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Medication Errors

Amanda Cook

University of South Florida

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Medication Errors

In the healthcare setting, medication errors are present, and deadly. These errors

can be extremely dangerous to the patient and could potentially put their health further at risk.

Taking your time when working in a fast-paced environment can be difficult but ensuring the

safety of the patient is the number one priority. As a student nurse, there are guidelines that are

taught and are expected to be followed throughout the course of nursing school and the career.

Common Medication Errors

Some common medication errors noted in inpatient care are “selecting the wrong

medication,” “giving the wrong dosage,” and “giving a medication to the wrong patient.” Some

may consider these errors “hard to make,” but they happen more than realized.

Selecting the Wrong Medication

As stated in the introductory paragraph, working as a nurse is a fast-paced job with little

downtime. It’s hard to move at a slow pace, so when medications either sound the same, or in

this case, have the same first few letters, it makes it even more difficult. For example,

medications that start with “met,” may cause confusion, and can cause many issues for nurses

who aren’t paying attention and for the patient on the receiving end. This situation has happened

recently, where a “nurse entered “VE” into an automated dispensing cabinet search filed via

override and mistakenly selected and removed vecuronium instead of VERSED” (Start the Year

Off, 2020). This situation resulted in death and was an unfortunate error due to selecting an

unintended drug.

Giving the Wrong Dosage

Giving the wrong dosage is a medication error that is seen a lot, as most medication

administration systems already have the calculations done. An article from the Journal of
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Professional Nursing expressed that “26.9% of medication errors were related to the wrong dose”

(Moriarty et al., 2022). However, when the calculations are not done, this leaves the nurse having

to do their own, with the little time that they have. This can increase the risk of an error as quick

math isn’t always done correctly. In pediatric settings especially, where dosage calculations are

heavily existent, it is imperative to get it right and get the exact amount, so the patient is not

getting too little or too much of the medication.

Giving the Medication to the Wrong Patient

This medication error could be considered the most prevalent, since more of the time than

not, all six rights of medication administration are not being performed. One of the most

important of these is if the right patient is getting the medication and should be the first thing that

is checked when the nurse enters the room. Nevertheless, it is sometimes neglected when a nurse

feels comfortable after being with a patient throughout the day. This said practice can be very

dangerous and can put many lives at risk.

Impact on Patients and Families

These three medications can be very detrimental to the patient and their families,

especially if they result in the patient’s health deteriorating or resulting in death. Many

psychosocial factors must be considered while they are in the hospital and should never be taken

advantage of. Making mistakes like giving the wrong medication to the right patient, wrong

dosage, or giving the wrong medication to the wrong patient can break trust and can make it very

difficult for the patient to heal properly. When a patient goes to the hospital, whether they chose

to or if it was emergent, they ultimately decided to agree to be under someone else’s full care at

their most helpless state. The last thing that should occur is an error that could put their lives at
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risk. Additional to this, their families are also on high alert, feeling very anxious and stressed for

what may happen to their loved one.

Avoiding Medication Errors

Although it may seem easier said than done, when selecting a medication with similar

letters or sounds, the best intervention for the nurse is to take their time as well as doing a triple

check with the MAR and medication dispensing machine. As for giving the wrong dosage, the

nurse can double check their work and have another nurse go over it as well. Even if it may seem

tedious, these extra steps can make a huge difference in the lives of the patients. Giving the

wrong medication to the wrong patient can be corrected by performing the six rights every time

there is a med-pass, ensuring that the wristband matches the MAR, and that the medication is the

correct drug, dosage, etc. Additionally, listening if the patient may express any concerns is a

good sign that the medication is right for them, especially if they have been taking it for a while.

Impact on Students

With graduation just around the corner and becoming a “new-grad nurse” near, I fear that

I will try to do everything I can to be as quick and efficient as I can, rather than taking my time, I

have always been the type to fully care about safety, but in a high-stress environment where a

patient is counting on me, I worry that I may not fully check these things when dispensing the

medication or checking “for the right patient” when in their room. I understand that this is

something that I will automatically do, especially with practice, but it is nerve-wracking knowing

that I am the barrier between a medication and a human being. I know that when I am on the job,

I will do everything I can to ensure the safety of my patient and consider their families as well.

Additionally, fully understanding dosage calculation will be something that I will put lots of

effort into.
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Conclusion

To conclude, this paper has fully enhanced my understanding of how important

medication errors are to not only catch before they happen but prepare for while in nursing

school. My passion has always been to be a nurse, and safety is something that I take very

seriously. I am grateful to have a clinical placement that also feels the same way, and I have

learned so much about what medication errors can do to not only a patient, but to a family as

well. We all have seen in the media the dangers, sadness, and despair that can come from these

mistakes and errors, and the preventative factors must start now in order to establish that it won’t

happen throughout our many years as nurses. Errors happen on a day-to-day basis, whether you

are a nurse are not, and taking accountability for your actions are so important. I have learned

that throughout the past 21 years of my life. Nonetheless, when understanding a life is on the

line, there is a sense of urgency with how situations are handled and taken care of that will ward

off those errors before they institute.

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References

Schroers, G., Ross, J. G., & Moriarty, H. (2022). Medication administration errors made among

undergraduate nursing students: A need for change in teaching methods. Journal of

Professional Nursing, 42, 26–33. https://doi.org/10.1016/j.profnurs.2022.05.012

Start the new year off right by preventing these top 10 medication errors and hazards. Institute

For Safe Medication Practices. (2020, January 16). Retrieved October 30, 2022, from

https://www.ismp.org/resources/start-new-year-right-preventing-these-top-10-medication-

errors-and-hazards