Understanding and Preventing Medication Errors in Healthcare

Medication errors are amongst the most common mistakes that have an impact on patient care. Medications are an absolute benefit if health care providers prescribe, dispense, and administer them to the patient by applying the appropriate technique. The administration of medication is a fundamental aspect of the nursing role and it is associated with significant risk, however, despite the health care team’s knowledge and devotion to quality care, errors with medications may occur. Therefore, it is important that health care providers are familiar with the most common encountered errors. Health care providers should be familiar with the basic rights of medication administration: Right drug, Right dose, Right patient, Right route, Right time, Right reason, and Right documentation and the three checks.

Despite the efforts to provide the best care, there are still different factors that may contribute to medication errors and they are the major cause of morbidity and mortality in the hospital setting. For instance, health care professionals, particularly nurses, use a broad variety of devices to help administer medications: infusion pumps, IV administration sets, oral syringes, etc. Infusion pumps are a common type of error identified in the hospitals and can cause serious harm, including death. Most of the errors are associated with

administration: rate deviation errors and programming mistakes. Smart pumps errors occur frequently and future research is concentrating on the success of new technology. According to Cummings “While smart pump technology helps reduce medication errors and prevent patient injury, it's not intended to replace clinical practices, institutional policies, and vigilant patient monitoring” (58).
On the other hand, infusion pumps are not the only cause of medication errors: in 2001 The Joint Commission issued an alert which requires that organizations utilize a list of “do not use” abbreviations in order to prevent medication errors.

The “do not use” list was then created in 2004; however, this requirement does not apply to electronic medical records but it remains under consideration. According to the JCAHO “surveyors found instances in which organizations had not taken to heart the requirements of the patient safety goals” (Thompson). Therefore, communication errors continue being the most common root of sentinel

events.
Sound-alike medication names are another concern, as well as, medications with the same chemical composition. For example, one can be taking over the counter Ibuprofen (Motrin, others) when already taken another medication that contains either Ibuprofen or some other type of NSAIDs (nonsteroidal anti-inflammatory drugs). That combination can put the patient at risk of overdose, stomach ulcers, or even toxicity. In the same way, Catapres (clonidine) and Klonopin (clonazepam), can also be confused which may result in hypotension, loss of seizure control, and other adverse effects. These are just some medications that can be confused but there are hundreds of medications with sound-alike names and with the same chemical composition, which can be fatal if the health care provider is not familiar with them. Poor communication among health care providers account for more than 60% of the cases reported to The Joint Commission.
However, health care employees are not the only one responsible for these mistakes. Health care workers should be trained by their employers in regards to new medication, updates concerning medication errors, cultural differences, facility policies, procedures, and protocols. In addition, appropriate assessment of medical devices is also key to error prevention; however, the safest high technology cannot prevent mistakes. The implementation of bar coding helps decrease medication mistakes but it also slows down patient flow and individualized care, which is already threatened by overworked and insufficient staff. Nevertheless, non-complaint patients are also responsible for these mistakes. When patients do not report that they are taking specific medications or when they take them all at once against medical advice, they are also accountable for medication errors. Polypharmacy (multiple drug use), pharmacokinetics (what the body does to the drug), pharmacogenetics (genetic differences in which the drug is metabolized), and pharmacodynamics (what the drug does to the body), can also affect drug absorption.
Medication errors are common and costly but they can be prevented by adhering to the rights of medication safety, minimize interruptions, use the barcode, and follow good communication skills with coworkers and patients, as well as, performing the three checks of medication and follow the hospital protocol at all times. Time management should also be implemented in order to avoid last minute medication administration. Staff and patient education may improve communication and diminish errors. Following these simple steps can improve medication safety, although, the potential for errors will always exist but it can be minimized; after all, prevention is better than the cure.