Medication Error

More people die each year in United States from medication errors, than from highway accident, breast cancer or AIDS. It is described best as an “unintended act or as an act that does not achieve its intended outcome.” (Wideman, 2010). Medication errors are among the biggest issues devoted in health care setting today in America. There are five “rights” to remember when administering medications: Right patient, Right medication, Right route, Right dose, and Right time. Documentation has been added as the sixth “right”. Poor transcriptions, drug interactions, drug name confuse, and poor documentation account for majority of the most common errors. Literature Review

This study will show that there is a complex procedure behind the simple act of medication administration. Many studies have been done to identify the breaks in this procedure leading to medication errors. Nurses are the last defense before a medication is administered to the patient. Human factors such as fatigue in this fast moving economy play a large role in failure to adhere to the correct procedures leading to errors in medication administration. Technological advancements have been put in place in an effort to reduce the occurrences of medication errors such as Computerized Physician Order Entry (CPOE), electronic Medical Administration Records (eMAR) and Barcode scanning. Nurses are also getting more education in the drug interactions and the correct dosages to question correctly when an order is being entered into a patient’s chart. Medication Errors – Implication for Nursing Practice

Medication errors can be caused by orders from the doctors and misunderstood by nurses due to poor concentrations caused by increased workload, fatigue and distractions from personal lives. In addition, errors are caused by misreading, miswriting and misunderstanding the prescriptions. There are occasions where verbal/telephone must be taken, the nurse taking the order should read the order back for verification purposes incase of misinterpretation or the doctors should be called back to clarify, rather than arriving to their assumption. “In 2007, twins of actor Dennis Quaid were given the wrong strength of Heparin, catapulting medication errors into the national spotlight.”(Kaushal, 2007). Dennis Quaid’s twins were supposed to be given 10 units of Heparin but were administered 10,000 units. . It is very important for the nurse to know the High-alert medication which has the potential for causing harm to the patient. The most common examples of high-alert medications include anticoagulants such as heparin, warfarin, multiple types of insulin and intravenous-concentrated potassium chloride for injection.

While this is not a complete list, but nurses should become familiar with medications that are deemed high-alert status (Miranda, 2011). Similar names of drugs are another common cause of medication errors. In 2009, two pregnant women at a Florida hospital received Prostin, a drug that induces labor instead of the ordered Progesterone suppositories the doctor ordered to prevent premature labor. The results were the death of the two twins and the premature birth of a baby that suffered severed brain damage (Inglesby, 2006). Institute for Safe Medication Practices (ISMP) have recommended that the prescribers should always include the purpose of the medication on the prescription which allows the pharmacists to dispense the correct medication. Also a new unfamiliar drug may be read as an older, more familiar one. Some of these errors can be fatal, such as prescribing methadone instead of methylphenidate. Such errors can be reduced by placing reminders on the stock bottles or in the computer system to alert staff about these commonly confused drug names (White, 2011). Another cause is administering medication to wrong patient.

A nurse could have all the right medication, with correct doses but could walk into a wrong room and administer to wrong patient leading to complications in the patient route to recovery or could cause even death. Despite all the technology advancements, incented of medication errors have increased from 35,000 in 1998 to 90,000 in 2005 (Hunter, 2011). Unfortunately not all hospitals have the Bar-Coding system in place which could reduce these medication errors. A good practice use no-interruption process and decreased noise while preparing patient dosages and in addition medication should be selected and prepared for one patient at a time. A nurse must use two unique patient identifies to accurately administer medication rather than using the room number or face identification (Miranda, 2011). Not having the entire correct drug history on a patient can lead to medication errors.

This is important to decrease drug interactions and double doses which could lead to adverse patient outcome (White, 2011). Poor and incorrect documentation is another issue in medication errors. Signing the Medication chart before the medication has been administered is a risk, as the patient may refuse their medication or, in some cases, forget to take them. Similarly, failing to sign when a medication has been administered creates the risk that another nurse may assume that it has not been administered, and repeat that dose. The lack of proper documentation can negatively impact patient care and can ultimately cause other problems. Also the right documentation will tell why the medication was not given to the patient at the scheduled time. It also has been said “If you did not document then it was never done” (Miranda, 2011). Conclusion

Medication errors are common in nursing practice. Nurses must aim to provide high quality, safe, evidence-based care. Patient safety and quality of care must be priorities at all times in all clinical situations. As medication errors can occur at different phases of the administration process, nurses have a vital role in prevention. Ensuring that the right drug form and the right response, in addition to following the established “five rights”, can help enhance patient safety. These medication rights are guidelines to ensure patient safety and prevent harm. The list of medication rights described here can help nurses perform their vital role in patient safety. Nurses should follow recommended guidelines on medication administration like ‘triple checking’ the medication during preparation, immediately before administration and afterwards. A nurse should not ‘blindly follow’ what has been prescribed. If the prescriber has made an error, such as ordering a toxic or fatal medication dose, the nurse should not administer it. Although the human error factor cannot be eliminated, the conditions in which humans function can be modified to make error less likely.

References

Hunter, K. (2011). Implementation of an Electronic Medication Administration Record and Bedside Verification System. . Online Journal of Nursing
Informatics, 15(2), 7. Miranda Jr., S. (2011). Back to basics, medication safety at the bedside: a nursing administrator’s perspective. Pennsylvania Nurse , 66(3), 6-10.

White, C. (2011). Advanced Practice Prescribing: Issues and Strategies in Preventing Medication Error. Journal of Nursing Law, 14(3-4), 120-127.
Wolf, Z. (2007, April). Pursuing safe medication use and the promise of technology. MEDSURG Nursing , 16(2), 92-100.