Medication Errors

This paper will start with three summaries of journal articles related to medication errors. A definition of medication errors is given, then, moves on to discuss the causes of medication errors, the impact that medication errors has to client care and nursing, followed with some strategies to prevent medication errors. In critical care “Providing 1 critically ill patient with a single dose of a single medication requires correctly executing 80-200 steps. ” (Camire, Moyen, Stelfox, 2009, p. 936) it is no wonder the potential for medication errors is so high.

This is why we as nurses have to so vigilant when administering medications. Summaries of Journal Articles In the article, Medication errors in critical care: risk factors, prevention and disclosure by Camire et al (2009), they discusses research of 49 articles related to medication errors in critical care. They studied the risk factors involved, strategies for prevention and disclosure to patients in relation to medical errors in the ICU. The authors state “Critically ill patients admitted to an ICU experience, on average, 1. 7 medical errors a day, and many patients suffer a potentially life-threatening error during their stay.

Medication errors are the most common type of error and account for 78% of serious medical errors in the ICU… The medication process involves 5 broad stages: prescription, transcription, preparation, dispensation and administration. ” (Camire et al, 2009, p. 936) “The frequency of medication errors was similar during the prescription (54%) and administration (46%) phases of the medication process. “(Camire et al, 2009, p. 937) “Medication classes most frequently associated with errors were cardiovascular drugs (24%), anticoagulants (20%) and anti-infective agents (13%).

” (Camire et al, 2009, p. 938) This study reported 7 prevention strategies: eliminating extended physician work schedules, computerizing physician order entry, implementing support systems for clinical decisions, computerizing intravenous devices, having pharmacists participate in the ICU, reconciling medications and standardizing medications. ” (Camire et al 2009, p. 938) According to the authors “Disclosure should take place whenever a patient has suffered an iatrogenic injury. ” (Camire et al, 2009, p. 940).

The second article, The Nine Rights of Medication Administration: an Overview, Elliott and Liu (2010) discuss the nurse’s responsibility for ensuring safety and quality care of patients at all times. Medication administration arguably carries the greatest risks and unfortunately, patients are often harmed or injured, causing permanent disability or death. Traditionally nurses follow the five rights of medication administration which include: right patient, right drug, right dose, right route and right time.

The authors go on to describe four additional rights: right documentation, right action, right form and right response. Elliott and Liu (2010, p. 301) state “The nine rights do not guarantee that medication errors will not occur but following them will help ensure safety and quality of patient care during the medication administration process. ” The third article, Antecedents of Severe and Nonsevere Medication Errors, by Chang and Mark (2009) is the result of a study that “examined nursing-unit characteristics contributing to medication errors at acute-care hospitals and investigated whether medication errors of different levels of severity have different antecedents…

Medication errors were categorized into two types: severe errors that required immediate clinical attention and interventions resulting from potential deterioration in patient conditions and nonsevere errors that did not require such attention and intervention. ” (Chang and Mark, 2009, p. 71) The authors developed a model of antecedents of medication errors based on the conceptualization of error-producing conditions which included:(a) work environment factors, (b) team factors, (c) person factors, (d) patient-specific factors, and (e) medication-related support services.

(Chang and Mark, 2009)They found that “none of the antecedents predicted both types of medication errors and some had a positive association with one type and a negative association with the other type of error. These results show that the two types of errors might indeed be different, which is in contrast to much of the previous literature that showed all medication errors as a single category under the implicit assumption that they were the same. ” (Chang and Mark, 2009, p. 75)

According to Chang and Mark (2009, p.76) results showed that “instead of all errors being the same, the two types of errors might differ, which will require different approaches to error prevention and management strategies. ” Definition of a Medication Error “Medication error can be defined as the failure of a planned action to be completed as intended or the use of a wrong plan to achieve a goal. Medication errors include prescribing errors, transcription or order communication errors, dispensing errors, administration errors, and errors in monitoring or education for proper use.

Medication errors can result in serious complications known as adverse drug events. ” (Clayton, Stock and Cooper, 2010, p. 100) Causes of Medication Errors There are many risk factors for medication errors, by identifying them can help prevent them. According to Elliott and Liu (2010, p. 300) factors contributing to medication errors are: poor medication labeling, miscommunication among clinicians, lack of verification, a disorganized medication trolley, an incomplete medication prescription, and inadequate staffing levels.

In the article by Camire et al (2009, p.937), they indicated the most frequent errors in the ICU as errors in “the dose, wrong rate, wrong preparation technique, physico-chemical incompatibility, wrong administration technique and wrong time. ” Other factors included were providers’ psychological state and sleep deprivation, frequent changes in substances and doses, care that is urgent, and a large number and complexity of interventions which are often life-saving. “Error were also found in prevention (e. g. , prophylaxis), diagnosis (e. g. , intravenous contrast agents) and monitoring (e.g. , glycemic monitoring and insulin therapy). “

(Camire et al, 2009, p. 938) They also indicated that “the strongest evidence that critically ill patients are at increased risk of medication error are increased severity of illness; failure to document the patient’s usual medication list; prescription of cardiovascular, sedative, analgesic, anticoagulant or anti-infective medications; prescription of additional medications; admission to a medical ICU compared with a surgical ICU; and more critically ill patients per nurse. ” (Camire et al, 2009, p.938)

Other reasons for medications errors presented in the article by Chang and Mark (2009, p. 71) include highly dynamic work situations; limited education and experience (insufficient skills and inadequate knowledge of pharmacology) and failure of communication, particularly those resulting from inadequate “hand off” between care providers, verbal miscommunication, and impaired communication between nurses and physicians. The Impact on Client Care Medication errors impact client care in many different ways ranging from harm and injury, to permanent disability and for some death.

