Medication errors in nursing: causes, classification, and prevention

Introduction
The saying, to err is human, means humans are prone to error. While health professionals are trained to be precise, careful, and to follow regulations and codes of conduct, they can still make mistakes. One of the most important parts of patient care and healing is the execution of medical orders. Nurses are normally in charge of executing medical orders. The performance of nurses is partly judged on how they execute medical orders. The correct execution of orders is also important for patient safety. An error in medication can massively negatively affect patient safety.
Additionally, it can increase the cost of treatment and lead to death. Because medication errors can significantly negatively affect patients, nurses have to be very careful when giving medicine. Otherwise, their action or actions can result in death, increased medical expenses, or extended hospital stays (Cheragi et al., 2013).
By definition, a medication error is an error when giving medicine that can potentially harm a patient. Medication errors can happen: when deciding medicine to give and the dosage (prescribing errors include overprescribing, under prescribing, ineffective prescribing, inappropriate prescribing, irrational prescribing); when manufacturing formulations (misleading packaging, wrong packaging, wrong strength, the introduction of contaminants); when dispensing formulations (wrong labeling, wrong formulation, wrong drug); when administering medicine (wrong duration, wrong frequency, wrong route, wrong dose); and when monitoring therapy (failure to change or stop therapy, wrong alteration of therapy) (Cheragi et al., 2013).
According to studies, out of every one hundred medication administrations, approximately five are medication errors that can cause injury. In hospitals, medication errors vary from 6.5 cases for every 100 non-obstetric admissions to approximately one error for every patient every day. Within hospital settings, medication errors usually occur in ICU departments. According to one study, medication errors occur more in teaching hospitals and less in community hospitals. However, this finding may be because teaching hospitals are under more scrutiny and tighter controls than community hospitals. And they also generally receive more patients (Cheragi et al., 2013). Common Medication Errors For every medicine administered, it must follow a medication chain that starts when the medication order is given (prescription is written) to when the patient receives and uses the drug. Since several steps within the chain mentioned above present multiples error opportunities, there is a demand for efforts to prevent medication errors to minimize healthcare costs, reduce the length of hospitalizations, and cut patient morbidity.
There exists a psychology-based classification system that allows the medication-error categorization and quantification, and the development of relevant strategies to reduce them. According to the classification system, a medication error can be a lapse, a slip, or a mistake. Additionally, it can also be categorized as per the location where it occurred within the medication chain. In other words, a medication error can be classified as a prescribing error, a dispensing error, or an administration error (Aronson, 2009).
By definition, a prescribing error is simply the wrong drug selection. A drug selection or prescription for a patient can be wrong if the indication, the quantity, or the dose is incorrect. It can also be wrong is the drug is contraindicated. Prescribing errors typically happen when medical professionals have little or no knowledge of the patient details or the prescribed drug. Factors that increase the likelihood of prescription errors include lack of knowledge, poor mental and physical wellbeing, poor communications within medical teams, poor work environment, and excess workload.
Organizational factors like lack of awareness about errors, poor medical team leadership, lack of seriousness when prescribing medication, and insufficient training have also been identified as contributors to prescribing errors. According to researchers, prescribing errors are estimated at 11 percent in primary care. Poor communication amid secondary and primary care is also a big contributor to prescribing errors. It has been approximated that more than 50 percent of patients fail to take the right medicine within a month of being discharged from a primary care facility (Marvanova & Henkel, 2018).
By definition, dispensing errors are errors that occur in the process of dispensing. A dispensing error can occur when a pharmacy is receiving a prescription or when a dispensed prescription drug is being supplied to a patient. The rate of occurrence of dispensing errors is between one to 24 percent, and it can also include the selection of the wrong medicine or wrong strength product at the pharmacy.
TO illustrate the above point, consider for example, if two drugs have similar names or pronunciations, they could be confused when dispensing medicine, especially when prescription orders are handwritten. For example, across the United States, two different drugs, Losec and Lasix, are confusing, yet they are different drugs. The former is omeprazole, while the latter is a frusemide. The confusion of these two different drugs caused several fatalities resulting in the FDA (Food and Drug Administration) ordering Losec to change its name (Marvanova & Henkel, 2018).
By definition, administration errors are medication errors that occur when there is a difference between a drug therapy ordered by a prescriber and the drug given to a patient. Drug administration is probably the biggest risk area in nursing. This is the reason why nursing education is largely about teaching nursing students the 'five rights,' which is "giving the right dose of the right drug to the right patient at the right time by the right route." The leading cause of drug administration errors is the error of omission, the lack of drug administration for one reason or the other (Marvanova & Henkel, 2018). Causes of Medication Errors The leading cause of medication errors is a distraction. According to various studies, approximately 75 percent of medication errors are caused by distraction. Medical doctors have many duties in hospitals. They have to examine patients, order tests, speak to patients, visit patients in wards, speak to patient family members, communicate with insurance providers, and so on. And in the middle of doing all the above, they have to prescribe medicine, which they often do in a hurry. The many distractions can make them write wrong or incorrect drugs when prescribing them to a patient. This does not take place frequently, but it does occur (Tariq & Scherbak, 2019).
