Strategies for preventing medication errors in clinical practice

¶ … Preventing Medication Errors

Definition of Mediation Errors (National Coordinating Council for Medication Error Reporting and Prevention)

Medication Errors by Medical Staff

Right Drug

Right Dose

Right Patient

Right Time

Right Route

Medication Errors Made by the Patient at home

Preventing Medication Errors at the Pharmacy

Strategies for Hospitals to improve patient outcome and decrease medication errors.

The National Coordinating Council for Mediation Error Reporting and Prevention defines a medication error as "Any preventable event that may cause or lead to in appropriate mediation use of patient harm while the medication is under the control of the health care professional, patient, or consumer. Such event may be related to professional practice, health care products, procedures, and systems, including prescribing; order communication, product labeling, packaging and nomenclature; compounding; dispensing; distribution; administration; education monitoring and use."

Medication errors by Nurses

It is the legal responsibility of all nurses to apply the five rights of administering medication. This is known as a standard of care.

1. Right drug

Ways of preventing the wrong drug being administered include:

Verbal orders should always be repeated to the person giving them

Do not use product or dosage abbreviations

Make sure you have the "route" of administration correct

Trailing zeros should never be used (30 is correct, not 30.0)

Never guess at illegible orders

If there is any question ask the doctor or pharmacist

Check the medication label and dosage against the written order three times before giving it

Always know what the drug's intended use for the patient

2. Right Dose

Medication errors are often made due to math errors in calculation. To remedy many of these errors always have a second person verify the calculations and final dosage. Wrong dosages are often ordered if the patient's age, size and vital signs have not been properly assessed. The nurse has a responsibility to assess these prior to giving the medication.

3. Right Time

The nurse can assist in avoiding mediation problems by adhering to the appropriate schedules. Some drugs may interfere with other drugs or there may be a drug-food interaction.

4. Right Route

Medication errors occur frequently due to negligent route administration. This is especially true with IV or injected drugs that could also be taken orally. The nurse must be sure of the route of administration before giving it to the patient. This could be a deadly mistake.

5. Right Patient

Administering medication to the wrong patient happens much too often. It is essential that the patient's ID bracelet be checked; along with having the patient state his/her name. (Kathy Quan)

Medication doses should always be given at the scheduled time unless there are questions or problems to be resolved. Medicines should only be removed from their packaging or labeling immediately prior to giving it. Nurses must document as soon as drug is given.

(Davis NM, Cohen MR)

Medication Errors Made by the Patient

Some patients have a problem swallowing pills and they attempt to crush, break, chew or dissolve the pill in water. Many pills have a long acting effect and by doing this it could cause a severe reaction by releasing too fast. A remedy for this occurrence would be patient education and getting a history of medication problems (ingestion) and previous compliance. Many drugs come in a liquid form, which could be tolerated better than a pill form.

Patients like to keep old medications past their expiration date and use them instead of calling the doctor. Toxicity can occur with some outdated medicines. Again, patient education is most valuable tool.

Patients with multiple problems and numerous medicines, in addition to different doctors/specialists will often get confused regarding which is the current prescribed medication and may be taking 2 or more medicines for the condition. The patient should be taught to take ALL medications (including over the counter and herbal products) to each and every doctor's visit for review by the physician or nurse. (Institute for Safe Medication Practices)

Many medication errors by the patient occur because they do not know about the drugs they are taking. Nurses can help to identify these gaps and provide education and written materials for the patient.

Medication errors could be greatly reduced if the patient was taught to:

1. Inform doctors of all allergies and any previous reactions to drugs

2. Ask the doctors and pharmacist about prescribed medications in layman terms

3. If English is not the first language always take an interpreter

4. Most important is to be active participant in the health care team. (Woolston, Chris)

Patients in the hospital can help avoid medication errors by:

1. When receiving a new medication, ask what it is and what is for, who ordered it and how often it is given.

2. Always make sure your ID bracelet is checked and state your name to the nurse.

3. Read the name on the IV bag or have someone read it to you.

4. If your pill looks different. Do not be afraid to question it.

Preventing Medication Errors at the Pharmacy

Many of the medication errors made in the pharmacy could be improved by having a strong relationship with the doctors and patient. (Christine Stencel, Media Relations Officer, Institute of Medicine, Board on Health Care Services, Report 2004 by the Committee on Identifying and Preventing Medication Errors)

New computerized systems for prescribing drugs will reduce medication errors. It eliminates the need for hand written prescriptions which can be misread. (National Coordinating Council for Medication Reporting and Prevention)

25% of all pharmacy errors occur because of drugs which have similar names. Drug naming should be standardized to reduce these errors. That means that all companies would be required to use the same terms. This is a recommendation by the Committee on Identifying and Preventiing Medication Errors. (Christine Stencel)

The use of abbreviation and dosage expressions have resulted in many medication errors in the pharmacy. They need to eliminated entirely to ensure safe dosing for the patients. (Ibid)

Pharmacists in the hospital should be involved with medication administration, patient education and prescribing whenever it is possible. (Ibid)

Strategies for Hospitals to improve patient outcome and decrease medication errors

Prescribing errors occur frequently in the hospital setting. To reduce these errors the doctor should be current on the medications and consult with the pharmacist. Additionally the doctor should thoroughly evaluate and assess the patient's status prior to prescribing. The doctor should always be clear about the medication order and never use vague language or abbreviations (say "daily, not "q.d."). If the doctor's handwriting is poor then printing the prescription should be enforced.