It has a financial impact on both the client and their families due to loss of wages and additional health care costs. Elliott and Liu (2010, p. 300) state that “patients experiencing an adverse event in British hospitals are admitted for an extra 8. 6 days”. As well “The National Academy of Science’s Institute of Medicine (IOM) has estimated the number of lives lost caused by preventable medication errors accounts for more than 7000 deaths in hospitals annually. The IOM has further estimated that the additional costs of adverse drug effects annually are $2 billion in hospitals and more than $3 billion in extended-care facilities.

” (Clayton et al, 2010, p. 100) There may also be long term psychological, social and economic effects on the client. “All medication errors can be linked, in some way to an inconsistency in adhering to the following six rights of medication administration: (1) The right medication, (2) The right dose, (3) The right client (4) The right route, (5) The right time, (6) The right documentation. ” (Potter, Perry, Ross-Kerr & Wood, 2006, p. 850) When any of these rights are violated it is considered a medication error.

“Once a medication is administered, the nurse should monitor the patient to see if the medication has the desired effect or response. This right of medication administration involves an evaluation of the effectiveness of the medication’s intended purpose which is crucial for some high-risk medications such as anticoagulants, anti-arrhythmics and insulin. ” (Elliott and Liu, 2010, p. 303) “Side effects, adverse effects and allergic reactions must also be monitored for. ” (Elliott and Liu, 2010, p. 304) this would ensure “The right response” to the medications and any unwanted effects.

“Unfortunately, many medication errors are never identified. When an error occurs, it should be acknowledged immediately and reported to the appropriate hospital personnel. Measures to counteract the effects of the error may be necessary. The nurse is responsible for completing an incident report describing the nature of the incident. Incident reports assist administrative personnel in identifying hospital system problems that contribute to medication errors. References to incident reports should not be made in a client’s permanent record. ” (Potter et al, 2006, p.849)

Camire et al (2009, p. 940) state that “Patients want full disclosure of harmful errors and that disclosure of medical errors is increasingly recognized as an ethical imperative. Nonetheless, surveys show that only 17%-30% of physicians inform their patients when they experience a medical error. Disclosure should take place whenever a patient has suffered an iatrogenic injury. ” Strategies to Prevent Medication Errors “Critical thinkers admit what they do not know and try to acquire the knowledge needed for the safe administration of unfamiliar medications. “

(Potter et al, 2010, p.850) It is essential that as nurses we are always using critical thinking when making decisions and problem solving. By following not only the 6 rights, but the 9 rights of medication administration: right patient, right drug, right dose, right route, right time, right documentation, right action, right form and right response, medication errors can be avoided. (Elliott and Liu, 2010) “Verbal verification of the ‘right patient’ is one method of correct identification… both name and medical record number should be verified on the patient’s wristband and medication chart.

” (Elliott and Liu, 2010, p. 301) A nurse needs to have a quiet environment and take sufficient time when preparing medications. If the nurse is in a hurry and the environment is noisy with lots of distractions, a medication error is more likely to happen. It is essential that a nurse research all medications prior to administering them to patients. This allows the nurse to ensure the right drug is given by the right route, in the right form, in the right dose, at the right time for the right action (appropriate reason).

The nurse will need to ensure the right documentation by signing the MAR, PRN’s and IPN, as well as monitor for the right response (assess the effects of the drugs). If orders, labels or dosages are unclear the nurse should never assume to understand them. Medications on the MAR sheets should be compared to the physician’s orders. The nurse should not administer the medication before verifying it with the physician or pharmacist if the order is not understood completely. Abbreviations should be avoided, and both the generic and trade names should be included in a medication order.

Nurses need to check labels carefully, often medications come in packages that look alike or have names that are similar. If a label is unclear it should returned to the pharmacy for relabeling. The labels should be read three times (3 checks) during the administration process. All dosage calculations should be double checked by the nurse administering the medication. If they are still unclear about the dosage calculation they should have it clarified by another nurse. Conclusion “Medication errors are common in clinical practice. Nurses must aim to provide high quality, safe, evidence-based care.

Patient safety and quality care must be priorities at all times in all clinical situations… Nurses need to consider how to manage the environment in which they work to reduce the possibility of error. ” (Elliott and Liu, 2010, p. 304) By being a critical thinker and following the nine rights of medication administration many medication errors can be avoided. Nurses must have the necessary knowledge and skills to satisfy the responsibilities of safe and effective medication administration. Ensuring patient safety is everyone’s responsibility and challenge.

Patient’s trust that we will make them well, not worse! It is evident that there are many different factors that can lead to medication errors which have a huge impact on client care, nurses need to learn the strategies to avoid them. It is so very important that as nurses we be vigilant when administering medications. By applying this learning and continuing to learn as we grow in our careers the hope is medication errors will be reduced and avoided. References Camire, E. , Moyen, E. , & Stelfox, H. (2009). Medication errors in critical care: risk factors, prevention and disclosure.

CMAJ: Canadian Medical Association Journal, 180(9), 936-E29. Chang, Y. , & Mark, B. (2009). Antecedents of severe and nonsevere medication errors. Journal of Nursing Scholarship, 41(1), 70-78 Clayton, B. , Stock, Y. , & Cooper, S. (2010). Basic Pharmacology for Nurses (15th ed. ). St Louis, Missouri: Mosby Elsevier Elliott, M. , & Liu, Y. (2010). The nine rights of medication administration: an overview. British Journal of Nursing (BJN), 19(5), 300-305. Potter, P. , Perry, A. , Ross-Kerr, J. , & Wood, M. (2006). Canadian Fundamentals of Nursing (3rd ed. ). Toronto, ON: Elsevier Canada.

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