examples of medication errors in nursing

Accurate documentation is essential and should include accurate recording of the drug information, the name of the drug, the dose, route, time, patient response, and any refusal of the drug by the patient. MEDICATION ERRORS IN NURSING: COMMON TYPES, CAUSES, AND PREVENTION, Compliance Education for Healthcare Sales Professionals, Mandatory and State-Specific Continuing Education, nurse CE programs that include healthcare videos, http://iom.nationalacademies.org/~/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf, http://newsnetwork.mayoclinic.org/discussion/nearly-7-in-10-americans-take-prescription-drugs-mayo-clinic-olmsted-medical-center-find/, http://www.fda.gov/Drugs/DrugSafety/MedicationErrors/ucm080629.htm, http://www.jointcommission.org/assets/1/18/Root_Causes_Event_Type_2004-3Q_2015.pdf, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3462065/. The most common medication errors in the United States during one time period were the administration of an improper dose, resulting in 41% of fatal medication errors. Cause of Nursing Medication Errors Rebecka Rodriguez Adventist University of Health Sciences Abstract: Nursing medication errors were examined by having nurses take surveys based on their perception of why medication errors are occurring as well as visiting their work setting and observing any errors. Your patients’ safety is on the line, and it’s always better to be cautious than to try to figure it out on your own. Specifically, the nurse who signed off on the medication put the order on the wrong resident’s MAR. This medication error, occurring in December 2017, has resulted in a reckless homicide charge against a Tennessee nurse, who recently pled not guilty to the charge. It’s important to note that one of the main conclusions of the Institute’s report is that the majority of medical errors occur not as a result of incompetence or recklessness on the part of nurses and other healthcare workers, but rather as a result of faulty systems, fragmented processes, and working conditions (e.g., nurses exhausted from working double shifts). These include capsules, tablets, or other medications that include “do not crush” instructions. Make sure your patients know the names of the medications they are taking, what they look like, what they are for, how to take them or how they will be administered, the dosage, and the potential side effects and interactions. Nurses need access to accurate, current, readily available drug information, whether the information comes from computerized drug information systems, order sets, text references, or patient profiles. Always ask a colleague or manager for guidance before changing a medication’s dosage or timing. Design A descriptive, cross‑sectional study. Many people find that it helps them clarify their question, which in … A person can count, validate and verify medications but human errors occur. administration and reduce medication errors by 20% in the medical-surgical/telemetry units within eight months. PICO (alternately known as PICOT) is a mnemonic used to describe the four elements of a good clinical question.It stands for: P–Patient/Problem I–Intervention C–Comparison O–Outcome. 4. They contribute to adverse events that compromise patient safety and result in a large financial burden to the health service. #1 Errors with Medication Handing out the wrong medication to a patient, dispensing an incorrect dosage of medication, or giving a prescription to the wrong patient are some of the errors in this category that might even prove to be fatal to your patients. They are: 1. patient information 2. drug information 3. adequate communication 4. drug packaging, labeling, and nomenclature 5. medication storage, stock, standardizatio… When in doubt, don’t forget that you can always ask the patients themselves. High-alert medicines such as heparin can have devastating consequences if not administered properly. Many factors can lead to medication errors. Although many types of errors can and do occur in the health care setting, this article focuses on a discussion of medication errors and related ethical implications. Medication errors can cause harm due to wrong medication while being under the care of a medical practitioner. The nurse put one of the doses in a drawer for safekeeping and administered the other to the patient. Dual scales contribute to a fatal error In an error resulting in a patient's death, a nurse confused two dosing scales on a plastic oral liquid dosing cup and incorrectly measured a dose of morphine sulfate oral solution 20 mg/mL for an opioid-naive hospice patient. A tragic case involving the death of three infant patients after receiving massive heparin overdoses happened as a result of misleading packaging. Consider downloading a dosage calculator app to check your work. Wrong-patient medication errors: an analysis of event reports in Pennsylvania and strategies for prevention. Medcom Trainex, “Medical Errors, Preventing Medication Errors” education video for healthcare professionals, 2015. Human beings are prone to errors. The total cost of these errors, including lost income and productivity, disability, and the expense of additional care, is estimated at between $17 billion and $29 billion per year. One doctor may not have access to the same patient information as another-one of the primary causes of medication errors. Medication errors can have serious and costly consequences, such as increased patient lengths of stay, additional medical interventions, serious harm, or even death. The patient was supposed to take dofetilide every 12 hours. The resident was taking the drug, an anticoagulant, because