Medication errors remain one of the most common causes of unintended harm to patients. They contribute to adverse events that compromise patient safety and result in a large financial burden on the health service. The prevention of medication errors, which can happen at every stage of the medication preparation and distribution process, is essential to maintaining a safe healthcare system. One-third of the errors that harm patients occur during the nurse administration phase: administering medication to patients is, therefore, a high-risk activity. This article highlights factors that contribute to medication errors, including the safety culture of institutions. It also discusses factors that relate specifically to nurses, such as patient acuity and nursing workload, the distractions and interruptions that can occur during medication administration, the complexity of some medication calculations and administration methods, and the failure of nurses to adhere to policies or guidelines.
It is important for all nurses to become familiar with various strategies to prevent or reduce the likelihood of medication errors. Here are ten ways to help you do just that.
- Ensure the five rights of medication administration.
Nurses must ensure that institutional policies related to medication transcription are followed. It isn’t adequate to transcribe the medication as prescribed but to ensure the correct medication is prescribed for the correct patient, in the correct dosage, via the correct route, and timed correctly (also known as the five rights).
- Follow proper medication reconciliation procedures.
Institutions must have mechanisms in place for medication reconciliation when transferring a patient from one institution to the next or from one unit to the next in the same institution. Review and verify each medication for the correct patient, correct medication, correct dosage, the correct route, and correct time against the transfer orders, or medications listed on the transfer documents. Nurses must compare this to the medication administration record (MAR). Often, not all elements of a medication record are available for easy verification, but it is of paramount importance to verify with every possible source—including the discharging or transferring institution/unit, the patient or patient’s family, and physician—to prevent potential errors related to improper reconciliation. There are several forms for medication reconciliation available from various vendors.
- Double-check or even triple-check procedures.
This is a process whereby another nurse on the same shift or an incoming shift reviews all new orders to ensure each patient’s order is noted and transcribed correctly on the physician’s order and the medication administration record (MAR) or the treatment administration record. Some institutions have a chart flag process in place to highlight charts with new orders that require order verification.
- Have the physician (or another nurse) read it back.
This is a process whereby a nurse reads back an order to the prescribing physician to ensure the ordered medication is transcribed correctly. This process can also be carried out from one nurse to the next whereby a nurse reads back an order transcribed to the physician’s order form to another nurse as the MAR is reviewed to ensure accuracy.
- Consider using a name alert.
Some institutions use name alerts to prevent similar-sounding patient names from potential medication mix up. Names such as Johnson and Johnston can lead to easy confusion on the part of nursing staff, so it is for this reason that name alerts posted in front of the MAR can prevent medication errors.
- Place a zero in front of the decimal point.
A dosage of 0.25mg can easily be construed as 25mg without the zero in front of the decimal point, and this can result in an adverse outcome for a patient.
- Document everything.
This includes proper medication labeling, legible documentation, or proper recording of administered medication. A lack of proper documentation for any medication can result in an error. For example, a nurse forgetting to document an as-needed medication can result in another dosage being administered by another nurse since no documentation denoting previous administration exists. Reading the prescription label and expiration date of the medication is also another best practice. A correct medication can have an incorrect label or vice versa, and this can also lead to a med error.
- Ensure proper storage of medications for proper efficacy.
Medications that should be refrigerated must be kept refrigerated to maintain efficacy, and similarly, medications that should be kept at room temperature should be stored accordingly. Most biologicals require refrigeration, and if a multidose vial is used, it must be labeled to ensure it is not used beyond its expiration date from the date it was opened.
- Learn your institution’s medication administration policies, regulations, and guidelines.
In order for nurses to follow an institution’s medication policy, they must become familiar with the content of the policy. This is where education comes into play whereby the institution’s educator or education department educates nurses on the content of their medication policy. These policies often contain vital information regarding the institution’s practices on medication ordering, transcription, administration, and documentation. Nurses can also familiarize themselves with guidelines such as the Beers’ list, black box warning labels, and look-alike/sound-alike medication lists.
- Consider having a drug guide available at all times.
Whether it’s print or electronic is a matter of personal (or institutional) preference, but both are equally valuable in providing important information on most categories of medication, including trade and generic names, therapeutic class, drug-to-drug interactions, dosing, nursing considerations, side effects/adverse reactions, and drug cautionary such as “do not crush, or give with meals.”
Utilizing any or all of the above strategies can help to prevent or reduce medication errors. Nurses must never cease to remember that a medication error can lead to a fatal outcome and it is for this reason that med safety matters.