TYPES AND CAUSES OF MEDICATION ERRORS

FROM A NURSE'S VIEWPOINT

The main professional goal of nurses is to provide and improve human health. Medication errors are
among the most common health threatening mistakes that affect patient care. Such mistakes are
considered as a global problem which increases mortality rates, length of hospital stay, and related costs.
This study was conducted to evaluate the types and causes of nursing medication errors.
I. TYPES OF MEDICATION ERRORS

Medication errors can occur anywhere along the route, from the clinician who prescribes the
medication to the healthcare professional who administers the medication.
The different types of medication errors include (but are not necessarily limited to):
Prescribing errors , wherein the selection of a drug is incorrect based on the patient’s allergies or
other indications. Additionally, the wrong dose, form, quantity, route (oral vs intravenous),
concentration, or rate of admission could be used.
Omission errors , in which there is a failure to give a medication dose before the next one is
scheduled.
Wrong time errors , wherein a medication is given outside the predetermined interval from its
scheduled time.
Improper dosing errors , wherein a greater or lesser amount of a medication is delivered than is
required to manage the patient’s condition.
Wrong dose errors , wherein the correct dosage was prescribed, but the wrong dose was
administered.
Improper administration technique errors , such as administering a medication intravenously
instead of orally.
Wrong drug preparation errors , wherein a medication is incorrectly formulated (i.e., too much or
too little diluting solution added when a medication is reconstituted).
Fragmented care errors , wherein a lack of communication exists between the prescribing
physician and other healthcare professionals.
These are just some of the many possible medication errors that can occur.

II. CAUSES OF MEDICATION ERRORS

Distraction : A nurse who is distracted may read “diazepam” as “diltiazem.” The outcome is not
insignificant-if diazepam is accidentally administered, it could sedate the patient, or worse (e.g.,
if the patient has an allergy to the drug).
Environment : A nurse who is chronically overworked can make medication errors out of
exhaustion. Additionally, lack of proper lighting, heat/cold, and other environmental factors can
cause distractions that lead to errors.
Lack of knowledge/understanding : Nurses who lack complete knowledge about how a drug
works, its various names (generic and brand), its side effects, its contraindications, etc. can make
errors.
Incomplete patient information : Lacking information about which medications a patient is
allergic to, other medications the patient is taking, previous diagnoses, or current lab results can
all lead to errors. Nurses who aren’t sure should always ask the physician or cross-check with
another nurse.
 Memory lapses : A nurse may know that a patient is allergic, but forget. This is often caused by
distractions. Forgetting to specify a maximum daily dose for an “as required” drug is another
example of a memory-based error.
Systemic problems : Medications that aren’t properly labeled, medications with similar names
placed in close proximity to one another, lack of bar code scanning system, and other issues can
lead to medical errors.

III. PREVENTING MEDICATION ERRORS

Nurses may not have the authority to make infrastructural changes, but they do have the power to suggest
needed changes and take precautions to prevent medication errors, including the following:

KNOW THE PATIENT

This includes the patient’s name, age, date of birth, weight, vital signs, allergies, diagnosis, and
current lab results. If patients have a barcode armband-use it. The added administration times of
using arm band systems have led some nurses to create potentially dangerous “workarounds” to
avoid scanning barcodes. Don’t make this potentially dangerous mistake- use all of the
information at your disposal to ensure patient safety, and avoid shortcuts.

KNOW THE DRUG

Nurses need access to accurate, current, readily available drug information, whether the
information comes from computerized drug information systems, order sets, text references, or
patient profiles. If you have any questions or concerns about a drug, don’t ignore your instincts-
ask. Remember that you are still culpable, even if the physician prescribed the wrong medication,
the wrong dose, the wrong frequency, etc.

KEEP LINES OF COMMUNICATION OPEN

a) Breakdowns in communication among physicians, nurses, pharmacists, and others in the

healthcare system can lead to medication errors. The “SBAR” method can help alleviate
miscommunications. SBAR (Situation, Background, Assessment, Recommendation)
works like this:
b) Situation : “The situation is that Mr. Smith is complaining of chest pain.”
c) Background : “He had hip surgery yesterday. About two hours ago he began complaining
of chest discomfort. His pulse is 115, and he is short of breath and agitated.”
d) Assessment : “My assessment is that Mr. Smith may be having a cardiac event.”
e) Recommendation : “My recommendation is that you see him immediately, and that we
start him on O2 and administer an analgesic immediately. Do you agree?”
f) Communication is vitally important, as it is the root cause of many sentinel events,
according to the Joint Commission (TJC).5

DOUBLE CHECK HIGH ALERT MEDICINES

High-alert medicines such as heparin can have devastating consequences if not administered
properly. A tragic case involving the death of three infant patients after receiving massive heparin
overdoses happened as a result of misleading packaging. Since this incident, the drug
manufacturer now uses larger font sizes, tear-off cautionary labels, and different colors to
distinguish drug doses.6 Medications often look alike and sound alike-this can be a source of
errors. Double check high alert medications with another nurse to prevent accidental overdoses
and other medication errors.

DOCUMENT EACH DRUG ADMINISTERED

Accurate documentation is essential and should include accurate recording of the drug
information, the name of the drug, the dose, route, time, patient response, and any refusal of the
drug by the patient.
TAKE AN ACTIVE ROLE IN CORRECTING ISSUES YOU IDENTIFY

If you see that look-alike or sound-alike medications are stored next to each other, ask your
supervisor to correct the problem, emphasizing the increased risk of medication errors. Request
that medications be reconciled (i.e., that the names, dosages, and administration routes of all
medications are compared to identify conflicts). Request that a bar coding system be
implemented that allows for the verification of the six medication rights (right individual, right
medication, right dose, right time, right route, right documentation).