The Nurse’s Guide to Medication Errors and Preventing Them

• Medication errors can occur at any stage of the medication process and can have severe consequences for patients. 
• Nurses are integral members of the healthcare team and can play a vital role in preventing and mitigating medication errors. 
• Understanding the common causes of medication errors and implementing practical strategies, such as thorough record keeping, double-checking, and utilizing modern technologies, can help nurses minimize the risks associated with medication errors and create a safer environment for their patients.
  

In the fast-paced world of healthcare, medication errors can occur at any stage, from prescription to administration, and can have severe consequences for patients. Nurses, as integral members of the healthcare team, play a vital role in preventing and mitigating these errors. The National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) emphasizes the importance of understanding medication errors and their potential impact on patient health.  

In this blog, we will discuss common causes of medication errors and provide practical strategies that nurses can implement to minimize these risks. By staying vigilant and informed, nurses can contribute significantly to improving patient safety and overall quality of care.

What Is a Medication Error?

The NCC MERP defines a medication error as “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient or consumer.” 

A medication error can occur at any stage of prescribing, dispensing, transcription, handling, mixing, and administration of the drug. They can be lethal at times, often worsening the health condition of the patient. For healthcare providers, preventing medication errors is critical.  

When many nurses work with several patients simultaneously, the risk of medication error increases. Thorough record keeping and double-checking should not be overlooked as valuable steps in preventing error.   

Some common reasons for medication errors include: 

• Use of the wrong medication, strength, or dose 
• Confusion over sound-alike or look-alike drugs 
• Administration of medications by the wrong route.  
• Miscalculations of drugs, especially when given to pediatric patients or when administering medications intravenously. 
• Errors in prescribing and transcription that can contribute to compromising the safety of the patient. 

Potential Sources of Medication Errors

Let’s take a deeper look at some potential sources of error when it comes to writing the prescription, and how nurses can prevent medication error through this medium. 

Illegible Handwriting

Poor handwriting can make it difficult to understand the prescription, especially when differentiating between two drugs. Some drugs sound similar when spoke aloud, especially over the telephone, which can lead to initial transcription errors that are further taken out of context when haded off. 

To overcome errors resulting from illegible handwriting, the healthcare professionals can take the following precautions: 

• Take time and write a legible note or prescription.  
• To prevent misinterpretation, keep phone or verbal orders to a minimum. Or when given over the phone, repeat back the orders.  
• Print the name of the drug when ordering a new or rarely used medicine.  
• Always specify the strength of the drug, even if it comes in a single strength.  
• For liquid dosage form, express the quantity in metrics such as ml and cc rather than one or two teaspoons or tablespoons.  
• Print a list of generic and brand names of look-alike or sound-alike medications so that you know about them.

Misplaced or Unclear Zeroes and Decimal Points

A clearly-written medication means nothing if the dosage is written illegibly. If decimal points are not placed in the correct location, it can lead to life-threatening situations. For example, if the dose to be administered was 0.25 mg and the zero was not placed before the decimal point, the chances are high that the nurse might confuse it with 25mg of that drug.

Therefore, to prevent that error, never leave a decimal point without a zero. Putting a zero with a neat decimal point is crucial when you give medication orders.  

Moreover, never have a trailing zero following a decimal point. Write 2 mg instead of 2.0mg.  

Misunderstood Abbreviations

Various errors may occur if you speak abbreviations verbally when giving an order. It is recommended to avoid the following abbreviations: 

• U to spell unit. Instead, say “unit” clearly.  
• “Once-daily” as OD or QD or “every other day” as QOD. Instead, spell it out. 
• Abbreviations of drug names. Instead, write or spell the generic or brand names.  

Incomplete or Ambiguous Orders

When the prescriber fails to record all of the details of the prescription, it creates unnecessary and dangerous confusion. This may occur if the healthcare provider does not record the time of dose, dosage form, or route of administration. 

To prevent this, providers should abide by the following precautions: 

• Do not use a slash ( / ) sign while prescribing. The healthcare providers can confuse it with the number 1.  
• When reviewing an unusual order, verify the order with the prescriber to prevent a misunderstanding. 
• After writing the orders, read and recheck them.  
• Promote that the drug’s indications are also written in the prescription. In this way, it will be clear which drug has been given for what health condition.  
• Instead of writing “resume preop” or “continue previous meds” in the order, provide complete medication orders.  
• Provide the age and, when appropriate, the weight of the patient. 

How to Prevent a Medication Error

Technology is everywhere in modern healthcare, and these advancements can be utilized to help minimize medication error.  

Electronic prescribing systems and barcodes, for instance, can minimize transcription errors and ensure the accurate dispensing of medications. Smart infusion pumps equipped with alarms that trigger when the ordered dose exceeds typical limits can act as an extra layer of protection against potential mistakes. Automated dispensing systems can streamline the process of medication management, reducing the likelihood of human error.  

Furthermore, implementing a pharmacy order entry system that is fully integrated with an electronic prescribing system can help maintain accurate records, facilitate communication between healthcare professionals, and ultimately lead to safer and more efficient medication administration.  

By harnessing the power of these technologies, healthcare providers can work together to minimize the risks associated with medication errors and create a safer environment for their patients. 

The Bottom Line

As we’ve explored throughout this blog, medication errors pose a significant risk to patient safety, and nurses play a crucial role in minimizing these occurrences. By understanding the common causes of medication errors and implementing practical strategies, nurses can make a meaningful impact on patient outcomes.

By staying vigilant and informed, nurses can ensure that every stage of the medication process is handled with care and precision. It’s essential to adopt modern technologies and best practices, communicate effectively with fellow healthcare professionals, and never hesitate to seek clarification when in doubt. By doing so, nurses can create a safer environment for their patients and contribute to the overall quality of healthcare.

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