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Preventing Medication Errors

Overview

Medication Errors

According to the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP), a medication error is “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer.” Medication errors impede pharmacotherapeutic outcomes, and can cause serious illness or death. Furthermore, medication errors can lead to litigation against the nurse, physician, or health care agency. Despite extensive efforts on the part of health care providers, medication error rates in communities, hospitals, and homes are increasing.

Factors leading to medication errors include the following:

Because lack of knowledge about medications is a cause for errors, it is important that nurses remain current in pharmacotherapeutics. Nurses should never administer any medication with which they are unfamiliar, as it is considered an unsafe practice. There are many avenues by which the nurse can obtain medication knowledge and updates. Current drug references should be available on every nursing unit. Other medication sources are available on the Internet and in nursing journals. It is recommended that nurses familiarize themselves with research on medical errors and how they can be prevented.

Reporting Medication Errors

There has been some hesitation in reporting medication errors in the nursing profession. Most nurses fear humiliation from superiors and their peers when reporting medication errors, although it is the nurse’s ethical and legal responsibility to document such occurrences. Unreported errors can affect the health of patients and cause legal ramifications for the nurse. In severe cases, adverse reactions caused by medication errors might require the initiation of lifesaving interventions for the patient. After such an event, the patient may need intense supervision and additional medical treatments.

The Food and Drug Administration (FDA) is concerned with medication errors at the federal level. The FDA requests that nurses and other health care providers report medication errors in order to build a database that can be used to assist other professionals in avoiding these mistakes. Medication errors, or situations that can lead to errors, may be reported in confidence directly to the FDA by telephone at 1–800–23–ERROR.

A second organization that has been established to provide assistance on the subject of medication errors is the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP). This organization was formed by the U.S. Pharmacopoeia Convention in 1995, to help examine interdisciplinary causes of medication errors and promote medication safety. The telephone number for NCCMERP is 1–800–822–8772.

Preventing Medication Errors

What can the nurse do in the clinical setting to prevent medication errors? The nurse can begin by using the four steps of the Nursing Process:

  1. Assessment Ask the patient about allergies to food or medications, current health concerns, and use of OTC medications and herbal supplements. Ensure that the patient is receiving the right dose, at the right time, and by the right route. Assess renal and liver function, as well as other body systems impairments that might impact pharmacotherapy.
  2. Planning Have the patient state the prescribed outcome of the medication, including the right time to take medication and the right dose.
  3. Implementation Advise the patient to take medication as prescribed and to question the nurse if medications “look different” (different color, larger pill).
  4. Evaluation Assess whether the expected outcomes of pharmacotherapy have been achieved and whether the patient encountered adverse reactions.

One of the best preventative practices is to educate patients about their medications. When patients are knowledgeable about the outcomes of pharmacotherapy, errors decrease. Teaching methods can include written handouts and audiovisual teaching aids on medications (at a reading level and language the patient can understand) and contact information for health care providers who should be notified in the event of adverse reactions. Nurses should collaborate with other health care providers and agencies to seek means of medication error reduction. Examples of common errors that can be fixed by changing policies and procedures within an institution include the following:

Legal Considerations

Age-Related Issues in Drug Administration

The Pediatric Population

The Elderly Population

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