Oct 23, 2017 | Blog
It is important for all nurses to become familiar with various strategies to prevent or reduce the likelihood of medication errors. Here are ten strategies to help you do just that.
1. Ensure the five rights of medication administration.
Nurses must ensure that institutional policies related to medication transcription are followed. It isn’t adequate to transcribe the medication as prescribed, but to ensure the correct medication is prescribed for the correct patient, in the correct dosage, via the correct route, and timed correctly (also known as the five rights).
2. Follow proper medication reconciliation procedures.
Institutions must have mechanisms in place for medication reconciliation when transferring a patient from one institution to the next or from one unit to the next in the same institution. Review and verify each medication for the correct patient, correct medication, correct dosage, correct route, and correct time against the transfer orders, or medications listed on the transfer documents. Nurses must compare this to the medication administration record (MAR). Often not all elements of a medication record are available for easy verification, but it is of paramount importance to verify with every possible source—including the discharging or transferring institution/unit, the patient or patient’s family, and physician—to prevent potential errors related to improper reconciliation. There are several forms for medication reconciliation available from various vendors.
3. Double check—or even triple check—procedures.
This is a process whereby another nurse on the same shift or an incoming shift reviews all new orders to ensure each patient’s order is noted and transcribed correctly on the physician’s order and the medication administration record (MAR) or the treatment administration record. Some institutions have a chart flag process in place to highlight charts with new orders that require order verification.
4. Have the physician (or another nurse) read it back.
This is a process whereby a nurse reads back an order to the prescribing physician to ensure the ordered medication is transcribed correctly. This process can also be carried out from one nurse to the next whereby a nurse reads back an order transcribed to the physician’s order form to another nurse as the MAR is reviewed to ensure accuracy.
5. Consider using a name alert.
Some institutions use name alerts to prevent similar sounding patient names from potential medication mix up. Names such as Johnson and Johnston can lead to easy confusion on the part of nursing staff, so it is for this reason that name alerts posted in front of the MAR can prevent medication errors.
6. Place a zero in front of the decimal point.
A dosage of 0.25mg can easily be construed as 25mg without the zero in front of the decimal point, and this can result in an adverse outcome for a patient.
7. Document everything.
This includes proper medication labeling, legible documentation, or proper recording of administered medication. A lack of proper documentation for any medication can result in an error. For example, a nurse forgetting to document an as needed medication can result in another dosage being administered by another nurse since no documentation denoting previous administration exists. Reading the prescription label and expiration date of the medication is also another best practice. A correct medication can have an incorrect label or vice versa, and this can also lead to a med error.
8. Ensure proper storage of medications for proper efficacy.
Medications that should be refrigerated must be kept refrigerated to maintain efficacy, and similarly, medications that should be kept at room temperature should be stored accordingly. Most biologicals require refrigeration, and if a multidose vial is used, it must be labeled to ensure it is not used beyond its expiration date from the date it was opened.
9. Learn your institution’s medication administration policies, regulations, and guidelines.
In order for nurses to follow an institution’s medication policy, they must become familiar with the content of the policy. This is where education comes into play whereby the institution’s educator or education department educates nurses on the content of their medication policy. These policies often contain vital information regarding the institution’s practices on medication ordering, transcription, administration, and documentation. Nurses can also familiarize themselves with guidelines such as the Beers’ list, black box warning labels, and look alike/sound alike medication lists.
10. Consider having a drug guide available at all times.
Whether it’s print or electronic is a matter of personal (or institutional) preference, but both are equally valuable in providing important information on most categories of medication, including: trade and generic names, therapeutic class, drug-to-drug interactions, dosing, nursing considerations, side effects/adverse reactions, and drug cautionaries such as “do not crush, or give with meals.”
Utilizing any or all of the above strategies can help to prevent or reduce medication errors. Nurses must never cease to remember that a medication error can lead to a fatal outcome and it is for this reason that med safety matters.
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- 10 Strategies for Preventing Medication Errors - October 23, 2017
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loveypao0on December 11, 2016 at 8:06 pm
It was great to stumble upon this post. Has anyone ever wondered how to fill out forms online? I have, and found a simple service. Try PDFfiller to fill Deshutes MAR here
https://goo.gl/AkwCzQ. It allows you to to fill out PDF files.
Mel Ellisonon October 25, 2017 at 11:48 pm
Although ensuring the five rights of medication administration is important, how do we reconcile the “right time” rule with the need to be flexible when caring for patients with dementia? I’m sure the majority of us have had patients refuse medications that we consider important, but we may succeed in convincing the patient to take the medication outside of the time frame of the “right time”. Must we request a physician’s order each time we have to go outside the ordered time?
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What are the top 10 reasons for medication errors? ›
- Unsafe overrides with automated dispensing cabinets.
- Unsafe use of IV push meds. ...
- Wrong route errors with tranexamic acid. ...
- Unsafe labeling of prefilled syringes and infusions by compounders. ...
