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    COMMON MEDICATION ERROR



    RAHUL SHARMA (M.T.I.N)


    MEDICATION ERRORS


    Medication administration is a complex multistep 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.
    Administration errors account for 26% to 32% of total medication errors—and nurses administer most medications. Unfortunately, most administration errors aren’t intercepted. Recent technological advances have focused on reducing errors during administration.



    Ten key points to be kept in mind for medication


    Many factors can lead to error in medication. The Institute for Safe Medication Practices (ISMP) has identified 10 key elements with the greatest influence on medication use, noting that weaknesses in these can lead to medication errors. They are:

    • patient information
    • drug information
    • adequate communication
    • drug packing, label and nomenclature
    • medication storage, stock, standardization, and distribution
    • drug device acquisition, use, and monitoring
    • environment factors
    • staff education and competency
    • patient education
    • quality processes and risk management

    Patient information
    Accurate demographic information (the “right patient”) is the first of the “five rights” of medication administration. Required patient information includes name, age, birth date, weight, allergies, diagnosis, current lab results, and vital signs.

    Drug information
    Accurate and current drug information must be readily available to all caregivers. This information can come from protocols, text references, order sets, computerized, medication administration records, and patient profiles.

    Adequate communication
    Many medication errors comes from miscommunication among physicians, pharmacists, and nurses. Communication barriers should be eliminated and drug information should always be verified.

    Drug packaging, labeling, and nomenclature
    Healthcare organizations should ensure that all medications are provided in clearly labeled unit-dose packages for institutional use. Packaging for many drugs looks similar which should be avoided.Look-alike or sound-alike medications—products that can be confused because their names look alike or sound alike—also are a source of errors.

    Medication storage, stock, standardization, and distribution
    Many experienced nurses remember when critical care units kept a medication “stash,” which frequently caused duplication errors. Potentially, many errors could be prevented by decreasing availability of floor-stock medications, restricting access to high-alert drugs, and distributing new medications from the pharmacy in a timely manner. Also, hospitals can use commercially available products to decrease the need for I.V. compounding medications and I.V. admixing. Use of preprinted order sets and standardized formularies can reduce errors, too.
    Drug device acquisition, use,and monitoring Improper acquisition, use, and monitoring of drug delivery devices may lead to medication errors. Some delivery systems have inherent flaws that increase the error risk.

    Environmental factors
    Environmental factors that can promote medication errors include inadequate lighting, cluttered work environments, increased patient acuity, distractions during drug preparation or administration, heavy work load and caregiver fatigue.

    Staff education and competency
    Continuing education of the nursing staff can help reduce medication errors. Medications that are new to the facility should receive high teaching priority. Staff should receive updates on both internal and external error in medication , as an error that has occurred at one facility is likely to occur at another.

    Patient education
    Caregivers should teach patient about the name of each medication they’re taking, how to take it, the dosage, potential adverse effects and interactions, what it looks like, and what it’s being used to treat. Quality processes and risk management A final strategy for reducing medication errors is to establish adequate quality processes and risk-management strategies. Every facility should have a culture of safety that encourages discussion of medication errors and near-misses (errors that don’t reach a patient) in a nonpunitive fashion. Only then can effective systems-based solutions be identified and used.

    Consequences for the nurse
    For a nurse who makes a medication error, consequences may include disciplinary action by the state board of nursing, job dismissal, mental anguish, and possible civil or criminal charges. In one study of fatal medication errors made by healthcare providers, the providers reported they felt immobilized, nervous, fearful, guilty, and anxious. Many experienced insomnia and loss of self-confidence.

    Avoiding medication errors
    How can you safeguard your practice from medication errors? For starters, be conscientious about performing the “five rights” of medication administration every time—right patient (using two identifiers), right drug, right dosage, right time, and right route. Some experts have expanded this list to include:
    • right reason for the drug
    • right documentation
    • right to refuse medication
    • right evaluation and monitoring
    Additional steps you can take to promote safe medication use include:
    • reading back and verifying medication orders given verbally or over the phone.
    • asking a colleague to double-check your medications when giving high-alert drugs
    • using an oral syringe to administer oral or NG medications
    • assessing patients for drug allergies before giving new medications
    • becoming familiar with your facility’s “do not use” list of abbreviations.
    In 2004, the JC published a list of abbreviations that shouldn’t be used because they can contribute to medication errors. For instance, in one documented case, a “naked” decimal point (one without a leading zero) led to a fatal tenfold overdose of morphine in a 9-month-old infant. The dosage was written as “.5 mg” and interpreted as “5 mg.”

    Eliminating medication errors
    Avoiding medication errors requires vigilance and the use of appropriate technology to help ensure proper procedures are followed. Computerized physician order entry reduces errors by identifying and alerting physicians to patient allergies or drug interactions, eliminating poorly handwritten prescriptions, and giving decision support regarding standardized dosing regimens.
    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. (See Websites that can help you avoid medication errors by clicking on the PDF icon above.) Finally, be aware of the role fatigue can play in medication errors.

    Selected references
    Hicks RW, Becker SC, Cousins DD. MEDMARX data report. A report on the relationship of drug names and medication errors in response to the Institute of Medicine’s call for action. Rockville, MD: Center for the Advancement of Patient Safety, U.S. Pharmacopeia; 2008.
    Kohn LT, Corrigan JM, Donaldson MS, eds. To Err is Human: Building a Safer Health System. Washington, DC: National Academy Press; 2000. Koppel R, Wetterneck T, Telles J, Karsh B. Workarounds to barcode medication administration systems: their occurrences, causes, and threats to patient safety. J Am Med Inform Assoc. 2008;15(4):408-423.
    Rogers A, Hwang W, Scott L, Aiken L, Dinges D. The working hours of hospital staff nurses and patient safety. Health Aff (Millwood). 2004;23(4):202-212.
    Article on medication error in American nurse today by Pamela Anderson

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