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MODULE 7: MEDICATION ERRORS AND RISK REDUCTION

LEARNING OUTCOMES:
After reading this module (7), the student should be able to:
1. Define medication error.
2. Identify factors that contribute to medication errors.
3. Explain the impact of medication errors on patients and health care agencies.
4. Describe methods for reporting and documenting medication errors.
5. Describe strategies that the nurse can implement to reduce medication errors
and incidents.
6. Explain how effective medication reconciliation can reduce medication errors.
7. Identify patient teaching information that can be used to reduce medication
errors and incidents.
8. Explain strategies used by health care organizations to reduce the number of
medication errors and incidents.

1. Defining Medication Errors

 Medication error is “any preventable event that may cause or lead to inappropriate
medication use or patient harm while the medication is in the control of the health care
professional, patient, or consumer.”

 Medication error index. This index categorizes medication errors by evaluating the extent
of the harm an error can cause

 Stated simply, a medication error is any error that occurs in the medication
administration process whether or not it harms the patient. These errors may be related
to misinterpretations, miscalculations, misadministrations, handwriting misinterpretation,
and misunderstanding of verbal or phone orders.

2. Factors Contributing to Medication Errors

 Factors contributing to medication errors by health care providers include, but are not
limited to, the following:
ₒ Omitting one of the rights of drug administration. Common errors include giving
an incorrect dose, not giving an ordered dose, and giving the wrong drug.
ₒ Failing to perform an agency system check. The pharmacist and nurse must
collaborate on checking the accuracy and appropriateness of drug orders prior
to administering drugs to a patient.
ₒ Failing to account for patient variables such as age, body size, and impairment
in renal or hepatic function. The nurse should always review recent laboratory
data and other information in the patient’s chart before administering
medications, especially for those drugs that have a narrow margin of safety.
ₒ Giving medications based on verbal orders or phone orders, which may be
misinterpreted or go undocumented. The nurse should remind the prescriber

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that medication orders must be in writing before the drug can be administered.
ₒ Giving medications based on an incomplete order or an illegible order when
the nurse is unsure of the correct drug, dosage, or administration method.
Incomplete orders should be clarified with the prescriber before the medication
is administered. Written orders should avoid certain abbreviations that are
frequent sources of medication errors,
ₒ Practicing under stressful work conditions. Studies have correlated an
increased number of errors with the stress level of nurses. Studies have also
indicated that the rate of medication errors may increase when individual
nurses are assigned to patients who are the most acutely ill.

 Patients, or their home caregivers, may also contribute to medication errors by:
ₒ Taking drugs prescribed by several practitioners without informing each of their
health care providers about all prescribed medications.
ₒ Getting their prescriptions filled at more than one pharmacy.
ₒ Not filling or refilling their prescriptions.
ₒ Taking medications incorrectly.
ₒ Taking medications that may have been left over from a previous illness or
prescribed for something else.

3. The Impact of Medication Errors

 Medication errors are the most common cause of morbidity and preventable death within
hospitals.
› When a medication error occurs, the repercussions can be emotionally
devastating for the nurse and extend beyond the particular nurse and patient
involved.
› A medication error can lengthen the patient’s stay in the hospital, which
increases costs and the time that a patient is separated from his or her family.
› The nurse or health care provider making the medication error may suffer from
self-doubt and embarrassment.
› If a high error rate occurs within a particular unit, the nursing unit may develop
a poor reputation within the facility. If frequent medication errors or serious
errors are publicized, the reputation of the facility may suffer, because it may
be perceived as unsafe.
› Administrative personnel may also be penalized because of errors within their
departments or the hospital as a whole.

 All errors, whether or not they harm the patient, should be investigated with the goal of
identifying ways to improve the medication administration process to prevent future
errors.
› The investigation should occur in a nonpunitive manner that will encourage
staff to report errors, thereby building a culture of safety within an organization.
Analysis of error patterns can alert nurses and health care administrators that
a new policy or procedure needs to be implemented to reduce or eliminate
medication errors

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4. Reporting and Documenting Medication Errors

 Although some errors go unreported, it is always the nurse’s legal and ethical
responsibility to report all occurrences.

 Documentation of the error should occur in a factual manner; the nurse should avoid
blaming or making judgments.
› Documentation does not simply record that a medical error occurred.
Documentation in the medical record must include specific nursing
interventions that were implemented following the error to protect patient
safety, such as monitoring vital signs and assessing the patient for possible
complications.
› Failure to report nursing actions implies either negligence (i.e., no interventions
were taken) or lack of acknowledgment that the incident occurred.
› The nurse should also document all individuals who were notified of the error.
› The medication administration record (MAR) is another source that should
contain information about what medication was given or omitted.

