Transcript Pharmacology and the Nursing Process, 4th ed. Lilley/Harrington

Chapter 5
Medication Errors:
Preventing and Responding
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
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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?
A.
B.
C.
D.
400,000
800,000
1 million
1.5 million
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Medication Errors



Preventable
Common cause of adverse health care
outcomes
More potential for harm with “high-alert”
medications
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Issues Contributing to Errors

Errors can occur during any step of medication
process:

Procuring
 Prescribing
 Transcribing
 Dispensing
 Administering
 Monitoring
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Issues Contributing to Errors
(cont’d)



Organizational issues
Educational system issues
Sociologic factors
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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
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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
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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
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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
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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
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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
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Preventing Medication Errors
(cont’d)


Take time to learn special administration
techniques of certain dosage forms
Always verify new medication administration
records
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Preventing Medication Errors
(cont’d)


Always listen to and honor any concerns
expressed by patients regarding medications
Check patient allergies and identification
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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?
A. Give 10 mg because June 1 is an odd-numbered day
B. Hold the dose until the next odd-numbered day
C. Change the order to read “Give 10 mg on evennumbered days and 5 mg on odd-numbered days”
D. Consult the prescriber to verify that the dose should
alternate each day, no matter whether the day is oddor even-numbered
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Reporting Medication Errors

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Report to prescriber and nursing management
Document error per policy and procedure
Factual documentation only

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
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Medication administered
Actual dose
Observed changes in patient condition
Prescriber notified/follow-up orders
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Reporting Medication Errors
(cont’d)

External reporting of errors
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
USP MERP (United States Pharmacopeia Medication
Errors Reporting Program)
MedWatch, sponsored by the FDA
Institute for Safe Medication Practices (ISMP)
The Joint Commission
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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?
A.
B.
C.
D.
Notify the patient’s physician
Notify the clinical faculty
Take the patient’s blood pressure
Continue to monitor the patient
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Medication Reconciliation

Continuous assessment and updating of patient
medication information



Verification
Clarification
Reconciliation
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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
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Ethical Issues


Notification of patients
Possible consequences for nurses
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