paediatric Nursing. 17, 9, 24-26.
Savvato K, Efstratios A (2014) An inside look
into the factors contributing to medication
errors in the clinical nursing practice.
Health Science Journal. 8, 1, 32-44.
Seki Y, Yamazaki Y (2006) Effects of working
conditions on intravenous medication errors
in a Japanese hospital. Journal of Nursing
Management. 14, 2, 128-139.
Spencer R, Coiera E, Logan P (2004) Variation
in communication loads on clinical staff in the
emergency department. Annals of Emergency
Medicine. 44, 3, 268-273.
Stimpfel AW, Sloane DM, Aiken LH (2012) The
longer the shifts for hospital nurses, the higher
the levels of burnout and patient dissatisfaction.
Health Affairs. 31, 11, 2501-2509.
Suzuki K, Ohida T, Kanieta Y et al (2005)
Daytime sleepiness, sleep habits and
occupational accidents among hospital nurses.
Journal of Advanced Nursing. 52, 4, 447-453.
Tang F, Sheu S, Yu S et al (2007) Nurses
relate the contributing factors involved in
medication errors. Journal of Clinical Nursing.
16, 3, 447-457.
Thompson C, McCaughan D, Cullum N et al
(2001) Research information in nurses’ clinical
decision-making: what is useful? Journal of
Advanced Nursing. 36, 3, 376-388.
Thompson C, Cullum N, McCaughan D et al
(2004) Nurses, information use, and clinical
decision making – the real world potential for
evidence-based decisions in nursing.
Evidence-Based Nursing. 7, 3, 68-72.
Tucker A, Spear S (2006) Operational failures
and interruptions in hospital nursing.
Health Services Research. 41, 3 Pt 1, 643-662.
Ulanimo V, O’Leary-Kelley C, Connolly P (2007)
Nurses’ perceptions of causes of medication
errors and barriers to reporting. Journal of
Nursing Care Quality. 22, 1, 28-33.
Vagliardo JJ, Schmittau J (2008) Mapping
Cantor’s dust: mathematical understanding
of nursing students. In Cañas A, Novak J,
Reiska P et al (Eds) Concept Mapping. tinyurl.
com/kwhzxsj (Last accessed: December 29 2014.)
Valentin A, Capuzzo M, Guidet B et al (2009)
Errors in the administration of parenteral drugs
in intensive care units: multinational prospective
study. British Medical Journal. 338, b814.
Walsh KA (2008) The relationship among
mathematics anxiety, beliefs about mathematics,
mathematics self-efficacy, and mathematics
performance in associate degree nursing students.
Nursing Education Perspectives. 29, 4, 226-229.
Westbrook JI, Woods A, Rob MI et al (2010)
Association of interruptions with an increased
risk and severity of medication administration
errors. Archives of Internal Medicine.
170, 8, 683-690.
Wickens CD, Hollands JG (2000) Engineering
Psychology and Human Performance.
Prentice Hall, Upper Saddle River NJ.
World Health Organization (2009a) Topic 11:
improving medication safety. In WHO Patient
Safety. WHO, Geneva.
World Health Organization (2009b) Human
Factors in Patient Safety: Review of Topics and
Tools. WHO, Geneva.
Worrell PJ, Hodson KE (1989) Posology: the
battle against drug calculation errors.
Nurse Educator. 14, 2, 27-31.
Wright K (2004) An investigation to find
strategies to improve student nurses’
maths skills. British Journal of Nursing.
13, 21, 1280-1287.
Wright K (2005) An exploration into the most
effective way to teach drug calculation skills
to nursing students. Nurse Education Today.
25, 6, 430-436.
Wright K (2007) Student nurses need more
maths to improve their drug calculating skills.
Nurse Education Today. 27, 4, 278-285.

Get Professional Assignment Help Cheaply

Buy Custom Essay

Don't use plagiarized sources. Get Your Custom Essay on
Reducing medication errors in nursing practice
Just from $10/Page
Order Essay

Are you busy and do not have time to handle your assignment? Are you scared that your paper will not make the grade? Do you have responsibilities that may hinder you from turning in your assignment on time? Are you tired and can barely handle your assignment? Are your grades inconsistent?

