Chapter 5
MEDICATION ERRORS:
PREVENTING AND RESPONDING
DSN
KEVIN DOBI, MS, APRN
Copyright © 2014 by Mosby, an imprint of Elsevier
Inc.
Adverse Drug Event
2
 Medication errors
 Institute of Medicine studies (1999, 2006)
 Adverse drug reactions
 Allergic reaction
 Idiosyncratic reaction
Copyright © 2014 by Mosby, an imprint of Elsevier
Inc.
3
Copyright © 2014 by Mosby, an imprint of Elsevier
Inc.
Classroom Response Question
4
In the 2006 Institute of Medicine Study, it was estimated that
some form of medication error resulted in harm to how many
patients?
A.
B.
C.
D.
400,000
800,000
1 million
1.5 million
Copyright © 2014 by Mosby, an imprint of Elsevier
Inc.
Medication Errors
5
 Preventable
 Common cause of adverse health care outcomes
 More potential for harm with “high-alert”
medications
Copyright © 2014 by Mosby, an imprint of Elsevier
Inc.
Issues Contributing to Errors
6
 Errors can occur during any step of medication
process:
Procuring
 Prescribing
 Transcribing
 Dispensing
 Administering
 Monitoring

Copyright © 2014 by Mosby, an imprint of Elsevier
Inc.
Issues Contributing to Errors (cont’d)
7
 Organizational issues
 Educational system issues
 Sociologic factors
Copyright © 2014 by Mosby, an imprint of Elsevier
Inc.
Types of Medication Errors
8
 No error, although circumstances or events
occurred that could have led to an error
 Medication error that causes no harm
 Medication error that causes harm
 Medication error that results in death
Copyright © 2014 by Mosby, an imprint of Elsevier
Inc.
Preventing Medication Errors
9
 Multiple systems of checks and balances
 Legible and correct orders
 Appropriate consultation
 Check medication order three times
 “Six Rights” of medication administration
Copyright © 2014 by Mosby, an imprint of Elsevier
Inc.
Preventing Medication Errors (cont’d)
10
 Minimize verbal or telephone orders
 Repeat order to prescriber
 Spell drug name aloud
 Speak slowly and clearly
 List indication next to each order
 Avoid medical shorthand, including
abbreviations and acronyms
Copyright © 2014 by Mosby, an imprint of Elsevier
Inc.
Preventing Medication Errors (cont’d)
11
 Never assume anything about items not specified
in a drug order (e.g., route)
 Do not hesitate to question a medication order
for any reason when in doubt
 Do not try to decipher illegibly written orders;
contact prescriber for clarification
Copyright © 2014 by Mosby, an imprint of Elsevier
Inc.
Preventing Medication Errors (cont’d)
12
 NEVER use a “trailing zero” with medication
orders
Do not use 1.0 mg; use 1 mg
 1.0 mg could be misread as 10 mg, resulting in a tenfold
dose increase

Copyright © 2014 by Mosby, an imprint of Elsevier
Inc.
Preventing Medication Errors (cont’d)
13
 ALWAYS use a “leading zero” for decimal
dosages
Do not use .25 mg; use 0.25 mg
 .25 mg may be misread as 25 mg

Copyright © 2014 by Mosby, an imprint of Elsevier
Inc.
Preventing Medication Errors (cont’d)
14
 Take time to learn special administration
techniques of certain dosage forms
 Always verify new medication administration
records
Copyright © 2014 by Mosby, an imprint of Elsevier
Inc.
Preventing Medication Errors (cont’d)
15
 Always listen to and honor any concerns
expressed by patients regarding medications
 Check patient allergies and identification
Copyright © 2014 by Mosby, an imprint of Elsevier
Inc.
Classroom Response Question
16
The nurse is administering a drug that has been ordered as
follows: “Give 10 mg on odd-numbered days and 5 mg on
even-numbered days.” When the date changes from May 31
to June 1, what should the nurse do?
A. Give 10 mg because June 1 is an odd-numbered day
B. Hold the dose until the next odd-numbered day
C. Change the order to read “Give 10 mg on evennumbered days and 5 mg on odd-numbered days”
D. Consult the prescriber to verify that the dose should
alternate each day, no matter whether the day is odd- or
even-numbered
Copyright © 2014 by Mosby, an imprint of Elsevier
Inc.
Reporting Medication Errors
17
 Report to prescriber and nursing management
 Document error per policy and procedure
 Factual documentation only
 Medication administered
 Actual dose
 Observed changes in patient condition
 Prescriber notified/follow-up orders
Copyright © 2014 by Mosby, an imprint of Elsevier
Inc.
Reporting Medication Errors (cont’d)
18
 External reporting of errors
 USP MERP (United States Pharmacopeia Medication
Errors Reporting Program)
 MedWatch, sponsored by the FDA
 Institute for Safe Medication Practices (ISMP)
 The Joint Commission
Copyright © 2014 by Mosby, an imprint of Elsevier
Inc.
Classroom Response Question
19
The nursing student realizes that she has given a patient a
double dose of an antihypertensive medication. The tablet
was supposed to be cut in half, but the student forgot and
administered the entire tablet. The patient’s blood pressure
just before the dose was 146/98 mm Hg. What should the
student nurse do first?
A.
B.
C.
D.
Notify the patient’s physician
Notify the clinical faculty
Take the patient’s blood pressure
Continue to monitor the patient
Copyright © 2014 by Mosby, an imprint of Elsevier
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Medication Reconciliation
20
 Continuous assessment and updating of patient
medication information
Verification
 Clarification
 Reconciliation

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Medication Reconciliation (cont’d)
21
 Should be done at each stage of health care
delivery:
Admission
 Status change
 Patient transfer within or between facilities/provider
teams
 Discharge

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Ethical Issues
22
 Notification of patients
 Possible consequences for nurses
Copyright © 2014 by Mosby, an imprint of Elsevier
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