On the flip side of that, they are also instilled with a sense of terror and dread that medication errors can happen. It is a big lesson and one that has turned many a hospital elevator full of nursing students into a sweating, shivering box of panic.
We are all human, right? Everyone makes mistakes, correct? Yes. But if there are systems and techniques available to avoid making those mistakes, we should pay attention and do our best to “do no harm.”
Between 26%- 32% of medication errors are errors in administration. Considering that nurses are often the ones doing the administering, this is significant. According to the 2006 report “Preventing Medication Errors” from the Institute of Medicine, these errors injure 1.5 million Americans each year and cost $3.5 billion in lost productivity, wages, and additional medical expenses.
Aside from the Five Rights of Medication Administration – right patient, right time, right medication, right dose, and right route, some experts have expanded this list to include: right reason for the drug, right documentation, right to refuse medication and right evaluation and monitoring.
In addition, there is a list identified by the Institute of Safe Medication Practice (ISMP) of ten items that, if applied, will help reduce the possibility of medication error.
- Patient Information: Hospitals have instituted a barcode system that helps prevent the error of giving meds to the wrong patient, but it is time consuming, and nurses have developed methods to work around it that may lead to error.
- Drug Information: Accurate information must be available to all caregivers at the time of administration.
- Adequate Communication: Communication between doctors, nurses and pharmacists is crucial. One way to promote effective communication is to use the “SBAR” method (situation, background, assessment, and recommendations).
- Drug Packaging, Labeling, and Nomenclature: Labels should be clearly marked. The risk of administering the wrong drug because the label or name is similar to another drug is quite high.
- Medication Storage, Stock, Standardization, and Distribution: Many errors can be prevented by the decreased ability of floor stock medications.
- Drug Device Acquisition, Use, and Monitoring: Some IV tubing systems are not made to stop flow when removed from the pump. Being sure that safety systems are in place for IV tubing is important.
- Environmental Factors: Environmental factors that can increase the risk of error include inadequate lighting, cluttered work environments, increased patient acuity, distractions during drug preparation or administration, and caregiver fatigue.
- Staff Education and Competency: Continuing education can help reduce error.
- Patient Education: Teaching the patient what medications they are taking and what they are for will increase their awareness and reduce risk of error.
- Quality Processes and Risk Management: Discussing medication errors and “near misses” in a non-judgemental environment will also help reduce error because it will provide an atmosphere of support for staff.
About the Author
Sarah Heroman is an RN, BSN who has found her niche as a school nurse in Texas. With almost 20 years of experience, Sarah is still passionate about the nursing field and enjoys mentoring and helping nurses continue to find the joy in their careers. She believes that a good nurse is able to combine the science and the art of nursing and find fulfillment in providing the best care for their patients.