Preventing Medication Errors Chapter 9 MAT 119

Medication Errors Medication errors are a significant problem in health care. Mistakes can occur at various points in each phase of the medication administration process: prescription, transcription, and administration.

Medication Errors A medication error is any preventable event that may cause or lead to inappropriate medication use or harm to a patient. Since 2000, the Food and Drug Administration (FDA) has received more than 95,000 reports of medication errors. Reports are voluntary. http://www.fda.gov/Drugs/DrugSafety/MedicationErrors/default.htm

Medication Errors Effects of medication errors Increase length of stay Increased cost Patient disability Death Nurse’s personal and professional status, confidence, and practice

Safe Medication Administration Medication orders are either written or verbal, and must contain all seven parts 1. patient’s name 2. date and time of the order 3. drug name 4. dosage/amount 5. route 6. frequency 7. prescriber’s name and licensure

Safe Medication Administration Prescription Licensed providers must have authority within their state to write prescriptions Includes telephone/verbal orders Telephone orders: Write it down, read it back, get confirmation Verbal orders: Repeat and verify all verbal orders for accuracy

Safe Medication Administration Nurses play an important role in preventing errors Practitioner who administers a drug shares liability for injury, even if medical order was incorrect Verify safety of drug order by checking a reliable drug reference

Institute for Safe Medication Practice (ISMP) Identifies unsafe Abbreviations Acronyms Symbols Error Prone Abbreviations http://www.ismp.org/Tools/errorproneabbreviations.pdf (also on pp 182-183)

“Do Not Use” List Joint Commission has an official “Do Not Use” list of medical abbreviations Official Do Not Use list http://www.jointcommission.org/assets/1/18/Do_Not_Use_List.pdf (also on p 181)

Do Not Use “U” (unit) IU (international unit) Q.D, QD, q.d., qd (daily) Q.O.D, QOD, q.o.d., qod (every other day) SC (subcut, or subcutaneously) Trailing zero (X.0 mg) Lack of leading zero (.X mg)

Safe Medication Administration Six Rights of Safe Medication Administration 1. Right patient 2. Right drug 3. Right dosage 4. Right route 5. Right frequency/time 6. Right documentation

1. Right Patient Correctly identify patient prior to medication administration; of the three most common causes of medication errors, failure to accurately identify a patient is the most common Joint Commission requires two (2) unique patient identifiers – neither can be the patient’s room number Compare armband with medication administration record Ask the patient to state his name and date of birth or name and ID on arm band Compare picture to patient Technological advances to prevent errors

Right Patient Tell patient at time of administration what medication and dosage is being administered – patient has Right to Know! Patient may question drug or dosage Provides an opportunity for medication teaching

2. Right Drug Check medication 3 times to ensure the right drug by checking the medication label against the order or MAR during the administration process: On first contact with drug Prior to measuring Pouring, counting, or withdrawing After obtaining the drug, just prior to administration

Right Drug Be aware of distractions Do not multitask during drug administration Use bar-coding scanning when available Be knowledgeable about the drug’s actions, indications, and contraindications

3. Right Route Consult a drug information source to confirm correct route May need to change or clarify forms or routes of the drug for safe medication administration NPO status Nasogastric or surgically inserted tubes Time-released or enteric-coated medications

4. Right Frequency / Time Order should include frequency of administration Use safe abbreviations Joint Commission has identified q.d. as being transcribed as q.i.d. Q.D. needs to be written as daily

5. Right Dose Illegible prescriber’s handwriting, a transcription error, miscalculation of the amount, or misreading the label can result in errors of an incorrect dose of medication Carefully read and clarify drug orders Recheck labels Have two nurses double-check potent medications Common sources of errors Insulin Consult drug references Accurate dosage calculations – main purpose of course!!

6. Right Documentation! The nurse MUST document administration of the drug If it’s not documented… it wasn’t done! Document AFTER administration of medication NEVER leave meds at patient’s bedside With computerized delivery system, a second scan is done as a signature Omitting documentation can result in over or under medication PRN medications is most problematic in over medication

Computerized Systems CPOE – computerized physician order entry Avoids illegible writing All patients admitted to the facility receive a barcoded armband The eMAR and barcoding system uses mobile carts with laptops, tethered barcode scanners, or desktop computers with wireless scanners to read barcode labels on medications and patient armbands Automated Dispensing Machines These do NOT prevent medication errors!!!

eMar The nurse views the eMAR screen and reviews the patient's medication list and verifies with the physician orders. eMAR alerts the nurse about the next dose due, overdue doses, or cautions about medications Nurse takes the cart to the patient, scans the medication and the patient's wristband.

Reminders Check labels carefully Follow Six Rights of medication administration Be aware and adhere to facility’s policies on medication administration

Reminders Check medication three times before administering Identify if the form is appropriate for the route If unsure of order, clarify prior to administration

Reminders When you give a medication, you are responsible if an injury occurs even if the order was incorrect. When you receive an order, make sure it is safe. If you are not familiar with the medication, look it up in a reliable reference such as a Nurse’s Drug Handbook, Hospital Formulary, hospital pharmacy intranet YOU are the last line of defense between a safe or not safe medication administration.