4. PREVENTION OF MEDICATION ERRORS



PREVENTION OF MEDICATION ERRORS


Objectives



PREVENTING MEDICATION ERRORS


According to the Institute of Safe Medication Practices (ISMP), more than 100,000 medication errors (MEs) were reported by hospitals nationwide in 2001. As the result of medication errors, the ISMP states that 7000 inpatient deaths per year occur at a cost of approximately 2 billion dollars. About half of the MEs were intercepted, and of those, 86% were intercepted by nurses. One national report stated that MEs include 39% related to ordering, 12% transcribing, 11% preparing, and 38% administering.


On the national level, there are various governmental agencies (e.g., U.S. Food and Drug Administration [FDA], Institute for Safe Medication Practices [ISMP]). There are also many professional groups (i.e., Quality and Safety Education for Nurses [QSEN], funded by the Robert Wood Johnson Foundation; National Coordinating Council for Medication Error Reporting and Prevention [NCC MERP]; and others). These government and professional groups study and research methods to prevent drug errors. The Institute of Medicine (IOM), a council of the National Academies that advises the nation on topics in health care, has defined MEs as those that occur during the process of using medications. The process includes procuring, prescribing, dispensing, administering the drug, and monitoring the patient’s response. An adverse drug event (ADE) occurs when the patient suffers any physical, mental, or functional injury due to medication. ADEs are the outcome of MEs and considered preventable.


In the past 20 years, more than 300,000 new drugs have been developed. The FDA proposed in 2002 a rule titled Bar Code Label Requirements for Human Drug Products and Blood. It contains the national drug code that identifies the drug strength and its dosage form. The FDA also has featured a “black box” warning to health care providers of risks associated with certain drugs.


With so many drugs available today, the nurse should have reference books and programs such as Micromedex on the unit for prompt information about the drug to be given, especially if it is a high-alert drug such as dobutamine, epinephrine, dopamine, potassium chloride, and others. Access to these references would promote safe medication practice.



Here are some examples of the types of medication errors (MEs):



1. The physician or health care provider makes a prescribing error and/or the written drug order is NOT legible.


2. Transcription errors occur because the medications have similar names; the decimals and zeros are not correctly written; or numbers are transposed.


3. Telephone and verbal orders are misinterpreted.


4. Interruptions occur when preparing medications.


5. Drug labels look similar, and packing obscures print on the label.


6. Trade names and generic names for drugs are used interchangeably, which causes confusion.


7. Oral dosages and intravenous dosages are different for the same drug.


8. The pharmacy delivers the wrong drug.


9. Intravenous medication is given too fast or too concentrated.


10. The amount of the drug is incorrectly calculated.


11. The drug is given intramuscularly or subcutaneously and should be given intravenously.


12. Two or three patients with the same names are on the same unit and their identification wristbands are hard to read. One patient receives another’s medication.


13. Medication is given and not monitored, and an overdose occurs.


14. An infusion pump malfunctions or is incorrectly programmed.


Ways to prevent medication errors (MEs):



1. Ask the physician or health care provider to rewrite or clarify medication order.


2. Use only approved abbreviations from TJC list to use with medication dosage. Do not use “u” for unit; it should be spelled out. Avoid use of a slash mark (/) that could be interrupted as a one (1).


3. Do not use abbreviations for medication names (e.g., MSO4 for morphine sulfate).


4. Use leading zeros for doses less than a unit (e.g., 0.1 mg; NOT .1 mg). Do not use a zero following a whole number (e.g., 5 mg; NOT 5.0 mg). The decimal point after 5 may not be noticed and would look like 50 mg.


5. Check medication orders with written order and MAR/eMAR.


6. Check the drug dose sent from the pharmacy with the eMAR.


7. Limit interruptions when preparing and administering drugs. Have an environment inductive for drug preparation.


8. Never administer a medication that has been prepared by another nurse.


9. Have another nurse check the dosage preparation, especially if in doubt. Recalculate drug dosage as needed.


10. Check if the patient is allergic to drugs that are prescribed and any other medication. If an allergy exists, report the type of reaction the patient is having.


11. Check the patient’s identification band with the eMAR and bar code.


12. Do not leave medication on the bedside. Stay with the patient until the medications are swallowed.


13. Know if the medication the patient is to receive would be contraindicated because of the patient’s health (liver disease and Tylenol [acetaminophen]), or a possible drug interaction with another drug the patient is taking.


14. Assess physical parameters (e.g., apical pulse, respiration, BP, INR, and electrolyte values) before administering the medication that could affect these parameters.


15. Monitor the effects of the administered drug, the rate of IV flow, and the patient’s response to the medication.


16. Check when to administer medication for a patient whose status is nothing by mouth (NPO). When in doubt, check with the health care provider (HCP) or nurse manager.


17. Record medications that are given immediately after their administration.


18. Report MEs immediately to the HCP.


19. Educate the patient and family of the drug and its action.


20. Know the compatibility of drugs that are being given. Report any contraindications.

Related posts:

  1. 5. ALTERNATIVE METHODS FOR DRUG ADMINISTRATION
  2. 14. LABOR AND DELIVERY
  3. 13. PEDIATRIC CRITICAL CARE
  4. 9. INJECTABLE PREPARATIONS WITH CLINICAL APPLICATIONS

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Feb 11, 2017 | Posted by in PHARMACY | Comments Off on 4. PREVENTION OF MEDICATION ERRORS

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