Medication Errors & Risk Reduction
How do you define a medication error? “any preventable event that may cause or lead to inappropriate medication use or client harm while the medication is in the control of the healthcare professional, client, or consumer.” • Definition from the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP)
Why are medication errors such a concern? • Because a shocking number of patients die every year in United States hospitals as a result of medication errors, and many more are harmed. • Medication errors are the fourth to sixth leading cause of death in America. • Medication errors are the most common cause of morbidity and preventable death in hospitals today.
What are key factors contributing to medication errors by the health care provider? • Many new drugs on the market • Distractions/Interruptions • Understaffed facilities/overworked nurses • Wrong med, dose, patient, route, time. • Omission of dose • Discontinued meds at D/C misinterpreted • Misinterpretation • Miscalculations • Lack of clinical evaluation/assessment
Who are the collaborative partners in medication administration • Prescribers • Pharmacists • Transcribers/Clerical Staff • Nurses • Patient / Personal Caregivers
Types of Medication Errors • Prescribing error • Omission error • Wrong time order • Unauthorized drug error • Improper dose error • Wrong dosage-form error • Wrong drug preparation error • Wrong administration technique error • Deteriorated drug error • Monitoring error • Compliance error • Other errors not classified above
Common Causes of Medication Errors • Ambiguous strength designation on labels • Drug product nomenclature ( look/sound alike) • Equipment Failure • Illegible handwriting • Improper transcription • Inaccurate dosage calculations • Inadequately trained personnel • Inappropriate abbreviations used in prescribing • Labeling errors • Excessive workload • Medication unavailable
Reduction of Medication Errors- Planning • Use only approved abbreviations • Question unclear orders • Do not accept verbal orders unless emergency (repeat back for clarification) • Follow agency policy and procedures • Ask for client participation & provide medication education • Be familiar with the medication ordering system and delivery devices • Always review patients medications with respect to desired outcome • Verify all drug orders prior to initial dose administration. • Provide medications on time • When standard dosage charts are not available have a second nurse check the drug calculations • If a large dose is ordered; more than 2 tablets, ampules or vials this should raise a flag! Consult with Pharmacy! • Listen to the patient; hold if they have concerns and double check the order • NEVER!!!! Give any medication prepared by another nurse (You should prepare all medications that you administer this is the only way to be 100% sure of what medication you are administering).
Reduction of Medication Errors- Implementation • Assess • Food or medication allergies • Current health concerns • Use of OTCs and herbal supplements • Adverse reactions • Review • Recent laboratory tests • Recent physical assessment findings • Identify • Need for education about medication regimen
Reduction of Medication Errors-Implementation • Be aware of potential distractions • Remove distractions if possible • Focus on medication administration task • Practice six rights • Maintain knowledge of medications and dosage calculations • Always have another nurse re-check your drug calculations
Reducing Medication Errors in Health Care Facilities • Methods: • Automated, computerized, locked cabinets for medication storage on client-care units • Risk management departments • Collaboration with nursing to modify policies and procedures
Reporting and Documenting Medication Errors • Document and Report according to agency policy. • Report the medication error with an incident report. • In relation to the associated legality, why is documentation of the error important? • Quality Improvements Addressed in the 2011 National Patient Safety Goals Address NPSG.01.01.01& 03.04.01,03.05.01, 03.06.01
Agencies that Collect and Report on Medication Errors • FDA’s MedWatch • Institute of Safe Medication Practices (ISMP) • MedMarx
Nurse Practice Act and Standards of Care • The Nurse Practice Act serves as a minimal guideline to determine what a nurse should or should not perform to ensure safe and competent care. • A medication error may be considered negligence and involve an investigation from the NC Board of Nursing and possibly result in a revoked licensed to practice as a Registered Nurse.
How will you ensure that you will administer medication safely? Your patients and their families will be depending on you.