Planning and problem-solving strategies for medication errors in ICU settings

Medication Errors Including Look-Alike Sound-Alike Drugs in an ICU

People mistakes. This is true in every field and in every job. But in certain areas, mistakes can be costly, even deadly. Medication errors happen because sometimes staff at the medical facility or hospital see drug names that not just look alike, but also sound alike. Statistics point to only 0-2% detection rate of medication errors and prescribing errors. Although over 34% of adverse events happen when it comes to medication errors and over a half for prescribing errors, the very low detection rate presents problems. Medication safety, patient safety should be paramount especially in ICU conditions where the health of patients is at best stable, at worst at the brink of death.

To prevent things like accidental overdose, allergic reactions, or other complications resulting from medication errors, a possible solution is renaming drugs, especially those that have to be injected. Surveys nationwide suggest medication errors are due in part to the wide range of formulations available of the same drug that may be packaged differently and may lead to wrong dosage, rapid administration of medication, and wrong route. Changing the names as well as increasing medical personnel awareness of such inconsistencies and variations may lead to a reduction medication errors.

Initiatives to reduce Medication errors

Some initiatives involve standardization of equipment like utilization of smart pumps. Smart pumps come with DERS or dose error reduction software and lessen the occurrence of improper dosage administration when it comes to injectable medication. These are not only able to reduce dosage problems, but will less the burden placed on medical personnel to remember exact dosage, which often happens when dealing with numerous patients throughout their shift. It's a solution that uses new and innovative software, reducing human error. Other solutions involve recommendations like: "national recommendations for injectable medicines and the promotion of drug concentration standardization" (Upton & Quinn, 2013, p. 4).

Smart pumps offer a solution to dosage but do not offer a solution to concentration as some drug formulations are stronger than others. So even if proper dosage was administered, potential adverse reactions may happen, especially in unstable patients treated in ICU. The national recommendations aspect of the initiatives not only brings awareness to medical personnel of dosage, but also helps staff become knowledgeable on the kind of drugs out there as well as how much of each drug should be administered. "…hospitals should use double checking systems such as an independent check by another practitioner, and dose checking software in smart infusion pumps and syringe drivers, uptake of smart pump technology in Europe remains low compared with the U.S.A." (Upton & Quinn, 2013, p. 7).

Five Part Intervention, does it decrease omitted medications?

Even though new technology exists, software, like smart pumps that control dosing, there are still other facets to the problem of medication errors. "Nursing administrators reported that medication administration errors had continued despite the use of bar code medication administration, especially in terms of omitted medications"(Pape, 2013, p. 211). In order for medical personnel to better handle things like omitted medications, they have to adopt a system that will help them of what they are doing. A system that can minimize distractions. An article by Pape, suggest use of a five-part intervention system.

This five-part intervention system is meant to allow nurses to remove the common things that may cause medication administration errors, like distractions, and interruptions. Especially in the case with similar medications that sound and look the same, these errors can happen the highest. Pape suggests the system is a conclusive solution in minimizing error because it allows nurses to increase awareness of what they are doing at the present time as well as check for situations that may increase mistakes like when conversing or discussing things with patients or medical staff. The intervention's findings prove the system works at reducing medication administration errors. "The five-part intervention decreased nurses interruptions and distractions by 84% compared with the control group. The results indicated the type of distractions and interruptions nurses typically experience during medication administration was highest from conversation in the environment and by other personnel" (Pape, 2013, p. 211).

The effect of proximity

An article from Irwin et al. offered a solution of using Tall man lettering when it came to seeing drug names and doses. Although a promising solution, the effect was marginal at best with results concluding Tall man lettering had no positive effects. "The presence of multiple similarly named medications in close proximity to a target medication increases the difficulty of the visual search for the target. Tall Man lettering has no impact on this adverse effect" (Irwin, Mearns, Watson & Urquhart, 2012, p. 253). Medical personnel often have to strain when looking at the names and doses of medications and although change in text may seem like an obvious solution in terms of increasing the text size and even font, what could be more useful is a color coding solution.

People can recognize certain colors more than others. If drug labels are redesigned with dosage in a different color or size, this may help medical personnel distinguish medications more easily. Especially for patients with chronic disease, taking medication becomes frequent, increasing the risk for error. Another solution offered that minimizes medication administration error is a medication dispenser. It can be pre-filled and allows more time for medical personnel to check if the medication is properly dosed and is the correct medication for the patient. "A medication dispenser is a device that delivers medication to the patient according to predetermined schedules; it is considered a very efficient device of improving medication adherence" (Pak & Park, 2012, p. 2). Solutions like these improve efficacy and reduce rate of error for medications that look and sound similar.

Look alike and sound alike medicines, solutions