Medication errors are a serious and all too common problem in nursing homes but can be prevented by following a few simple guidelines. Studies suggest that one in five nursing home residents will suffer from medical errors, and 37% of those medical errors will be medication errors. These can include incorrect dosage, incorrect method of administration, and even providing the incorrect medication. Before we dive into how we can prevent drug mistakes, let’s first understand why they happen:
Why do medication errors occur?
Prescribing errors – for example, the drug choice is incorrect for the condition or the patient; or the wrong dose, route, concentration, frequency is prescribed.
Timing errors – a drug is administered or prescribed at incorrect frequencies. In serious cases, this could result in toxicity or overdose (or the reverse and a lack of critical medicine given to control an illness or condition).
Omission errors – failing to give a dose when prescribed which can result in conditions not being treated/managed properly.
Incorrect dosage administration errors– too much or too little of a medication being administered, for example, Morphine 100mg rather than Morphine 10mg despite the correct amount being prescribed on the patient prescription chart.
Wrong administration technique – for example, giving an oral drug intravenously, a subcutaneous injection via intramuscular route etc.
Incorrect preparation of a drug – for example, not adding the right dilutions, additives or solutions to ensure a drug is safe and/or effective.
The causes of medication errors can be as many and varied as the types of mistakes made. But evidence suggests that medication errors are mainly due to distraction, the environment (such as chronically understaffed and overworked employees), a lack of knowledge and understanding and poor information about individual patients and their medical history/condition.
Drug errors are dangerous and damage the trust and confidence that the public have for nursing home staff and the social care as a whole. Given this information, what can nurses do to prevent medication errors from happening in the first place?
Here are some simple tips to help:
1. Know the patient:
Always check the patient identification band and details. Make sure that the date of birth, allergies, pertinent blood results as well as weight, vital signs and other relevant factors are known before administering any medicine.
2. Know the drug:
know the indications, side effects, normal dose, frequency, administration route, contraindications and compatibility of the drug.
3. Be proactive:
maintain good communication and take action on potential problems you have identified in terms of a patient's medication or dosage. Although nurses are not responsible for prescribing drugs, with experience it is common to develop a deeper understanding of them. Share your knowledge or concerns with other nurses, doctors and healthcare professionals and don’t be afraid to speak out.
4. Ask questions and double check:
There is nothing wrong with double checking. Ask lots of questions and seek advice and help when you feel uncertain. It's better to be safe than sorry.
5. Maintain good documentation:
Maintain good habits recording and documenting your medication rounds. By consistently signing as soon as a drug is administered and never signing for a medicine not yet given, the safety of the patient is protected.
6. Keep up to date and educated:
The Royal Pharmaceutical Society and the Royal College of Nursing coproduced a clear, well-defined guide to ensure the safe administration of medicines by healthcare professionals. Keeping up to date on materials like this will help you stay sharp and avoid medication errors due to having outdated knowledge. Every nurse and midwife should be aware of the laws, policies and protocols surrounding the safe administration of medicines stipulated by their regulatory body.
Medication errors are dangerous. But by having a culture of continuous learning, open and honest reporting and transparent, no-blame culture, we can hope to reduce the incidents of medication errors, protecting our patients and ourselves.