Whichever your reason is, it is valid! You can get professional academic help from our service at affordable rates. We have a team of professional academic writers who can handle all your assignments.

Why Choose Our Academic Writing Service?

  • Plagiarism free papers
  • Timely delivery
  • Any deadline
  • Skilled, Experienced Native English Writers
  • Subject-relevant academic writer
  • Adherence to paper instructions
  • Ability to tackle bulk assignments
  • Reasonable prices
  • 24/7 Customer Support
  • Get superb grades consistently

Online Academic Help With Different Subjects


Students barely have time to read. We got you! Have your literature essay or book review written without having the hassle of reading the book. You can get your literature paper custom-written for you by our literature specialists.


Do you struggle with finance? No need to torture yourself if finance is not your cup of tea. You can order your finance paper from our academic writing service and get 100% original work from competent finance experts.

Computer science

Computer science is a tough subject. Fortunately, our computer science experts are up to the match. No need to stress and have sleepless nights. Our academic writers will tackle all your computer science assignments and deliver them on time. Let us handle all your python, java, ruby, JavaScript, php , C+ assignments!


While psychology may be an interesting subject, you may lack sufficient time to handle your assignments. Don’t despair; by using our academic writing service, you can be assured of perfect grades. Moreover, your grades will be consistent.


Engineering is quite a demanding subject. Students face a lot of pressure and barely have enough time to do what they love to do. Our academic writing service got you covered! Our engineering specialists follow the paper instructions and ensure timely delivery of the paper.


In the nursing course, you may have difficulties with literature reviews, annotated bibliographies, critical essays, and other assignments. Our nursing assignment writers will offer you professional nursing paper help at low prices.


Truth be told, sociology papers can be quite exhausting. Our academic writing service relieves you of fatigue, pressure, and stress. You can relax and have peace of mind as our academic writers handle your sociology assignment.


We take pride in having some of the best business writers in the industry. Our business writers have a lot of experience in the field. They are reliable, and you can be assured of a high-grade paper. They are able to handle business papers of any subject, length, deadline, and difficulty!


We boast of having some of the most experienced statistics experts in the industry. Our statistics experts have diverse skills, expertise, and knowledge to handle any kind of assignment. They have access to all kinds of software to get your assignment done.


Writing a law essay may prove to be an insurmountable obstacle, especially when you need to know the peculiarities of the legislative framework. Take advantage of our top-notch law specialists and get superb grades and 100% satisfaction.

What discipline/subjects do you deal in?

We have highlighted some of the most popular subjects we handle above. Those are just a tip of the iceberg. We deal in all academic disciplines since our writers are as diverse. They have been drawn from across all disciplines, and orders are assigned to those writers believed to be the best in the field. In a nutshell, there is no task we cannot handle; all you need to do is place your order with us. As long as your instructions are clear, just trust we shall deliver irrespective of the discipline.

Are your writers competent enough to handle my paper?

Our essay writers are graduates with bachelor's, masters, Ph.D., and doctorate degrees in various subjects. The minimum requirement to be an essay writer with our essay writing service is to have a college degree. All our academic writers have a minimum of two years of academic writing. We have a stringent recruitment process to ensure that we get only the most competent essay writers in the industry. We also ensure that the writers are handsomely compensated for their value. The majority of our writers are native English speakers. As such, the fluency of language and grammar is impeccable.

What if I don’t like the paper?

There is a very low likelihood that you won’t like the paper.

Reasons being:

  • When assigning your order, we match the paper’s discipline with the writer’s field/specialization. Since all our writers are graduates, we match the paper’s subject with the field the writer studied. For instance, if it’s a nursing paper, only a nursing graduate and writer will handle it. Furthermore, all our writers have academic writing experience and top-notch research skills.
  • We have a quality assurance that reviews the paper before it gets to you. As such, we ensure that you get a paper that meets the required standard and will most definitely make the grade.

In the event that you don’t like your paper:

  • The writer will revise the paper up to your pleasing. You have unlimited revisions. You simply need to highlight what specifically you don’t like about the paper, and the writer will make the amendments. The paper will be revised until you are satisfied. Revisions are free of charge
  • We will have a different writer write the paper from scratch.
  • Last resort, if the above does not work, we will refund your money.

