1. Preventing Medication Errors
Chapter 9
MAT 119

2. 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.

3. 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.

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

5. 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

6. 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

7. 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

8. Institute for Safe Medication Practice (ISMP)
Identifies unsafe
Abbreviations
Acronyms
Symbols
Error Prone Abbreviations
(also on pp )

9. “Do Not Use” List
Joint Commission has an official “Do Not Use” list of medical abbreviations
Official Do Not Use list
(also on p 181)

10. 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)

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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!!

19. 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

20. 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!!!

21. 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.

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

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

24. 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.