1. Medication Errors: Preventing and Responding
Chapter 5
Medication Errors: Preventing and Responding
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

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

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

4. 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.

5. Copyright © 2014 by Mosby, 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.

6. 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.

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

8. 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.

9. 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.

10. 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.

11. 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.

12. 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.

13. 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.

14. 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.

15. 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.

16. 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.

17. 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.

18. 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.

19. 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.

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

21. 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.

22. 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.