Medication Errors: Preventing and Responding DSN Kevin Dobi, MS, APrn Chapter 5 Medication Errors: Preventing and Responding DSN Kevin Dobi, MS, APrn Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Adverse Drug Event Medication errors Adverse drug reactions Institute of Medicine studies (1999, 2006) Adverse drug reactions Allergic reaction Idiosyncratic reaction Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Classroom Response Question In the 2006 Institute of Medicine Study, it was estimated that some form of medication error resulted in harm to how many patients? 400,000 800,000 1 million 1.5 million Correct answer: D Rationale: In the 2006 Institute of Medicine Study, it was estimated that some form of medication error resulted in harm to 1.5 million patients per year, including 400,000 in hospitals and up to 800,000 in long-term care settings. Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Elsevier items and derived items © 2009, 2005, 2001 by Saunders, an imprint of Elsevier Inc.

Medication Errors Preventable Common cause of adverse health care outcomes More potential for harm with “high-alert” medications Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Issues Contributing to Errors Errors can occur during any step of medication process: Procuring Prescribing Transcribing Dispensing Administering Monitoring Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Issues Contributing to Errors (cont’d) Organizational issues Educational system issues Sociologic factors Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Types of Medication Errors No error, although circumstances or events occurred that could have led to an error Medication error that causes no harm Medication error that causes harm Medication error that results in death Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Preventing Medication Errors Multiple systems of checks and balances Legible and correct orders Appropriate consultation Check medication order three times “Six Rights” of medication administration Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Preventing Medication Errors (cont’d) Minimize verbal or telephone orders Repeat order to prescriber Spell drug name aloud Speak slowly and clearly List indication next to each order Avoid medical shorthand, including abbreviations and acronyms Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Preventing Medication Errors (cont’d) Never assume anything about items not specified in a drug order (e.g., route) Do not hesitate to question a medication order for any reason when in doubt Do not try to decipher illegibly written orders; contact prescriber for clarification Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Preventing Medication Errors (cont’d) NEVER use a “trailing zero” with medication orders Do not use 1.0 mg; use 1 mg 1.0 mg could be misread as 10 mg, resulting in a tenfold dose increase Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Preventing Medication Errors (cont’d) ALWAYS use a “leading zero” for decimal dosages Do not use .25 mg; use 0.25 mg .25 mg may be misread as 25 mg Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Preventing Medication Errors (cont’d) Take time to learn special administration techniques of certain dosage forms Always verify new medication administration records Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Preventing Medication Errors (cont’d) Always listen to and honor any concerns expressed by patients regarding medications Check patient allergies and identification Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Classroom Response Question The nurse is administering a drug that has been ordered as follows: “Give 10 mg on odd-numbered days and 5 mg on even-numbered days.” When the date changes from May 31 to June 1, what should the nurse do? Give 10 mg because June 1 is an odd-numbered day Hold the dose until the next odd-numbered day Change the order to read “Give 10 mg on even-numbered days and 5 mg on odd-numbered days” Consult the prescriber to verify that the dose should alternate each day, no matter whether the day is odd- or even-numbered Correct answer: D Rationale: While option C seems reasonable, the nurse does not have prescriptive authority to change the order. Therefore, the prescriber should be consulted to verify the order, which can be written in clearer terms. The other options would result in a change in the alternating dose schedule. Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Elsevier items and derived items © 2009, 2005, 2001 by Saunders, an imprint of Elsevier Inc.

Reporting Medication Errors Report to prescriber and nursing management Document error per policy and procedure Factual documentation only Medication administered Actual dose Observed changes in patient condition Prescriber notified/follow-up orders Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Reporting Medication Errors (cont’d) External reporting of errors USP MERP (United States Pharmacopeia Medication Errors Reporting Program) MedWatch, sponsored by the FDA Institute for Safe Medication Practices (ISMP) The Joint Commission Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Classroom Response Question The nursing student realizes that she has given a patient a double dose of an antihypertensive medication. The tablet was supposed to be cut in half, but the student forgot and administered the entire tablet. The patient’s blood pressure just before the dose was 146/98 mm Hg. What should the student nurse do first? Notify the patient’s physician Notify the clinical faculty Take the patient’s blood pressure Continue to monitor the patient Correct answer: B Rationale: The patient’s blood pressure will need to be monitored, but it was just taken and the medication dose will not have an immediate effect. The student should notify the clinical instructor immediately. Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Elsevier items and derived items © 2009, 2005, 2001 by Saunders, an imprint of Elsevier Inc.

Medication Reconciliation Continuous assessment and updating of patient medication information Verification Clarification Reconciliation Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Medication Reconciliation (cont’d) Should be done at each stage of health care delivery: Admission Status change Patient transfer within or between facilities/provider teams Discharge Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Ethical Issues Notification of patients Possible consequences for nurses Copyright © 2014 by Mosby, an imprint of Elsevier Inc.