How to Avoid Medication Errors in Nursing

By Kim Maryniak, PhDc, MSN, RNC-NIC, Contributor

Statistics on medication errors in U.S.

hospitals are difficult to calculate, due to
the variability in reporting. In 1999, the
government released a report titled To Err
is Human: Building a Safer Healthcare
System, which stated that approximately
98,000 people die each year in the United
States due to medical errors (Institute of
Medicine [IOM], 1999). Based on the IOM
report, it is now estimated that as many
as 440,000 deaths occur each year due to
medical errors (James, 2013). Studies
estimate that approximately 19.1% of
these errors are medication administration
errors (Keers, Williams, Cooke, &
Ashcroft, 2013).

A cross-sectional study was done with 203 nurses to examine medication knowledge and the
risk of medical errors. Participants were from acute care hospitals and primary care settings. As
part of the study, each participant was given a test on pharmacology, drug management and
drug calculations. The study showed that the participants had a 39% moderate risk and 11%
high risk for pharmacology knowledge, 33% moderate risk and 26% high risk with drug
management, and 32% moderate risk and 7% high risk with drug calculations (Simonsen,
Johansson, Daehlin, Osvik, & Farup, 2011).

As nurses, we are often the last “gatekeeper” in the administration process to prevent
medication errors. It is important to take the time needed to ensure patient safety, and to
minimize distractions throughout the process. Here are strategies on how to prevent medication
errors in nursing:

• The rights of medication administration. Initially, there were five rights for administration
including the right patient, drug, time, dose and route. A sixth right is the right reason. Some
literature describes up to 12 rights, including education, documentation, right to refusal and
expiration date.

• Independent double checks. The Institute for Safe Medication Practices (ISMP) (2014)
recommends the use of redundancies, such as independent double checks of high alert
medications due to the increased risk for patient harm. This includes independent calculations
for dose and rates of medication. The list of high alert medications can be found at
http://www.ismp.org/tools/institutionalhighAlert.asp

• Medication review. Practices include comparing the medication administration record and
patient record at the beginning of a nurse’s shift; determining the rationale for each ordered
medication, and requesting that physicians rewrite orders when improper abbreviations are
used, are important strategies.

• Knowledge. A nurse should never administer a medication which he/she is unfamiliar.

• Patient education. Ensuring that patients and families are knowledgeable regarding the
medication regimen so that they can question unexplained variances are also associated with
lower rates of medication errors.

• Practice environment. A supportive practice environment, including teamwork between

physicians and nurses; opportunities for nurses to participate in hospital- and unit-level
decisions; continuity of patient care assignments; continuing education opportunities; and the
retention of nurse administrators who are visible and accessible, who listen to nurses’ concerns,
and who have high expectations of their nurses are associated with a higher quality of nursing
care. (James, 2013; RWJF, 2012; Simonsen et al., 2011)