- Using syringes for vinca alkaloids. ...
- Zinc overdoses. ...
- Ensure the five rights of medication administration are adhered to. ...
- Pay close attention to drug packaging, labeling and nomenclature. ...
- Double check — or even triple-check — individual patient procedures. ...
- Put a zero in front of the decimal point. ...
- Document everything.
Adopt a reporting system.
The only way to reduce medication errors is to develop a reporting system and then make changes to prevent similar errors from reoccurring. Even a near miss should be reported. The staff should be encouraged to report without any repercussions.
- Remain consistent. If you're determining your pediatric patient to be 32kg, then broadcast it. ...
- Read your containers. ...
- Measure twice, draw once. ...
- Label your syringe. ...
- Practice medication dosing often.
- MINIMIZE CLUTTER. ...
- VERIFY ORDERS. ...
- USE BARCODES. ...
- BE AWARE OF LOOK-ALIKE SOUND-ALIKE (LASA) DRUGS. ...
- HAVE A SECOND PAIR OF EYES CHECK PRESCRIPTIONS. ...
- DESIGN EFFECTIVE WARNING SYSTEMS. ...
- INVOLVE THE PATIENT. ...
- TRUST YOUR GUT.
It is important to remember that a medication error can result in patient morbidity and even mortality. Also, these errors can negatively affect the reputation of a healthcare facility and lead to high institutional and governmental costs.What are strategies for using medications safely? ›
- Follow instructions. Read all medicine labels and be sure to follow instructions. ...
- Take medicine on time. ...
- Turn on a light. ...
- Report problems. ...
- Tell your doctor about alcohol, tobacco, and drug use. ...
- Ask your loved ones for help. ...
- Check before stopping. ...
- Don't share.
- Check for storage instructions on the medicine label — for example, some medicines need to be stored in the refrigerator.
- Store medicines that don't have special storage instructions in a cool, dry place. ...
- Keep medicines away from children and pets.
Report the event to the hospital and professional advisors. Encourage an open approach to error to facilitate more reporting. Disclose the event to the patient and family. Provide full details of the event, being clear, concise, and timely.What are two ways to avoid medication mistakes? ›
"Use the measuring device that comes with the medicine," suggests Fitzpatrick. "If you don't have a medicine device for measuring your liquid medicine, ask for one at the pharmacy." Also, read the patient medication information that comes with your prescription thoroughly before using your medication.
What are 5 common causes of medication errors? ›
Common causes of medication error include incorrect diagnosis, prescribing errors, dose miscalculations, poor drug distribution practices, drug and drug device related problems, incorrect drug administration, failed communication and lack of patient education.What's the first step to take to reduce medication errors? ›
- Ensure the five rights of medication administration. ...
- Follow proper medication reconciliation procedures. ...
- Double check—or even triple check—procedures. ...
- Have the physician (or another nurse) read it back. ...
- Consider using a name alert.
Medication errors are common in hospitals, but only about 1 in a 100 actually results in harm to the patient. Conversely, only about 30% of injuries due to drugs in hospitals are associated with a medication error, and are thus preventable.How can you prevent self medication errors? ›
- Make a medication list. ...
- Keep your medication list up-to-date. ...
- Read labels carefully. ...
- Follow dosing instructions exactly. ...
- Store medications in their original containers. ...
- Use a pillbox to organize medicines. ...
- Use one pharmacy for all prescriptions.
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.How can doctors prevent medical errors? ›
Physicians can help reduce medication errors by writing legibly, avoiding verbal orders, and not using abbreviations. Reporting deficiencies in packaging, labeling, and presentation of drug products to manufacturers and the FDA may help prevent future errors.What are the 14 rights of medication? ›
- Right Drug/Medication.
- Right Client/Patient.
- Right Route.
- Right Dose.
- Right Frequency/Time.
- Right Assessment.
- Right Approach.
- Right Education.
- Right patient. Change the name band e.g. date of birth or medical record number. ...
- Right reason. Add medications that make no sense for a patient. ...
- Right medication. ...
- Right dose. ...
- Right route. ...
- Right time. ...
- Right documentation. ...
- Right response.
To ensure safe medication preparation and administration, nurses are trained to practice the “7 rights” of medication administration: right patient, right drug, right dose, right time, right route, right reason and right documentation [12, 13].What are the five rights medication strategy? ›
- The right patient.
- The right drug.
- The right dose.
- The right route.
- The right time.
What is medication strategy? ›
Introduction. The Medication Management strategy is an effort to engage patients and families to actively participate with you in developing a complete and accurate medication list from which you can complete medication reconciliation.What are the 10 rights of the patient? ›
- The Right to Be Treated with Respect.
- The Right to Obtain Your Medical Records.
- The Right to Privacy of Your Medical Records.
- The Right to Make a Treatment Choice.
- The Right to Informed Consent.
- The Right to Refuse Treatment.
