See Scholarly Outline

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Medication Errors
I.
What are Medication Errors? (MAE)
A. The National Coordinating Council for Medication Error Reporting and
Prevention (NCC MERP) defines medication errors as: “Any preventable event
that may cause or lead to inappropriate medication use or patient harm while the
medication is in the control of health care professional, patient, or consumer. Such
events may be related to professional practice, health care products, procedures,
and systems, including prescribing; order communication; product labeling,
packaging, and nomenclature; compounding; dispensing; distribution;
administration; education; monitoring; and use (NCC MERP, 1998-2011, para
1).”
B. Types of Medication Errors (Agyemang & White, 2010, p. 381)
1. Preparation Errors
a. Wrong Dosage
b. Dose Omission
c. Wrong drug/fluid
d. Wrong Patient
e. Wrong Time
f. Wrong form of medication
g. Wrong solvent
h. Unlabelled drug containers
2. Administrative errors
a. Wrong administration rate
II.
Factors that contribute to Medication Errors
A. Prescribing Errors- “Prescribing errors occur in 0.4% of prescriptions, and happen
as a result of inadequate knowledge of the patient and his/her clinical condition,
inadequate knowledge of the drug, calculation errors, illegible prescriptions, drug
name confusion, dosage formulation, use of uncommon/complicated dosage
regimens and poor history taking (Agyemang & White, 2010, p. 381).”
1. Prescribing wrong drug
2. Prescribing wrong dose, quantity, and indication
3. Prescribing a contraindicated drug
B. Dispensing Errors
1. Drug name confusion
2. Failure to clarify an ambiguous or illegible prescription
3. Similar packaging
4. Single checking
C. Administration Errors- “It is estimated that administration errors on hospital
wards involve around 5% of doses and occur when the drug administered to the
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patient is not what was intended by the prescriber (Agyemang & White, 2010, p.
381).”
1. Illegible Prescriptions
2. Verbal Orders
3. Transcribing errors
4. Inadequate labeling
5. Personal Factors
a. Lack of knowledge
b. Fatigue
c. Illness
d. Stress
e. Distractions
6. Organizational Factors
a. Understaffing
b. Storage of similar drugs in the same place
c. Preparing medications in a crowded clinical room
d. Overcrowded medication trolley
e. Equipment failure or malfunction
f. Excessive workload
III.
Unwillingness of Nurses to Report MAE- MAE are a threat to the quality
of nursing care when they go underreported (Lin & Ma, 2009.
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
IV.
Worried about taking medical responsibility
Worried about getting punished
Easier causing medical disputes
Worried about distrust by patients
Causing patients no obvious harm
Working; are busy
After reporting more people will now this incident
Reporting processes are too much trouble
Worried about getting discrimination from coworkers
Do not know how to report it
There will be no change even if I report it.
How to minimize MAE
A. Follow medication policies and procedures provided by the organization
B. Obey by the “six rights” prior to administering any medications to a patient
1. Right patient
2. Right time and frequency of administration
3. Right dose
4. Right route of administration
5. Right drug
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6. Right documentation
C. Training with infusion pumps
D. Bar-Code-Assisted Medication Administration (BCMA)
V.
MAE impact on nurses (Agyemang & White, 2010, p. 384).
A.
B.
C.
D.
E.
F.
G.
H.
I.
Feelings of guilt
Fear of loss of confidence
Fear of disciplinary action
Exposure to criticism
Reproach from their managers
Feelings of embarrassment and ashamed
Fear of making new mistakes
Increased distrust of themselves
Feelings of incompetency because of supervision by their colleagues
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References
Agyemang, R., & While, A. (2010). Medication errors: types, causes and impact on nursing
practice. British Journal of Nursing (BJN), 19(6), 380-385. Retrieved from
http://web.ebscohost.com.proxy.ohiolink.edu:9099/ehost/pdfviewer/pdfviewer?hid=105&
sid=a3ba93b6-b2d5-4a41-b750-f125e793fd01%40sessionmgr111&vid=7.
Hall, C., & Madsen, L. (2009). New graduates' medication rounds: an improvement in practice.
Practice Development in Health Care, 8(3), 139-151. doi:10.1002/pdh.289.
Helmons, P., Wargel, L., & Daniels, C. (2009). Effect of bar-code-assisted medication
administration on medication administration errors and accuracy in multiple patient care
areas. American Journal of Health-System Pharmacy, 66(13), 1202-1210. Retrieved from
http://web.ebscohost.com.proxy.ohiolink.edu:9099/ehost/pdfviewer/pdfviewer?hid=122&
sid=58aa0f92-10dd-4a9e-988b-324c465d879d%40sessionmgr114&vid=9.
Hewitt, P. (2010). Nurses' perceptions of the causes of medication errors: an integrative literature
review. MEDSURG Nursing, 19(3), 159-167. Retrieved from
http://web.ebscohost.com.proxy.ohiolink.edu:9099/ehost/pdfviewer/pdfviewer?hid=122&
sid=58aa0f92-10dd-4a9e-988b-324c465d879d%40sessionmgr114&vid=13.
International Council of Nurses. (2002). Nursing matters: Medication errors. Retrieved from
http://www.icn.ch/images/stories/documents/publications/fact_sheets/20a_FSMedication_Errors.pdf.
Lin, Y., & Ma, S. (2009). Willingness of nurses to report medication administration errors in
southern Taiwan: a cross-sectional survey. Worldviews on Evidence-Based Nursing, 6(4),
237-245. doi:10.1111/j.1741-6787.2009.00169.x
McBride-Henry, K., & Foureur, M. (2006). Medication administration errors: understanding the
issues. Australian Journal of Advanced Nursing, 23(3), 33-41. Retrieved from
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http://web.ebscohost.com.proxy.ohiolink.edu:9099/ehost/pdfviewer/pdfviewer?hid=122&
sid=58aa0f92-10dd-4a9e-988b-324c465d879d%40sessionmgr114&vid=17.
National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP)
(1998-2011). About medication errors. Retrieved from http://www.nccmerp.org/about
MedErrors.html.
Petrova, E., Baldacchino, D., & Camilleri, M. (2010). Nurses' perceptions of medication errors in
Malta. Nursing Standard, 24(33), 41-48. Retrieved from
http://web.ebscohost.com.proxy.ohiolink.edu:9099/ehost/pdfviewer/pdfviewer?hid=122&
sid=58aa0f92-10dd-4a9e-988b-324c465d879d%40sessionmgr114&vid=21.
Sheu, S., Wei, I., Chen, C., Yu, S., & Tang, F. (2009). Using snowball sampling method with
nurses to understand medication administration errors. Journal of Clinical Nursing,
18(4), 559-569. Retrieved from
http://web.ebscohost.com.proxy.ohiolink.edu:9099/ehost/pdfviewer/pdfviewer?hid=122&
sid=58aa0f92-10dd-4a9e-988b-324c465d879d%40sessionmgr114&vid=25.