Medication Errors: How to avoid them

 

By Collins Onyango

We’ve all made mistakes, most of them small and inconsequential to the patient’s health, but sometimes the mistakes are serious.

Medication errors can compound a medical crisis, sometimes with tragic results — yes and nurses administer most medications. 
It’s common fact that I, and every nurse and doctor, have made medication errors.  Most hospitals where we work have put in place systems of checks and balances to be sure serious mistakes don’t slip through therefore most of the time, our errors don’t amount to much.
You often left with the knowledge that you almost harmed a patient you were trying to protect even when your mistake is caught and a potential crisis averted. Little is known regarding organizational factors that facilitate nurses’ efforts in performing this vital safety function yet, despite studies illuminating the critical role of nurses in the interception of medication errors.

Medication administration is a complex multi-step process that encompasses prescribing, transcribing, dispensing, and administering drugs and monitoring patient response. An error can happen at any step. Although many errors arise at the prescribing stage, some are intercepted by pharmacists, nurses, or other staff

Almost did it

My worst mistake ended up not mattering at all, but it still pains me to think about what could have happened as the result of my error.As a critical care nurse I try to catch up with emergency medications after the patient’s condition changes and this requires several procedures. The patient is intubated.
I decide to push it through the IV canula. During the haste I almost fail to notice the “look alike” warning on the ampule but fortunately stops just in time when she realizes she’s about to make a serious mistake. Unfortunately, most administration errors aren’t intercepted.

10 key elements identified by the Institute for Safe Medication Practices (ISMP) have greatest influence on medication use are:

1. Patient information
2. Drug information
3. Adequate communication
4. Drug packaging, labeling, and nomenclature
5. Medication storage, stock, standardization, and distribution
6. Drug device acquisition, use, and monitoring
7. Environmental factors
8. Staff education and competency
9. Patient education
10. Quality processes and risk management.

Preventing Medication Errors in Nursing

Administration errors account for 26% to 32% of total medication errors. Considering the magnitude, a conscious effort to prevent medication errors in nursing is a must. While an electronic medication and prescription system may help avoid some handwritten mistakes, human error can creep in at each step, errors and adverse drug effects may seem inevitable.  

Before administering medication

1. Utilize at least 2 identifiers that are specific to the patient. For example, along with the patient's name, confirm date of birth to be sure the order matches the patient. For patients who have similar names, another identifier may be needed to avoid medication errors. a special sticker or marker on the patient's chart can be useful
2. Review notes and confirm with patient about allergies and reactions to medicationsbefore any new medication is administered. update this information in patient chart.
3. Avoid abbreviations, which can be easily misinterpreted when documenting medication allergies.
4. Review patient's critical diagnoses which can affect not only the selection of medication but also dose and frequency. Patients with renal, liver and psychiatric disorders, cardiac as well as diabetes mellitus and pregnant fall under this category.
5. Note and update the patient's current medication regimen after every doctor's including any over-the-counter medicines or vitamin visit on the same chart for easy access.
6. Learn and decipher similar drug names. Some the drugs that sound similar or are spelled similarly to another drug have different uses. Celebrex is commonly used to treat arthritis while the similarly named Cerebyx is used to treat seizures
7. Repeat the order when calling prescriptions for a patient. Make sure to read each number individually such as "1-0" instead of 10 to help prevent errors in dosage.
8. Keep "high alert" or similar-sounding drugs in separately and well organized to avoid confusion.
9. Keep current on new information relating to prescription medications and their reactions.   Purchase the latest editions of drug reference resources such as. Look to the Institute For Safe Medication Practices (ISMP) for continuing education classes and their newsletter for further tips on how to prevent medication errors in nursing.
10. Take time out between rechecking calculations. Nurses are more likely to find their own errors when there is time between rechecks. Even with the practice of double checking medications with another nurse, studies suggest that there is always a great chance for error. Individuals see what they expect to see. So whatever medication or patient name one nurse may read, the second nurse has a tendency to see as well. A better way to implement double checks would be to have one nurse read what is on the medication package or dose and have the other nurse check it against the order, and then reverse the process.

Be sure to use the safety practices already in place in your facility. Eliminate distractions while preparing and administering medications. Learn as much as you can about the medications you administer and ways to avoid mistakes. 

Read more

1. Better Environments for Nurses Mean Fewer Medication Errors
2. ASHP Guidelines on Preventing Medication Errors in Hospitals
3. Medication Error Prevention for Healthcare Providers