Medication Errors in Nursing: Causes and Solutions

Introduction to Medication Errors in Nursing

Medication errors are a very serious concern to nursing staff. A medication error occurs when the wrong medication is given to a patient, resulting in potential serious harm that could have been prevented (Hidle). Medication errors occur at a high rate, with death occurring as frequently as once a day due to adverse drug events (ADE) (Menachemi and Brooks). Yet it is thought that a good deal more go unreported due to fear of retribution (Lefleur).

This topic is of personal interest because of a medication error experienced within my own family. My grandfather received the wrong medication during a hospital stay following a routine surgery. The error caused him physical pain due to an ADE, as well as an extended hospital stay — a frightening experience for the whole family.

There are four steps involved in giving the correct medication to a patient, beginning with a prescription from the doctor, followed by transcription, dispensing, and finally administration (Tang 448). Great advances in the first three steps have been made by adopting the computerized physician order entry (CPOE) system. However, many errors still occur at the administration level, which is primarily a nursing responsibility. Nurses are taught to observe the five rights prior to administration of medications to minimize errors: right medication, dose, time, route, and patient (Hidle 5). In a study to ascertain nursing perspectives on why medication errors occur, nurses identified three major areas of deficiency (Tang): personal neglect, heavy workload, and new staff. This is a problem that must be addressed for the safety of patients and the peace of mind of nurses.

The Medication Administration Process and Error Reporting

Without proper error reporting it is impossible to assess the true extent, causes, and possible preventions of medication errors. However, nurses often do not report medication errors due to fear of punishment or being fired. Although it is known that errors in administering medication stem from system-wide problems, nurses feel personally responsible for medication errors. Drach-Zahavy and Pud argue that focusing on deviations from procedures and policies rather than on the outcome of such deviations will help relieve the reluctance nurses feel toward error reporting. In addition, Dickens found that work environments with an open and communicative atmosphere lead to increased error reporting.

Several possible solutions to the problem of medication errors exist. Each solution focuses on a different step in the process of giving a medication to a patient and carries different attributes and drawbacks. The solutions examined here are: decreasing distractions, using barcodes, and using computerized medication software programs.

Reducing Errors Through Interruption-Free Zones

Although it had previously been denied that workload and long hours affect healthcare worker performance, Kozer found a positive correlation between hours worked and medication errors. Personal negligence due to distractions and heavy workload were also the top two reasons nurses cited as leading to medication errors (Tang). One study suggests that creating interruption-free zones — for example, around the medication cart or while a nurse is dispensing medications, denoted by wearing a red vest — would be a viable solution (McGillis Hall). Interruptions by coworkers are a significant source of distraction for nurses trying to concentrate on medications, and this approach would clearly reduce that problem.

However, this method has not yet been rigorously tested. More studies would be needed to determine how viable it is and whether reducing distractions does in fact lead to a measurable decrease in medication errors.