Medication Errors
Preventing and Responding
Objectives
When you reach the end of this chapter, you will be able to do the following:
2 Describe the most commonly encountered medication errors.
3 Develop a framework for professional nursing practice for prevention of medication errors.
4 Identify potential physical and emotional consequences of a medication error.
5 Discuss the impact of culture and age on the occurrence of medication errors.
7 Identify agencies concerned with prevention of and response to medication errors.
Key Terms
Adverse drug event Any undesirable occurrence related to administration of or failure to administer a prescribed medication. (p. 65)
Adverse drug reactions Unexpected, unintended, or excessive responses to medications given at therapeutic dosages (as opposed to overdose); one type of adverse drug event. (p. 65)
Allergic reaction An immunologic reaction resulting from an unusual sensitivity of a patient to a particular medication; a type of adverse drug event and a subtype of adverse drug reactions. (p. 65)
Idiosyncratic reaction Any abnormal and unexpected response to a medication, other than an allergic reaction, that is peculiar to an individual patient. (p. 65)
Medical errors A broad term used to refer to any errors at any point in patient care that cause or have the potential to cause patient harm. (p. 65)
Medication errors Any preventable adverse drug events involving inappropriate medication use by a patient or health care professional; they may or may not cause the patient harm. (p. 65)
Medication reconciliation A procedure implemented by health care providers to maintain an accurate and up-to-date list of medications for all patients between all phases of health care delivery. (p. 70)
http://evolve.elsevier.com/Lilley
• Answer Key—Textbook Case Studies
• Critical Thinking and Prioritization Questions
• Review Questions for the NCLEX® Examination
General Impact of Errors on Patients
Medical errors and medication errors in particular have received much national attention. The study that brought medical errors to the public was the landmark study done in 1999 by the Institute of Medicine (IOM). According to this study, the number of patient deaths from medical errors in U.S. hospitals ranged from 44,000 to 98,000 annually based on data from two large-scale studies. The IOM conducted a similar study in 2006 and found that medical errors harm at least 1.5 million people per year, including 117,000 hospitalizations at a cost of over $4 billion. A follow-up study in 2010 showed 25.1 “harms” per 100 admissions to the hospital. This study showed no significant change in rates of preventable errors since the IOM study. Numerous health institutions have made prevention of medical errors a top priority. The most important change is to recognize that reporting of errors should not be punitive toward the reporter. In fact, all health care professionals are encouraged to report errors. It has been shown that reporting of errors can prevent errors from occurring. This study also brought forth the notion that most errors occur as a breakdown in the medication use system, as opposed to being the fault of the individual. This concept has been taken a step further and has created “just culture.” Just culture recognizes that systems are generally at fault when an error occurs, but that when professionals do not follow policies or have repeated errors, that professional needs remedial education and must be held accountable.
Medical errors can occur during all phases of health care delivery and involve all categories of health professionals. Some of the more common types of error include misdiagnosis, patient misidentification, lack of patient monitoring, wrong-site surgery, and medication errors. Most studies have looked at medical errors occurring in hospitals; however, many serious medication errors occur in the home. Errors occurring in homes can be quite harmful, as potent drugs once used only in hospitals are now being prescribed for outpatients. The majority of fatal errors at home involve the mixing of prescription drugs with alcohol or other drugs. Intangible losses resulting from such adverse outcomes include patient dissatisfaction with, and loss of trust in, the health care system. This, in turn, can lead to adverse health outcomes because patients are afraid to seek health services. This chapter focuses on the issues related to medication errors and ways to prevent and respond to these errors.
Medication Errors
An adverse drug event is a general term that encompasses all types of clinical problems related to medication use. These include medication errors and adverse drug reactions. The various subsets of adverse drug events and their interrelationships are illustrated in Figure 5-1. Adverse drug reactions are reactions that occur with the use of the particular drug. Two types of adverse drug reactions are allergic reaction (often predictable) and idiosyncratic reaction (usually unpredictable). Medication errors are a common cause of adverse health care outcomes and can range from having no significant effect to directly causing patient disability or death.
It is important to consider all of the steps involved in the medication use system when discussing medication errors. Identifying, responding to, and ultimately preventing medication errors require an examination of the entire medication use process. Attention must be focused on all persons and all steps involved in the medication use process, including the prescriber, the transcriber of the order, nurses, pharmacists, and any other ancillary staff involved. A systems approach takes the “Six Rights” one step further and examines the entire health care system, the health care professionals involved, and any other factor that has an impact on the error.