 In addition to documenting in the patient’s medical record, the nurse making or

observing the medication error should complete a written report of the error. Depending
on the health care agency, these reports may be called “Incident Reports,” “Occurrence
Reports,” or similar titles.
› The written report is not included in the patient’s medical record but is used by
the agency’s risk management personnel for quality improvement and
assurance and may be used by nursing administration and education to
identify common error occurrences and the need for performance
improvement or educational intervention.

 Accurate documentation in the medical record and in the error report is essential for
legal reasons. These documents verify that the patient’s safety was protected and serve
as a tool to improve medication administration processes

 Sentinel events are defined as “unexpected occurrences involving death or serious

physical or psychological injury, or risk thereof” (The Joint Commission, 2009). Not all
errors are sentinel events and not all sentinel events occur because of an error. But
because of the grave nature of the event, sentinel events are always investigated and
interventions put in place to ensure that the event does not recur.

5. Strategies for Reducing Medication Errors

 The most common types of errors usually involve administering an improper dose, giving
the wrong drug, and using the wrong route of administration.
› There is an increased risk for errors in the elderly population because they
often take numerous medications, have multiple health care providers, and are
experiencing normal age-related changes in physiology.

› Children are another vulnerable population because they receive medication

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dosages based on weight (which increases the possibility of dosage

miscalculations), and the therapeutic dosages are much smaller

What can the nurse do in the clinical setting to avoid medication errors and promote safe
administration?
 The nurse can begin by following the steps of the nursing process:
1. Assessment. Ask the patient about allergies to food or medications, current health
concerns, and use of OTC medications and herbal supplements.
For all medications taken prior to assessment, ensure that the patient has been
receiving the right dose, at the right time, and by the right route. Assess kidney, liver,
and other body system functions to determine if impairments are present that could
affect pharmacotherapy.
2. Planning. Minimize factors that contribute to medication errors: Avoid using
abbreviations that can be misunderstood
3. Implementation. Eliminate potential distractions during medication administration that
could result in an error.
4. Evaluation. Assess the patient for expected outcomes and determine if any adverse
effects have occurred.

6. Medication Reconciliation
 Medication reconciliation is the process of keeping track of a patient’s medications as
the patient proceeds from one health care provider to another.

7. Effective Patient Teaching for Medication Usage

 An essential strategy for avoiding medication errors is to educate the patient by
providing written age-appropriate handouts, audiovisual teaching aids about the
medication, and contact information about whom to notify in the event of an adverse
reaction.

 Having the patient “teach back” to the nurse to confirm that the patient has understood
the content is a strategy that assists the nurse to evaluate the teaching

SUMMARY:
1. A medication error may be related to misinterpretations, miscalculations,
misadministrations, handwriting misinterpretation, and misunderstanding of verbal or
phone orders. Whether the patient is injured or not, it is still a medication error.

2. Numerous factors contribute to medication errors, including mistakes in the five rights of
drug administration, failing to follow agency procedures or consider patient variables,
giving medications based on verbal orders, not confirming orders that are illegible or
incomplete, and working under stressful conditions. Patients also contribute to errors by
using more than one pharmacy, not informing health care providers of all medications
they are taking, or not following instructions.

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3. Nurse practice acts define professional nursing, including safe medication delivery.
Standards of care are defined by nurse practice acts and the rule of reasonable and
prudent action.

4. The nurse is legally and ethically responsible for reporting medication errors—whether or
not they cause harm to a patient—in the patient’s medical record and on an incident
report.

5. The nurse can reduce medication errors by adhering to the four steps of the nursing
process: assessment, planning, implementation, and evaluation. Keeping up to date on
pharmacotherapeutics and knowing common error types are instrumental to safe
medication administration.

6. Medication reconciliation is an important means of reducing medication errors.

Medication reconciliation is a process of keeping track of a patient’s medications as the
patient proceeds from one health care provider to another.

7. Patient teaching includes providing age-appropriate medication handouts and

encouraging patients to keep a list of all prescribed medications, OTC drugs, herbal
therapies, and vitamins they are taking and to report them to all health care providers.

8. Facilities use risk-management departments and agency policies and procedures to

decrease the incidence of medication errors. Automated, computerized, locked cabinets
for medication storage are a means of safekeeping of medications and keeping track of
inventory at the unit level.

Reference: Pharmacology for Nurses: A pathophysiologic Approach by Adams, Holland and Urban (pp.
89-96).

Medication Errors and Risk Reduction Celia Cruz-Fajardo,M.D.