Will the professor find out I didn’t write the paper myself?

Not at all. All papers are written from scratch. There is no way your tutor or instructor will realize that you did not write the paper yourself. In fact, we recommend using our assignment help services for consistent results.

What if the paper is plagiarized?

We check all papers for plagiarism before we submit them. We use powerful plagiarism checking software such as SafeAssign, LopesWrite, and Turnitin. We also upload the plagiarism report so that you can review it. We understand that plagiarism is academic suicide. We would not take the risk of submitting plagiarized work and jeopardize your academic journey. Furthermore, we do not sell or use prewritten papers, and each paper is written from scratch.

When will I get my paper?

You determine when you get the paper by setting the deadline when placing the order. All papers are delivered within the deadline. We are well aware that we operate in a time-sensitive industry. As such, we have laid out strategies to ensure that the client receives the paper on time and they never miss the deadline. We understand that papers that are submitted late have some points deducted. We do not want you to miss any points due to late submission. We work on beating deadlines by huge margins in order to ensure that you have ample time to review the paper before you submit it.

Will anyone find out that I used your services?

We have a privacy and confidentiality policy that guides our work. We NEVER share any customer information with third parties. Noone will ever know that you used our assignment help services. It’s only between you and us. We are bound by our policies to protect the customer’s identity and information. All your information, such as your names, phone number, email, order information, and so on, are protected. We have robust security systems that ensure that your data is protected. Hacking our systems is close to impossible, and it has never happened.

How our Assignment Help Service Works

1. Place an order

You fill all the paper instructions in the order form. Make sure you include all the helpful materials so that our academic writers can deliver the perfect paper. It will also help to eliminate unnecessary revisions.

2. Pay for the order

Proceed to pay for the paper so that it can be assigned to one of our expert academic writers. The paper subject is matched with the writer’s area of specialization.

3. Track the progress

You communicate with the writer and know about the progress of the paper. The client can ask the writer for drafts of the paper. The client can upload extra material and include additional instructions from the lecturer. Receive a paper.

4. Download the paper

The paper is sent to your email and uploaded to your personal account. You also get a plagiarism report attached to your paper.

smile and order essay GET A PERFECT SCORE!!! smile and order essay Buy Custom Essay

Place your order
(550 words)

Approximate price: $22

Calculate the price of your order

550 words
We'll send you the first draft for approval by September 11, 2018 at 10:52 AM
Total price:
The price is based on these factors:
Academic level
Number of pages
Basic features
  • Free title page and bibliography
  • Unlimited revisions
  • Plagiarism-free guarantee
  • Money-back guarantee
  • 24/7 support
On-demand options
  • Writer’s samples
  • Part-by-part delivery
  • Overnight delivery
  • Copies of used sources
  • Expert Proofreading
Paper format
  • 275 words per page
  • 12 pt Arial/Times New Roman
  • Double line spacing
  • Any citation style (APA, MLA, Chicago/Turabian, Harvard)

Our guarantees

Delivering a high-quality product at a reasonable price is not enough anymore.
That’s why we have developed 5 beneficial guarantees that will make your experience with our service enjoyable, easy, and safe.

Money-back guarantee

You have to be 100% sure of the quality of your product to give a money-back guarantee. This describes us perfectly. Make sure that this guarantee is totally transparent.

Read more

Zero-plagiarism guarantee

Each paper is composed from scratch, according to your instructions. It is then checked by our plagiarism-detection software. There is no gap where plagiarism could squeeze in.

Read more

Free-revision policy

Thanks to our free revisions, there is no way for you to be unsatisfied. We will work on your paper until you are completely happy with the result.

Read more

Privacy policy

Your email is safe, as we store it according to international data protection rules. Your bank details are secure, as we use only reliable payment systems.

Read more

Fair-cooperation guarantee

By sending us your money, you buy the service we provide. Check out our terms and conditions if you prefer business talks to be laid out in official language.

Read more
error: Content is protected !!
Open chat
Need assignment help? You can contact our live agent via WhatsApp using +1 718 717 2861

Feel free to ask questions, clarifications, or discounts available when placing an order.
  +1 718 717 2861           + 44 161 818 7126           [email protected]
  +1 718 717 2861         [email protected]