CHAPTER 7
PHARMACOLOGY FOR NURGEC
Medication Errors and Risk Reduction
Medication Error
• Any error that occurs in medication
administration process, whether or not it
harms the patient. May be applied to
- Misinterpretations, miscalculations
- Misadministration
- Handwriting misinterpretation
- Misunderstanding of verbal orders
Factors That Contribute to Medication
Errors by the Health Care Provider
• 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
• 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
Factors That Contribute to
Medication Errors by the Patient
• Taking drugs prescribed by several
practitioners
• Getting prescriptions filled at more than one
pharmacy
• Not filling or refilling prescriptions
• Taking medications incorrectly
• Taking medications that may be left over from
a previous illness
• Taking medications prescribed for something
else
Impact of Medication Errors
• 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
• Poor reputation for unit or facility, caused by
high incidence of errors
• Penalizing of administrative staff because of
errors
Investigating Errors
• No acceptable rate of medication errors
• Errors should be investigated and subiected to
analysis to determine causes.
Reporting and Documenting
Medication Errors
• Documentation should occur in a factual
manner.
• Documentation in medical record must
include specific nursing interventions that
were implemented after the error in order to
protect the patient.
• Document all individuals who were notified of
error
• Medication-administration record (MAR)
• is a source detailing what medication was
given or omitted.
Reporting with an Incident Report
• Details recorded in factual and obiective
manner
• Allows nurse to identify factors that
contributed 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
• Accurate documentation verifies patient's safety
• Used as tool to improve drug administration
processes
• 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
Sentinel Events
• Unexpected occurrences involving death or serious
physical or psychological injury, or risk thereof
• Always investigated
• Interventions taken to ensure there is no repeat
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-PDAs
now help with this.

Reduction of Medication Errors and

Incidents-Assessment
• Assess food or medication allergies
• Assess current health concerns
• Assess use of OTCs and herbal supplements
• Review recent laboratory tests
• Review recent physical-assessment findings
• Identify need for education of medication regimen

Reduction of Medication Errors and

Incidents-Planning
• Avoid using abbreviations that can be
misunderstood
• Ouestion unclear orders
• Do not accept verbal orders
• Follow specific facility policies and procedures
related to medication administration
• Ask the patient to participate by restating the right
time and dose of medication

Reduction of Medication Errors and

Incidents -Implementation
• Be aware of potential distractions during medication
administration
• Remove distractions, if possible
• Focus on the task of administering medications
• Practice the rights of medication administration
• Keep in mind the following steps:
- Positively verify patient using name and
birthdate
- Use correct procedures for all routes of
administration
- Calculate medication doses correctly
- Open medications prior to administering
- 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

Reduction of Medication Errors and

Incidents-Evaluation
• Assess patient for expected outcomes
• Determine if any adverse effects have occurred

Frequent Types of Drug Errors
• Administering improper dose
• Giving wrong drug
• Using wrong route of administration
Severities
• One-half of fatal medication errors occurred in
patients older than 60 years of age.
• Children are another vulnerable population due to
smaller dosages.
Medication Reconciliation
• The process of "keeping track" of a patient's
medications as they proceed from one health care
provider to another
• Polypharmacy-patients to receive multiple
prescriptions that may have conflicting pharmacologic
actions
• Many serious medication errors tracked to poor
reconciliation
• Reconciliation lists all medications that a patient is
taking to 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
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 herbals
• Ask questions
Methods to Reduce Number of
Medication Errors
• Automated, computerized, locked cabinets for
medication storage on patient-care units
• Risk-management departments to examine risks and
minimize the number of medication errors
• Electronic health records and e-prescriptions
• Barcode-assisted medication administration
Examples of Beneficial Policies and
Procedures
• Correctly storing medication
• Reading drug label
• Avoid drug transfer between containers
• Avoid overstocking to prevent expiration
• Monitor compliance with current medication
abbreviations
• Removing outdated reference books
Governmental and Other Agencies that Track
Medication Errors
• FDA's MedWatch
-Health care providers are encouraged to
report errors.
- Errors may be reported anonymously.
• Institute for Safe Medication Practices (ISMP)
• MEDMARX - U.S. Pharmacopeia's anonymous
medication error reporting program