Running head: CAUSES AND PREVALENCE OF MEDICATION
Causes and Prevalence of Medication Errors in the Healthcare Setting
Margaret L. Destin
University of South Florida
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CAUSES AND PREVALENCE OF MEDICATION
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Causes and Prevalence of Medication Errors in the Healthcare Setting
In today’s world, healthcare has become extremely developed with an ever growing
knowledge of diseases, the processes of the human body and the development of technology
available to diagnose and treat those conditions. Many people would consider this a great
advance forward and they are correct. Unfortunately, there is an opposite side to this as well.
The ability to save patients or treat those with chronic life threatening diseases usually involves
the use of multiple procedures, interventions, and medications.
In addition to this, much of patient care today is handled by multidisciplinary teams and
multiple hospitals or specialty clinics. The increased amount of medical interventions, the
increased time patients are receiving these interventions and the fact that patients may be
receiving care from multiple healthcare providers, are all factors that increase the chance that
somewhere along the line, a mistake may be made. In a world where medications are calculated
and administered by healthcare providers who are neither perfect nor foolproof, there will always
the possibility for error. Unfortunately medication errors are a frequent occurrence in the health
care setting.
A study conducted which analyzed the results of a questionnaire administered randomly
to 237 nurses showed that 64% of those nurses reported having personally made medication
errors during their nursing careers. The results also showed that calculating the wrong
medication dosage and the wrong infusion rates were selected as the most common type of
medication error made. In addition to the 64% percent of nurses that reported having made
medication errors, another 31% of nurses reported that they had been on the verge of making a
medication error before self- identifying the mistake and correcting it (Cheragi, Manoocheri,
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Mohammadnejad, & Ehsani, 2013). There are many different factors that have been identified as
contributing to the incorrect calculation of medication dosages.
One of these factors is the drug calculation skills of the nurses themselves. One study
conducted on the drug calculation skills of nurses provided drug calculation tests to 124 nurses
from 5 different healthcare facilities. The years of working experience among the nurses ranged
from brand new nurses recently registered with 0 years of experience to nurses with 30 years of
working experience. The tests included calculation questions on metric conversions, tablet
dosages, fluid dosages and drip rates.
Out of the 124 nurses who took the medication exam only 5 managed to score a perfect
score. The individual sections of the exam that participants scored the highest and lowest
percentage of questions answered correctly were tablet dosages and drip rates. For tablet
dosages, 50% of nurses were able to answer all questions correctly for tablet dosages, while only
5.6% of nurses were able to answer all questions correctly regarding drip rate calculations
(Fleming, Brady, & Brady, 2014). The results of this study which showed drip rate calculations
to be the most prominent miscalculation of medication dosages are cause for concern.
The fast onset of effect from medication introduced directly into the bloodstream is a
critical reason why the correct dosage calculation must be ensured. The potential for patient
harm from this type of error is extremely high. To prevent medication errors from happening
and to decrease the incidence of medication errors there are many different practices that have
been put into place. One of these practices is the implementation of prevention intervention
programs.
A study conducted on the occurrences of medication errors on an ICU floor showed a
decreased percentage of errors after the implementation of an intervention program compared to
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the percentages of errors that occurred prior to use of the program. The program implemented
included educational workshops on medication administration facilitated by the pharmacy and
the development of standard operating procedures for enteral and parental medication
administration. After a time period of 6 months, the rate of medication errors occurring during
preparation and administration had decreased by 50% (Romero et al., 2013). In the medical field
where advances in practice and changes to existing practices are continually ongoing, it is
important to have clear guidelines and educational training to help maintain highly developed
medication administration skillsets of nurses.
Another factor attributed to the occurrence of medication errors is a high stress work
environment caused by high patient acuity and inadequate staffing of nurses. Nurses like any
other workers are more likely to make mistakes when rushed, tired or stressed. To reduce
medication errors occurring from this, it is important for nurse managers and hospitals to ensure
that they have adequate staffing available to meet the needs of their patients. When administering
medications, nurses should ensure that they always perform the 5 rights of medication
administration; right patient, right drug, right dose, right route and right time.
The error that I am the most afraid of making as a nurse is administering an incorrect
medication or incorrect medication dose and causing harm to a patient. As someone who came
into the nursing profession because of a desire to help people, the thought of causing further
harm to someone who has been trusted into my care is one of the worst things I can think of.
The action I plan to take to avoid making medication errors with my patients is to follow the 5
rights of medication administration. Also, if I ever question something about a medication for a
patient or with a dose I have calculated I will have another nurse verify with me that the
medication and dosage are correct.
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References
Cheragi, M. A., Manoocheri, H., Mohammadnejad, E., & Ehsani, S. R. (2013). Types and causes
of medication errors from nurse’s viewpoint. Iranian Journal of Nursing and Midwifery
Research, 18(3), 228–231. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3748543/?log$=activity
Fleming, S., Brady, A., & Brady, M. (2014). An evaluation of the drug calculation skills of
registered nurses. Nurse Education in Practice, 14(1), 55-61.
doi:10.1016/j.nepr.2013.06.002.
Romero, C. M., Salazar, N., Rojas, L., Escobar, L., Grinen, H., Berasain, M. A., Tobar, E., &
Jiron, M. (2013). Effects of the implementation of a preventive interventions program on
the reduction of medication errors in critically ill adult patients. Journal of Critical Care,
28(4), 451-460. doi:10.1016/j.jcrc.2012.11.011.