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Preventing Medication Errors
Overview: Medication Errors
According to the National Coordinating Council for Medication Error
Reporting and Prevention (NCC MERP), a medication error is “any
preventable event that may cause or lead to inappropriate medication
use or patient harm while the medication is in the control of the health
care professional, patient, or consumer.” Medication errors impede
pharmacotherapeutic outcomes, and can cause serious illness or
death. Furthermore, medication errors can lead to litigation against the
nurse, physician, or health care agency. Despite extensive efforts on
the part of health care providers, medication error rates in
communities, hospitals, and homes are increasing.
Factors leading to medication errors include the following:
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Omission of one of the five rights of drug administration. (The
five rights of medication administration: 1) Right Patient 2)
Right Route 3) Right Dose 4) Right Time 5) Right Medication.)
Failure to perform a system check within an agency. Pharmacists
and nurses must collaborate on checking the accuracy and
appropriateness of drug orders before they are administered to
patients.
Failure to take patient variables, such as recent changes in renal
or hepatic function, into account. Nurses should always review
recent laboratory data and other information in the patient’s
chart before administering medications.
Giving medications based on verbal orders, over the phone or at
bedside, that might be misinterpreted or go undocumented.
Nurses should remind the prescriber that medication orders
must be in writing before they can be administered.
Giving medications based on an incomplete order or an illegible
order, where the nurse is unsure of the correct drug, dosage, or
administration method. Incomplete orders should be clarified
with the prescriber before the medication is administered.
Drug names that have been mistaken for one another, including
look-alike and sound-alike name pairs.
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Because lack of knowledge about medications is a cause for errors, it
is important that nurses remain current in pharmacotherapeutic.
Nurses should never administer any medication with which they are
unfamiliar, as it is considered an unsafe practice. There are many
avenues by which the nurse can obtain medication knowledge and
updates. Current drug references should be available on every nursing
unit. Other medication sources are available on the Internet and in
nursing journals. It is recommended that nurses familiarize themselves
with research on medical errors and how they can be prevented.
Reporting Medication Errors
There has been some hesitation in reporting medication errors in the
nursing profession. Most nurses fear humiliation from superiors and
their peers when reporting medication errors, although it is the nurse’s
ethical and legal responsibility to document such occurrences.
Unreported errors can affect the health of patients and cause legal
ramifications for the nurse. In severe cases, adverse reactions caused
by medication errors might require the initiation of lifesaving
interventions for the patient. After such an event, the patient may
need intense supervision and additional medical treatments.
The Food and Drug Administration (FDA) is concerned with medication
errors at the federal level. The FDA requests that nurses and other
health care providers report medication errors in order to build a
database that can be used to assist other professionals in avoiding
these mistakes. Medication errors, or situations that can lead to errors,
may be reported in confidence directly to the FDA by telephone at 1–
800–23–ERROR.
A second organization that has been established to provide assistance
on the subject of medication errors is the National Coordinating
Council for Medication Error Reporting and Prevention (NCC MERP).
This organization was formed by the U.S. Pharmacopoeia Convention
in 1995, to help examine interdisciplinary causes of medication errors
and promote medication safety. The telephone number for NCCMERP is
1–800–822–8772.
Preventing Medication Errors
What can the nurse do in the clinical setting to prevent medication
errors? The nurse can begin by using the four steps of the Nursing
Process:
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1. Assessment Ask the patient about allergies to food or
medications, current health concerns, and use of OTC
medications and herbal supplements. Ensure that the patient is
receiving the right dose, at the right time, and by the right
route. Assess renal and liver function, as well as other body
systems impairments that might impact pharmacotherapy.
2. Planning Have the patient state the prescribed outcome of the
medication, including the right time to take medication and the
right dose.
3. Implementation Advise the patient to take medication as
prescribed and to question the nurse if medications “look
different” (different color, larger pill).
4. Evaluation Assess whether the expected outcomes of
pharmacotherapy have been achieved and whether the patient
encountered adverse reactions.
One of the best preventative practices is to educate patients about
their medications. When patients are knowledgeable about the
outcomes of pharmacotherapy, errors decrease. Teaching methods can
include written handouts and audiovisual teaching aids on medications
(at a reading level and language the patient can understand) and
contact information for health care providers who should be notified in
the event of adverse reactions. Nurses should collaborate with other
health care providers and agencies to seek means of medication error
reduction. Examples of common errors that can be fixed by changing
policies and procedures within an institution include the following:
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Improper storage of medication
Use of time-expired medications
Transfer of doses from one container to another
Overstocking of medications
Legal Considerations
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Each board of nursing has a provision regarding what medication
the registered nurse administers and how.
Each provision is sourced and referenced with the date.
These provisions are updated and revised as needed by
practicing nurses to state boards.
To protect consumers, standards of care are adopted by
individual nursing organizations, such as the Intravenous
Nurses Society (INS).
Many individual institutions adopt standards of care for their
policies and procedures.
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Medication errors are classified by NCC MERP in two categories:
medication errors that cause harm and those that do not.
Age-Related Issues in Drug Administration
The Pediatric Population
Always check identification bracelets prior to drug
administration.
• Most neonates’ identification bracelets are on their ankles.
• Verify safe dose of medications prescribed prior to
administration.
• Communication is essential in pediatric drug administration;
notify physician if order is incomplete or not legible.
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The Elderly Population
Always check identification bracelets prior to drug
administration, sometimes repeating the patient’s name. (This
might not be as helpful in identifying this population of patients
due to possible alteration in thought processes.)
• Asking this phrase may be helpful for alert patients: “Can you
tell me your name?”
• Remember that medications have the ability to cause adverse
effects in this population due to slowed ability to absorb and
metabolize medications.
• Monitor drug levels and current lab values for prevention of
adverse effects.
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