Drugs commonly involved in severe medication errors include central nervous system drugs, anticoagulants, and chemotherapeutic drugs. “High-alert” medications have been identified as those that, because of their potentially toxic nature, require special care when prescribing, dispensing, and/or administering. High-alert medications are not necessarily involved in more errors than other drugs; however, the potential for patient harm is higher. Some high-alert medications are listed in Box 5-1. Medication errors also result from the fact that there are large numbers of drugs that have similarities in spelling and/or pronunciation (i.e., look-alike or sound-alike names). Several acronyms have been created to refer to these drugs, including SALAD (sound-alike, look-alike drugs) and LASA (look-alike, sound-alike). Mix-ups between such drugs are most dangerous when two drugs from very different therapeutic classes have similar names. This can result in patient effects that are grossly different from those intended as part of the drug therapy. The Safety and Quality Improvement: Preventing Medication Errors box on p. 66 lists examples of commonly confused drug names. More information on high-alert medications and sound-alike, look-alike drugs can be found at the website of the Institute for Safe Medication Practices at http://www.ismp.org.
It is widely recognized that most medication errors result from weaknesses in the systems within health care organizations rather than from individual shortcomings. System weaknesses include failure to create a “just culture” or nonpunitive work atmosphere for reporting errors, excessive workload with minimal time for preventive education, and lack of interdisciplinary communication and collaboration. All hospitals are required to analyze medication errors and implement ways to prevent them. Nurses must take the time to report errors, because without reporting, no changes can be made. When errors are reported, trends can be identified and processes can be changed to prevent the errors from occurring again.
Issues Contributing to Errors
Organizational Issues
Medication errors can occur at any step in the medication process: procuring, prescribing, transcribing, dispensing, administering, and monitoring. One study noted that half of all preventable adverse drug events begin with an error at the medication ordering (prescribing) stage. Most prescribing errors can be caught by the pharmacist before order entry and by nurses prior to administration. Administration is the next most common point in the process at which medication errors
SAFETY AND QUALITY IMPROVEMENT: PREVENTING MEDICATION ERRORS
Institute for Safe Medication Practices: Examples of Look-Alike, Sound-Alike (LASA) Commonly Confused Drug Names
| NAMES OF MEDICATIONS | COMMENTS |
| carboplatin vs. cisplatin | Two different antineoplastic drugs |
| Celebrex vs. Celexa | Antiinflammatory drug vs. antidepressant drug |
| Depakote vs. Depakote ER | Same drug; immediate-release vs. extended-release dosage forms |
| dopamine vs. dobutamine | Vasopressor drugs of markedly different strengths; dobutamine is also a strong inotropic affecting the heart |
| fentanyl vs. sufentanil | Both are injectable anesthetics but with a significant difference in potency and duration of action |
| glipizide vs. glyburide | Two different antidiabetic drugs |
| Humulin vs. Humalog | Short-acting vs. rapid-acting insulin |
| Lamictal vs. Lamisil | Anticonvulsant/mood stabilizer vs. antifungal drug |
| metronidazole vs. metformin | Antibiotic vs. antidiabetic drug |
| MiraLax vs. Mirapex | Laxative vs. antiparkinson drug |
| morphine vs. hydromorphone | Two different potency opioids |
| oxycodone vs. OxyContin | Immediate-release vs. long-acting oxycodone |
| Paxil vs. Plavix | Antidepressant vs. antiplatelet drug |
| trazodone vs. tramadol | Antidepressant vs. analgesic |
Additional examples can be found at http://www.ismp.org/Tools/confuseddrugnames.pdf. Accessed February 23, 2011.
occur, followed by dispensing errors and transcription errors. It is very important for nurses to have good relationships with pharmacists, because the two professions, working together, can have a major impact in preventing medication errors. Hospital pharmacists are usually available 24/7 and serve as great resources when the nurse has any question regarding drug therapy.
The Joint Commission, the major accreditation body for hospitals, began a patient public awareness campaign in 2006 called Speak Up. It encourages patients to take a more active role in their health care by “speaking up” and asking questions whenever they feel the need to do so. The value of this program is twofold: patients learn more about their illnesses and the care provided, and they can advocate for their own safety at each health care encounter. Specific topics on the campaign website (http://www.jointcommission.org/speakup.aspx) include asking questions about care in general, learning about living organ donation, preventing infections in the hospital, avoiding medication errors, participating in research studies, planning for follow-up care, avoiding errors in medical tests, and knowing about patients rights in general (see Box 5-2).
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
