Medication Errors & Risk Reduction

Pharmacology for Nurses: A Pathophysiologic
Approach
Fifth Edition
Chapter 7
Medication Errors and Risk
Reduction
Copyright © 2017, 2014, 2011 Pearson Education, Inc. All Rights Reserved
Medication Error
• Assessing
• Diagnosing
• Planning
• Implementing
• Evaluating
Figure 7.1 Index for Categorizing
Medication Errors Algorithm
Source: Reprinted with the permission of the National Coordinating

Council for Medication Error Reporting and Prevention, ©2001.
Healthcare Provider Factors Contributing
to Medication Errors (1 of 2)
• Omitting one of the rights of drug administration
• Failing to perform an agency system check
• Failing to take into account for patient variables such as
age, body size, and renal or hepatic function
Healthcare Provider Factors Contributing
to Medication Errors (2 of 2)
• Giving medications based on verbal orders or phone
orders
• Giving medication based on an incomplete order or an
illegible order
• Practicing under stressful work conditions
Patient/Caregiver Factors Contributing to
Medication Errors (1 of 2)
• Taking drugs prescribed by several practitioners
• Getting prescriptions filled at more than one pharmacy
• Not filling or refilling prescriptions
Patient/Caregiver Factors Contributing to
Medication Errors (2 of 2)
• Taking medications incorrectly
• Taking medications that may be left over from a previous
illness
• Taking medications prescribed for someone else
Impact of Medication Errors (1 of 2)
• Common cause of morbidity and preventable death in

hospitals
• Emotionally devastating to nurse and patient
• Increased cost to patient and facility, as it may extend
patient’s stay
Impact of Medication Errors (2 of 2)
• Damaged reputation of unit or facility with high reported

incidence of errors
• Penalizing of administrative staff because of errors
Investigating Errors
• No acceptable rate of medication errors

• Errors should be investigated and subjected to analysis
to determine causes
Reporting and Documenting Medication
Errors (1 of 2)
• Documentation in medical record must include specific
nursing interventions implemented after the error to
protect the patient
Reporting and Documenting Medication
Errors (2 of 2)
• Document all individuals notified of error
• Give details of what medication was given or omitted in
medication-administration record (MAR)
Reporting with an Incident Report
• Recorded in factual and objective manner

• Allows nurse to identify factors contributing to the error
• Is not part of patient’s hospital record
• Used by agency’s risk management personnel for quality
improvement
Legality and Reducing Errors (1 of 2)
• Accurate documentation verifies patient’s safety

• Used as tool to improve drug administration processes
Sentinel Events
• Unexpected occurrences involving death or serious

physical or psychological injury, or risk thereof
• Always investigated
• Interventions to ensure no repetition
• Root cause analysis (RCA) seeks to prevent another
occurrence by asking what happened and why, and what
can be done to prevent it
Reduction of Medication Errors and
Incidents—Assessment (1 of 2)
• Assess food and medication allergies
• Assess current health concerns
• Assess use of OTCs and herbal supplements
• Review recent laboratory tests
• Assess kidney, liver, and other body functions
Incidents—Assessment (2 of 2)
• Review recent physical-assessment findings
• Identify need for education of medication regimen
Incidents—Planning
• Avoid using abbreviations that can be misunderstood
• Question unclear orders
• Do not accept verbal orders
• Follow facility policies and procedures
• Ask patient to demonstrate understanding of therapy
goals
Incidents—Implementation (1 of 3)
• Be aware of potential distractions during medication
administration
• Remove distractions, if possible
• Focus on task of administering medications
• Practice the rights of medication administration
• Keep in mind the following steps:
– Positively verify patient using two means of
identification
– Use correct procedures for all routes of administration
– Calculate medication doses correctly
– Record on MAR immediately after administering
– Confirm patient has swallowed medication
– Be alert for long-acting oral dosage forms with
indicators such as LA, XL, and XR
– Be alert for drugs whose names look and sound alike
Incidents—Evaluation
• Assess patient for expected outcomes
• Determine if any adverse effects have occurred
Nurses and Errors
• Nurses should know most frequent types of drug errors