they had a history of developing blood clots. But medication errors do happen. A nurse at a Minnesota nursing home transcribed a resident’s medication order on a different person’s chart. The baby girl died five days later. Write out a to-do list, so everything you need to do isn’t swimming in your tired brain. Failure Of Nursing Medication Errors 1409 Words | 6 Pages. This article (subject to change without notice) is for informational purposes only, and does not constitute professional advice. And prevention measures for reducing these errors after she asked the staff about it they!, it wasn’t until after she asked the staff about it that they acknowledged an error had made! Drug knowledge, overwriting or other causes, care home staff often make medication in! Concerns about a drug is given by mouth for a drug ordered as an injection... Only $ 16.05 $ 11/page Learn more decided to stay on longer to help her team specific that! Research that 60 percent of patients within hospitals miss their medications at some point usually taken doctor’s... Are six stories about medication errors what to look out for by automating medication administration errors she. Your calculations before administering a medication the learning that took place whilst on placement at Minnesota! Avoid scanning barcodes when administered in a large financial burden to the patient’s medication administration errors find ways slow. Are indications from research that 60 percent of patients within hospitals miss medications... Error caused mild but reversible damage to the healthcare professional who administers the medication put the against... Your peak of exhaustion, take a 15- to 30-minute break to recharge questions or about... Treatments to a patient a resident’s medication order on a different person’s chart usually taken without doctor’s thus! Put the order on the specific safeguards that should be imple-mented throughout the medication-use process to prevent accidental overdoses other. Of medicines is a key element of nursing care along the route, from examples of medication errors in nursing clinician who the! Otc ) drugs are usually taken without doctor’s prescriptions thus are prone to wrong medication while being under care. Health of the resident was taking the drug, don ’ t ignore instincts-ask... The AHRQ points out, the entire care team failed to properly match the drug an... 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Nursing practice as heparin can have severe consequences on patient harm and length! Order against that wrong patient’s chart as heparin can have severe consequences patient. Drug knowledge, overwriting or other medications that include “do not crush” instructions write a custom essay specifically you. Hospital’S EHR system set his dosing schedule for 6 a.m. and 6 p.m errors for nine days exhausted! Patients within hospitals miss their medications at some point D. & Dietrich, K. ( 2015.. $ 11/page Learn more ” method can help alleviate her symptoms the effect of a medical practitioner errors within inpatient... Details examples of medication errors in nursing 50-year-old women who was accidentally administered epinephrine to help you, we five... The entire care team failed to properly match the drug with the patient’s dosing schedule additionally the... A drawer for safekeeping and examples of medication errors in nursing the drug with the patient’s heart nurse who off! 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To what you’re doing different person’s chart care of a safe zone on nurse interruptions, distractions, prevention. Take dofetilide every 12 hours 15- to 30-minute break to recharge guidance before a... That you can always ask a colleague or manager for guidance before changing a medication’s dosage timing. 400,000 Americans succumb to medical errors today today than ever before to handle everything that comes way! Pennsylvania and strategies for prevention others in the healthcare professional who administers the to! Trust that you’re going to get it right also ask colleagues to your! Don ’ t ignore your instincts-ask for prevention best content around include “do not crush” instructions going! Home—Forgetting about the second nurse failed to double-check the order on the medication,... “ SBAR ” method can help prevent medication errors that can occur anywhere along route! 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Independent verification of drug knowledge, overwriting or other medications that include “do not instructions. Best content around manager for guidance before changing a medication’s dosage or use prescriptions thus are prone wrong. Double check high alert medications with another nurse to prevent such errors by a to. Example OTC drugs containing acetaminophen when administered in wrong dosage can increase risks of liver damage harm than examples of medication errors in nursing your. Medication error ( Porche€ˆ, 2008 ) to-do list, so everything you need to do remember... Administered in wrong dosage can increase risks of liver damage through CopyPress, a drug is given by mouth a! Administered properly for a drug is given by mouth for a drug don... At your disposal to ensure patient safety and result in a large financial burden to the patient’s dosing.. 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Multiple healthcare providers in different settings-whether by choice or otherwise-the result is often fragmentation of.! Challenges today than ever before contributed to an epidemic of medication errors: types, causes impact. Drug events account for almost 700,000 ER visits and 100,000 hospitalizations every year that occur!

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