How to prevent Medication Errors

Medication errors can have serious and costly consequences, such as increased patient lengths of stay, additional medical interventions, serious harm, or even death. According to a new study conducted at Johns Hopkins University, medical errors have become the third leading cause of death in the United States, claiming 250,000 lives annually.

For nurses, making a medication error is an emotionally traumatic experience that undermines their self-esteem and confidence to function in the workplace. Jones and Treiber used quantitative and qualitative questionnaires to survey 202 nurses; 158 claimed they'd made medication errors. Qualitative data analysis showed several themes. For instance, making an error makes nurses feel depressed, guilty, embarrassed, regretful, and fearful about providing safe care and violating the patient's trust. Nurses involved in medication errors experience moral distress and want to leave nursing practice.
Many hospitals use electronic reporting systems, which let the individual involved in a medication error provide information electronically. Managers and quality risk management are then notified electronically. The key benefits of the system include increased reporting of medication errors, identifying close-call events (errors that are identified and corrected before reaching the patient), and improved tracking, which is followed by action. When data from medication errors are shared, an action plan can be developed, which may reduce further errors.
To safeguard against medication errors, nurses must implement the proper procedures for medication administration, including at least these five rights: right patient, drug, dose, route, and time. In addition, they must complete accurate documentation once the patient receives the medication. Failure to record the medication administered increases the risk that the patient will receive another dose. Nurses should be cautioned not to document the dose before the medication is given because, for one reason or another, the patient may not receive the medication at all or might receive it at a different time than documented.

Patients need to be well informed of medications' therapeutic effects, potential adverse reactions, and desired outcomes. Evaluating the effect of certain medications is crucial to ensure the patient has responded to the medication; for example, high blood glucose levels may be treated with sliding scale insulin dosages. The patient's blood glucose levels must be closely monitored to ensure they're within the desired therapeutic range, and the patient must be closely monitored for and taught to report adverse reactions, such as signs and symptoms of hypoglycemia.

When administering an analgesic, the nurse must first assess the patient's pain level, administer the analgesic drug, and then monitor for adverse reactions and evaluate and document the therapeutic response. If the desired effect isn't achieved, the patient may have received an inadequate dose or may require a different analgesic for pain control.

Many medications can be administered via different routes, such as oral or I.V., increasing the possibility of confusion. Some forms of medications, such as enteric-coated medications intended to prevent stomach irritation, shouldn't be crushed. Nurses should frequently double-check to ensure they're administering medications via the correct route and in the prescribed form.

Providers may prescribe specific I.V. dosing regimens based on their own preference and previous experience, institutional standards, and smart pump setup. For example, dopamine infusion titrations may be prescribed using micro gram/kilogram/minute dosages or micro gram/minute dosages to maintain the mean arterial pressure above 65 mm Hg.
Medication errors are preventable events. Safe medication practices, adequate resources, a work environment free from interruptions, and a non punitive approach to error reporting should be encouraged.