1. Preventing Medication Errors
Chapter 9
Preventing Medication Errors
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2. Medication Errors
10 to18% of hospital injuries attributable to medication errors
44,000 to 98,000 people die in U.S. hospitals annually due to medication errors
$3.5 billion in annual costs in U.S. hospitals are due to medication errors
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3. Medication Errors (Continued)
IOM (Institute of Medicine, 2006) estimates that when all steps of the medication administration process are taken into account, hospitalized patients are subjected to an average of one medication error per day
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4. Medication Errors (Continued)
Studies addressing nurses’ perception of medication errors support the existence of underreporting by nurses (Mayo & Duncan, 2004; Stetina, Groves, & Pafford, 2005; Wolf & Serembus, 2004)
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5. Medication Errors (Continued)
Failure to administer a medication and administering a medication late are the most underreported errors because some nurses erroneously perceive that the patients will not be harmed in these situations (Mayo & Duncan, 2004; Stetina et al., 2005)
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6. Medication Errors (Continued)
Effects of medication errors
Increased length of hospital stay
Increased cost
Patient disability
Death
Detriment to nurse’s personal and professional status, confidence, and practice
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7. Safe Medication Administration
Prescription
Licensed providers must have authority within their state to write prescriptions
Includes verbal orders
Repeat and verify all verbal orders for accuracy
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8. Safe Medication Administration (Continued)
Nurses play an important role in preventing errors at prescription step
Verify safety of drug order by checking a reliable drug reference
Practitioner who administers a drug shares liability for injury, even if medical order was incorrect
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9. Verbal Orders
Write or enter verbal or telephone order into patient’s medical record
Read back to prescriber to ensure order is clear
Get confirmation that order is correct
Verification is required by the Joint Commission
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10. Verbal Orders (Continued)
Seven parts of drug orders
Patient’s name
Date and time of order
Name of drug
Amount of drug
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11. Verbal Orders (Continued)
Route
Frequency or administration schedule
Prescriber’s name and licensure
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12. Alert Verbal orders Can easily lead to medication errors
Nurses must understand their responsibility
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13. Institute for Safe Medication Practice (ISMP)
Identifies unsafe
Abbreviations
Acronyms
Symbols
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14. ISMP (Continued)
Suggests that health care facilities identify unsafe abbreviations within the organization
You must know your organization’s policies
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15. 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)
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16. Do Not Use (Continued) Trailing zero (X.0 mg)
Lack of leading zero (.X mg)
MS, MSO4 (morphine sulfate)
MgSO4 (magnesium sulfate)
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17. Safe Medication Administration
Transcription
Patient’s name
Date and time written
Drug name and dosage
Route of administration
Frequency or time of administration
Prescriber’s signature
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18. Safe Medication Administration (Continued)
Six Rights
Right drug
Right route
Right patient
Right dose
Right time
Right documentation
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19. Right Drug Check medication label On first contact with drug
Prior to measuring
Pouring, counting, or withdrawing
After obtaining the drug, just prior to administration
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20. Right Drug (Continued)
Be aware of distractions
Do not multi-task during drug administration
Use bar code scanner when available
Be knowledgeable about the drug’s actions, indications, and contraindications
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21. 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 administration
NPO status
Nasogastric or surgically inserted tubes
Time-released or enteric-coated medications
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22. Right Patient
Correctly identify patient prior to medication administration
Compare armband with medication administration record
Ask the patient to state his name
Compare picture to patient
Technological advances to prevent errors
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23. Right Patient (Continued)
Tell patient at time of administration what medication and dosage is being administered
Patient may question drug or dosage
Provides an opportunity to do medication teaching
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24. Right Dose Carefully read and clarify drug orders Recheck labels
Accurate dosage calculations
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25. Right Dose (Continued)
Have two nurses double-check potent medications
Common sources of errors
Insulin
Consult drug references
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26. Right Time Order should include frequency of administration
Use safe abbreviations
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27. Right Documentation Document after administration
Omitting documentation can result in over- or undermedication
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28. Reminders Check labels carefully
Follow Six Rights of medication administration
Be aware and adhere to facility’s policies on medication administration
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29. Reminders (Continued)
Check medication three times before administering
Identify if the form is appropriate for the route
If unsure of order, clarify prior to administration
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30. Caution
Stay alert to the guidelines and restrictions of the Joint Commission, the ISMP, and your own health care facility regarding abbreviations and medical notation
Acceptable medical communication is subject to abrupt change
© 2013 Delmar Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.