How to Avoid Medication Errors in Nursing
By Kim Maryniak, PhDc, MSN, RNC-NIC, Contributor
Statistics on medication errors in U.S. hospitals are difficult to calculate, due to the variability in reporting. In 1999, the government released a report titled To Err is Human: Building a Safer Healthcare System, which stated that approximately 98,000 people die each year in the United States due to medical errors (Institute of Medicine [IOM], 1999). Based on the IOM report, it is now estimated that as many as 440,000 deaths occur each year due to medical errors (James, 2013). Studies estimate that approximately 19.1% of these errors are medication administration errors (Keers, Williams, Cooke, & Ashcroft, 2013).
A cross-sectional study was done with 203 nurses to examine medication knowledge and the risk of medical errors. Participants were from acute care hospitals and primary care settings. As part of the study, each participant was given a test on pharmacology, drug management and drug calculations. The study showed that the participants had a 39% moderate risk and 11% high risk for pharmacology knowledge, 33% moderate risk and 26% high risk with drug management, and 32% moderate risk and 7% high risk with drug calculations (Simonsen, Johansson, Daehlin, Osvik, & Farup, 2011).
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. Here are strategies on how to prevent medication errors in nursing:
• The rights of medication administration. Initially, there were five rights for administration including the right patient, drug, time, dose and route. A sixth right is the right reason. Some literature describes up to 12 rights, including education, documentation, right to refusal and expiration date.
• Independent double checks. The Institute for Safe Medication Practices (ISMP) (2014) recommends the use of redundancies, such as independent double checks of high alert medications due to the increased risk for patient harm. This includes independent calculations for dose and rates of medication. The list of high alert medications can be found at http://www.ismp.org/tools/institutionalhighAlert.asp
• Medication review. Practices include comparing the medication administration record and patient record at the beginning of a nurse’s shift; determining the rationale for each ordered medication, and requesting that physicians rewrite orders when improper abbreviations are used, are important strategies.
• Knowledge. A nurse should never administer a medication which he/she is unfamiliar.
• Patient education. Ensuring that patients and families are knowledgeable regarding the medication regimen so that they can question unexplained variances are also associated with lower rates of medication errors.
• Practice environment. A supportive practice environment, including teamwork between physicians and nurses; opportunities for nurses to participate in hospital- and unit-level decisions; continuity of patient care assignments; continuing education opportunities; and the retention of nurse administrators who are visible and accessible, who listen to nurses’ concerns, and who have high expectations of their nurses are associated with a higher quality of nursing care. (James, 2013; RWJF, 2012; Simonsen et al., 2011)
For more information on medication safety and how to avoid medication errors in nursing, check out these courses on RN.com: “High-Alert Medications: Safe Practices,” “Medication Safety: Assuring Safe Outcomes” and “Medical Error Reduction: A Key to Quality Care”
Institute of Medicine [IOM]. (1999). To err is human. Washington, DC: Institute of Medicine.
Institute for Safe Medication Practices [ISMP]. (2014). ISMP high alert medications. Retrieved from http://www.ismp.org/tools/highalertmedicationLists.asp
James, J. (2013). A new, evidence-based estimate of patient harms associated with hospital care. Journal of Patient Safety, 9 (3), 122-128.
Keers, R., Williams, S., Cooke, J. & Ashcroft, D. (2013). Causes of medication administration errors in hospitals: A systematic review of quantitative and qualitative evidence. Drug Safety, 36(11), 1045–1067.
Robert Wood Johnson Foundation [RWJF]. (2012). Better environments for nurses mean fewer medication errors. Retrieved from http://www.rwjf.org/en/library/articles-and-news/2012/08/better-environments-for-nurses-mean-fewer-medication-errors.html
Simonsen, B., Johansson, I., Daehlin, G., Osvik, L. & Farup, P. (2011). Medication knowledge, certainty, and risk of errors in health care: A cross-sectional study. BMC Health Service Research, 11(175), 1-9.
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Kim Maryniak has over 26 years nursing experience in medical/surgical, psychiatry, pediatrics and neonatal intensive care nursing. She has been a staff nurse, charge nurse, educator, instructor, manager and nursing director. Kim is certified in Neonatal Intensive Care Nursing and has been active in both the National Association of Neonatal Nurses and American Nurses Association. Kim’s current and previous roles have included professional development and practice, research utilization, nursing peer review and advancement, education, infection control, nursing operations, quality and process improvement.