Distortions also lead to medication errors. Most distortions are caused by poor translation, utilization of abbreviations, misunderstood symbols, and poor writing. Many healthcare professionals working in the United States are from different countries around the world. The ones who are still new, often order medications by brand name. And when such medications are not available, they ask pharmacists or nurses to substitute them with similar drugs. This sort of direction can also result in distortion leading to a medication error because drug substitution can only be done by a subscribing practitioner (Tariq & Scherbak, 2019).
Poor writing is also one of the leading causes of medication errors. Physicians are renowned for their bad writing, which they attribute to being in a hurry. Poor writing of prescriptions can result in wrong interpretations or guesswork by pharmacists or nurses, resulting in the dispensing of wrong or incorrect drugs. Nurses or pharmacists usually have to guess what a doctor was saying when the doctor's writing is poor. This is the reason why many hospital administrations ask pharmacists and nurses to call doctors and confirm medications in case they cannot read their prescriptions. Many hospital administrations also require the typing out of prescriptions to ensure they cannot be easily misinterpreted (Tariq & Scherbak, 2019).
Writing diagnosis or the indication for a drug is quite important. This is because most drugs have several uses. However, most medical prescribers usually do not write the diagnosis of prescription documents. The omission of this information sometimes leads to complications. By indicating the diagnosis, pharmacists will know how to explain the usage of the medicine they are dispensing, and the patient will be reminded of the express usage of the medicine they are using. The simple act of writing a diagnosis can, therefore, reinforce a patient's drug therapy plan and ensure a patient gets the education they need about a drug and its usage. It also enables pharmacists or nurses to dispense medication with complete knowledge of what they are doing rather than guessing the exact usage and the purpose (Tariq & Scherbak, 2019). Prevention of Medication Errors Medication prescribers should do all in their power to prevent medication errors. This is because prescribers, either directly or indirectly, cause most medication errors. Prescribing clinicians can help prevent medication errors by making the best evidence-based decisions for all patients, by recommending the most appropriate medications for patients, and by taking into account the potential benefits, potential risks, and the dosing of the medication they are prescribing.
When giving medication, they also have to make sure they have the right information and all the data they require about a patient and their clinical history, including any drugs they may be taking or have taken recently. They also have to take into account allergies and use of designer drugs, if any (Hughes & Ortiz, 2005). If prescribers do all these things and are careful when prescribing medicines, medication errors can significantly reduce.
Individuals charged with the responsibility of dispensing medication also have a role to play in reducing medication errors. They can do so by reviewing prescriptions and their suitability based on diagnoses, test results, symptoms, allergies, and other medications. In case they have doubts, they should contact prescribers immediately for clarification. It is up to these persons to ensure the appropriate drug is given in the right form and the right dose at the right time at the right frequency and the right route. They must also be sure that the drugs they are dispensing are the right drugs (Hughes & Ortiz, 2005).
Additionally, patients play a role in preventing medication errors as well. They must question why they are receiving a certain medication and verify whether it is the right medication being given in the right dose and the right route. They must also be alert when they are prescribed medicines and inform clinicians of their allergies and any drugs they are taking. However, patients usually do not do these things because they are not actively engaged. Sometimes due to pain or lack of consciousness, patients cannot be engaged properly. Therefore, the role that patients can play in preventing medication errors is usually not played at all (Hughes & Ortiz, 2005).
A patient-centered approach should be adopted to reduce medication errors. This is, of course, if it is evidence-based. By putting patients first, hospital administrations can reduce incidences of medication errors. Patient-centered approaches that include open communication can help to improve decision making during prescribing and ensure patients receive the right drugs.
It can also help to establish better communication and cooperation between medical professionals and patients to increase their partnership. Medical providers exist to help patients and, therefore, any approach that involves patients working more closely with medical providers is welcome because it is essentially helping patients to help themselves (Hughes & Ortiz, 2005).

References Aronson, J. K. (2009). Medication errors: what they are, how they happen, and how to avoid them. QJM: An International Journal of Medicine, 102(8), 513-521. Cheragi, M. A., Manoocheri, H., Mohammadnejad, E., & Ehsani, S. R. (2013). Types and causes of medication errors from the nurse's viewpoint. Iranian journal of nursing and midwifery research, 18(3), 228–231. Hughes, R. G., & Ortiz, E. (2005). Medication Errors: Why they happen and how they can be prevented. Journal of infusion nursing, 28, 14-24. Marvanova, M., & Henkel, P. J. (2018). Collaborating on medication errors in nursing. The clinical teacher, 15(2), 163-168. Tariq, R. A., & Scherbak, Y. (2019). Medication errors. In StatPearls [Internet]. StatPearls Publishing.