- The Right to Make Decisions About End-of-Life Care.
Use Medicines as Directed.
- Read the directions on the label and ask your healthcare provider how much you should take and when.
- Never skip taking your prescription medicine. Talk to your healthcare provider before you stop taking your medicines.
- Only take the suggested dose.
something known as the '6 R's', which stands for right resident, right medicine, right route, right dose, right time, resident's right to refuse. what to do if the person is having a meal or is asleep.What is one of the most important steps in handling a medication error? ›
Correct your error(s) by making sure minimal or no harm is done by addressing the problem right away. Once the error is under control, follow the policies of your organization so the error can be understood and learned from as a means of preventing a similar occurrence from happening in the future.What are the top 5 medication errors? ›
- Lack of awareness of expiration dates. Advertisement. ...
- Taking the incorrect dosage. ...
- Rate of usage. ...
- What time of day to take the drug. ...
- Combining drugs without physician guidance.
- Insulin (8%);
- Anticoagulants (6.2%);
- Amoxicillin (s) (4.3%);
- Aspirin (2.5%);
- Trimethoprim-sulfamethoxazole (2.2%);
- Hydrocodone/acetaminophen (2.2%);
- Ibuprofen (2.1%);
- Acetaminophen (1.8%);
- Suboptimal medication reconciliation workflow. ...
- Lack of medication reconciliation post-discharge (MRP) ...
- LASA medications. ...
- Poor communication during transitions. ...
- Poor communication between clinicians and patients. ...
- The emergency department.
Taking ownership of the error and doing the right thing by putting the patient first is the only realistic course of action. Take immediate corrective measures. Inform the patient's doctor of the mistake so that action can be taken as soon as possible to counteract the effects of the incorrect medication.What are the top 5 most common medical errors? ›
The top five medical errors are misdiagnosis, delayed diagnosis, medication error, infection, and harmful medical devices. The top five medical errors are responsible for most instances of medical malpractice in health care.
What are the 3 main sources of medical errors? ›
Inadequate Information Flow
- The lack of crucial information when needed to influence prescribing decisions.
- Lack of appropriate communication of test results.
- Poor coordination of medication orders for transfer of care.
- Speak up if you have questions or concerns. ...
- Make sure that someone is in charge of your care. ...
- Make sure that all health professionals involved in your care have health information about you. ...
- Ask a family member or friend to be there for you.
- Staffing shortages.
- COVID-19 effects on healthcare workers' mental health.
- Bias and racism in addressing patient safety.
- Vaccine coverage gaps and errors.
- Cognitive biases and diagnostic error.
- Nonventilator healthcare-associated pneumonia.
- Human factors in operationalizing telehealth.
- Plan medication administration to avoid disruption: ...
- Prepare medications for ONE patient at a time.
- Follow the SEVEN RIGHTS of medication preparation (see below).
- Check that the medication has not expired.
- Perform hand hygiene.
- Check room for additional precautions.
- Introduce yourself to patient.
dispensing the formulation—wrong drug, wrong formulation, wrong label; administering or taking the drug—wrong dose, wrong route, wrong frequency, wrong duration; monitoring therapy—failing to alter therapy when required, erroneous alteration.When a medication error occurs you should first? ›
someone else has made a medication error, you must IMMEDIATELY REPORT THE ERROR TO THE RN CM/DN AND APPROPRIATELY DOCUMENT THE ERROR. According to your agency's policy, your supervisor should also be notified.What are the 5 factors to be crucial to patient safety? ›
- Use monitoring technology. ...
- Make sure patients understand their treatment. ...
- Verify all medical procedures. ...
- Follow proper handwashing procedures. ...
- Promote a team atmosphere.
Common causes of medication error include incorrect diagnosis, prescribing errors, dose miscalculations, poor drug distribution practices, drug and drug device related problems, incorrect drug administration, failed communication and lack of patient education.What is the most common medication error? ›
Wrong dose, missing doses, and wrong medication are the most commonly reported administration errors. Contributing factors to patient and caregiver error include low health literacy, poor provider–patient communication, absence of health literacy, and universal precautions in the outpatient clinic.What are the 5 sources of error? ›
Common sources of error include instrumental, environmental, procedural, and human. All of these errors can be either random or systematic depending on how they affect the results. Instrumental error happens when the instruments being used are inaccurate, such as a balance that does not work (SF Fig. 1.4).
What are the top 10 most common medications? ›
- atorvastatin (Lipitor)
- metformin (Glucophage)
- simvastatin (Zocor)
- omeprazole (Prilosec)
- amlodipine (Norvasc)
- metoprolol (Lopressor)
- acetaminophen plus hydrocodone.
- albuterol (Ventolin)
Right Dose Illegible prescriber's handwriting, a transcription error, miscalculation of the amount, or misreading the label can result in errors of an incorrect dose of medication Carefully read and clarify drug orders Recheck labels Have two nurses double-check potent medications Common sources of errors Insulin ...