How to Prevent Medication Errors in Nursing

Human error is one of the biggest challenges facing the healthcare industry. Medical professionals do their best to avoid mistakes, but everyone is fallible, and problems still sometimes occur.

Of all the medical errors that affect hospital patients, one of the most common is medication error, also known as an adverse drug event (ADE). A study published in Pharmacy World and Science found that, over a period of 20 days, “the medication administration error rate was 14.9%.” Of those observed errors, 10% were found to be potentially life-threatening.

Because nurses have an active role in medication drug delivery, they need to know how to avoid medication errors, and the first step is understanding how errors happen.

Strategies for Preventing Medication Errors in Nursing

The Institute for Safe Medication Practices (ISMP) identified the following 10 factors most likely to affect medication accuracy:

1. Patient Information

Drug selection and dosage frequently depend on a patient’s clinical data and individual demographic information, including height and weight. Errors can occur if a nurse misinterprets or fails to read any such data.

Best Practices for Nursing

Identity verification of patients is critical to avoiding medication errors. Many healthcare organizations have had success with barcoded delivery procedures, which have been shown to reduce medication dispensing errors by up to 96%. This level of protection happened only when participating nurses were required to scan every dose. When that didn’t happen, dispensing errors only decreased by 60% and potential ADEs increased. All new medical technology takes time to implement, so nursing teams must have a shared commitment to implement the new systems correctly. In case of technology failures, multiple fail-safes should be in place, including written warnings on medications that are often confused with one another.

2. Drug Information

Any time comprehensive drug information is unavailable, medical professionals are at risk of making dangerously incorrect guesses. Every person who administers medication should have access to updated, accurate, and complete information on every drug they might have to give a patient. The information should be available in several different formats such as formularies, reference texts, and dosing scales for ease of access.

Best Practices for Nursing

Have a drug guide available in every work area that nurses might use for dosing. When nurses are in a hurry, they likely won’t have time to track down a guide that’s stored somewhere else. In addition to the guide, make sure all medication labeling is correct and complete, including dose and expiration date. It’s always possible for the right medication to have the wrong label or vice versa. More importantly, document everything. Record every time you administer medication, whether it’s scheduled or given as needed. An undocumented dose can easily lead to a coworker administering the medication again, thinking that the patient hasn’t yet received it.

3. Adequate Communication

Medication directives pass through the hands of many people on the care team. At any point, a misread or misheard instruction can have extremely damaging consequences.

 Best Practices for Nursing

Any time a unit receives a new patient, nurses should review every medication prescribed to the patient and check the five “rights”:

  • Right patient
  • Right medication
  • Right dosage
  • Right route
  • Right time

Most medication errors involve oversights in at least one of these categories, so nurses should check each one against the incoming Medication Administration Record (MAR). If any information is not in the record, the nurse must find it via an alternate source.

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4. Drug Packaging, Labeling, and Nomenclature

Many medications look alike or have similar-sounding names. If these drugs aren’t explicitly labeled with double-check warnings, healthcare professionals can easily deliver the wrong medication.

Best Practices for Nursing

Healthcare organizations should receive clearly labeled unit-dose packages from manufacturers whenever possible. When a medication is “high-alert,” meaning that a mistake could lead to serious patient harm, there should be extra precautions.

 5. Medication Storage, Stock, Standardization, and Distribution

When drug administration times are not standardized or when concentration isn’t reliable across the board, medication errors happen more easily. The same is true for dose concentrations, which need to be standardized but and limited in how much can be stored in patient care areas. These safeguards reduce the risk of error and limit the impact of any error that does occur.

Best Practices for Nursing

The ISMP encourages medical centers to limit the amount of a drug kept in floor stock. If there is minimal “extra,” the chance of a duplication error is lessened. Standardized formulations can also reduce the incidence of delivery errors. According to the Institute for Healthcare Improvement, preprinted protocols and standard orders should make up 75% of all medications that a facility uses.

Finally, nurses must be aware of which medications should be in refrigerated storage and which should not. Temperature fluctuations can render certain drugs ineffective.

6. Drug-Device Acquisition, Use, and Monitoring

When drug delivery devices are in use, the potential exists for machine error as well as human error.

Best Practices for Nursing

Prevention of device errors requires a threefold approach: Avoid purchasing products with known flaws, monitor active devices regularly, and report any potential malfunctions. Although the latter two points are most likely to be relevant to nurses, some do have purchasing roles and must be mindful of product quality.

7. Environmental Factors

Even within a well-designed system, environmental conditions like lighting, noise, and high patient-to-nurse ratios can cause errors.

Best Practices for Nursing

Nursing teams should advocate for change whenever any environmental factors inhibit medication delivery.

8. Staff Education and Competency

When anything happens to change the way medications are delivered, whether it be a new medication or a new procedure, the risk of error increases.

Best Practices for Nursing

Any new drug information should be a part of routine staff education, including any errors that have occurred with a drug the facility uses, whether the error happened on-site or not. Shift leaders should also encourage personnel to attend any grand rounds that involve medication. Many nurses have said that attending pharmacy grand rounds allows them to provide better care.

9. Patient Education

It is a nurse’s responsibility to ensure that patients receive the correct medication. However, if patients are kept in the dark about their medication regimen, risk increases for adverse interactions or dosage errors.

Best Practices for Nursing

As long as a patient is conscious and aware, nurses should teach them about each of their medications, including its name, the condition it treats, any side effects (intended or potential), and delivery routine. The more patients know, the more they can advocate for themselves and help caregivers to avoid errors.

10. Quality Processes and Risk Management

People make mistakes. The risk of medication errors increases when there is a lack of standardized delivery procedures and when risk protocol is lacking.

Best Practices for Nursing

Patient safety demands that all units have medication delivery protocol and safety checks for accuracy. Any errors that do happen should be topics for discussion. The focus has to be not on blame, but on understanding why an error happened and how to prevent it from happening again. Any necessary disciplinary action should be a separate process.

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