and severities of reaction
• Nurse should never administer a medication unless
familiar with uses and side effects—digital devices now
help with this
Governmental and Other Agencies that
Track Medication Errors
• FDA’s MedWatch
– Allows health care providers and the public to report
errors anonymously
– Provides up-to-date clinical information about safety
issues involving medical products
• Institute for Safe Medication Practices (ISMP)
• FDA’s Division of Medication Error Prevention and
Analysis (DMEPA) reviews all medication error reports
Table 7.1 Look-Alike and Sound-Alike
Drug Names (1 of 4)
acetazolamide acetohexamide
AcipHex Aricept
Adderall Inderal
bupropion buspirone
carboplatin cisplatin
Celebrex Cerebyx
chlorpromazine chlorpropamide
cycloserine cyclosporine
daunorubicin doxorubicin
dimenhydramine Diphenhydramine
Diprivan Ditropan
Drug Names (2 of 4)
dobutamine dopamine
ephedrine epinephrine
Humalog Humulin
hydromorphone morphine
infliximab rituximab
isotretinoin tretinoin
Kaletra Keppra
Lamisil Lamictal
lamivudine lamotrigine
leucovorin Leukeran
Lexapro Loxitane
Drug Names (3 of 4)
MS Contin OxyContin
Neulasta Neumega
oxycodone OxyContin
paroxetine fluoxetine
Retrovir ritonavir
Seroquel Sinequan
sumatriptan zolmitriptan
Tiagabine tizanidine
TobraDex Tobrex
Drug Names (4 of 4)
Tramadol trazodone
Trental tegretol
valacyclovir valganciclovir
vinblastine vincristine
Viracept Viramune
Zantac Zyrtec
Zestril Zetia
Zyprexa Celexa
Medication Reconciliation (1 of 2)
• The process of tracking a patient’s medications as they

proceed from one health care provider to another
• Very important for polypharmacy—patients (mainly older
adults) receiving multiple prescriptions that may have
conflicting pharmacologic actions
Medication Reconciliation (2 of 2)
• Many serious medication errors tracked to poor

reconciliation
• Reconciliation lists all medications that a patient is taking;
helps reduce errors
• Hospitals encouraged to document a complete list when
patient is admitted
Educate Patient with:
• Written, age-appropriate handouts

• Audiovisual teaching aids
• Contact information in case of adverse reaction
Additional Patient Education
• Know names of all medications

• Know what side effects may occur
• Use appropriate administration devices
• Read label before each drug administration
• Carry a list of all medications, including OTC and dietary
or herbal supplements
• Ask questions
Methods to Reduce Number of Medication
Errors (1 of 2)
• Electronic health records (EHRs) and e-prescriptions
• Barcode-assisted medication administration (BCMA) to
verify and document medication administration at point of
care
• Risk-management departments to examine risks and
minimize number of medication errors
Methods to Reduce Number of Medication
Errors (2 of 2)
• Root-cause analysis (RCA) to determine
– What happened?
– Why did it happen?
– What can prevent it from happening again?
Examples of Beneficial Policies and
Procedures
• Correctly storing medication
• Reading drug label
• Avoiding drug transfer between containers
• Avoiding overstocking to prevent expiration
• Monitoring compliance with current medication
abbreviations
• Removing outdated reference books
Legality and Reducing Errors (2 of 2)
• Medication errors can be reduced by using written data

– Root cause analysis (RCA) seeks to prevent another
occurrence by asking what happened and why, and
what can be done to prevent it
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Pharmacology for Nurses: A Pathophysiologic

Source: Reprinted with the permission of the National Coordinating

• Common cause of morbidity and preventable death in

• Damaged reputation of unit or facility with high reported

• No acceptable rate of medication errors

• Recorded in factual and objective manner

• Accurate documentation verifies patient’s safety

• Unexpected occurrences involving death or serious

• Nurses should know most frequent types of drug errors

• The process of tracking a patient’s medications as they

• Many serious medication errors tracked to poor

• Written, age-appropriate handouts

• Know names of all medications

• Medication errors can be reduced by using written data

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Pharmacology for Nurses: A Pathophysiologic

Source: Reprinted with the permission of the National Coordinating

• Common cause of morbidity and preventable death in

• Damaged reputation of unit or facility with high reported

• No acceptable rate of medication errors

• Recorded in factual and objective manner

• Accurate documentation verifies patient’s safety

• Unexpected occurrences involving death or serious

• Nurses should know most frequent types of drug errors

• The process of tracking a patient’s medications as they

• Many serious medication errors tracked to poor

• Written, age-appropriate handouts

• Know names of all medications

• Medication errors can be reduced by using written data

Anda mungkin juga menyukai

Medication Errors & Risk Reduction

Medication Errors & Risk Reduction