Introduction
Medication errors are the leading causes of morbidity and mortality among the medical errors reported in the United States. In fact, reports from the Institute of Medicine (IoM) indicate that medication errors harm over 1.5 million individuals in the US besides causing substantial costs in production, wages, and provision of unnecessary healthcare services. Medication error rates vary broadly from one facility to another. However, research indicates that at least a single medication error occurs in every health facility per day. Medication errors result in adverse effects on the patients, healthcare professionals, and even the organization. This paper delves into medication errors with a view of defining, examining causes, and reasons for their occurrence. Besides, it provides various recommendations on the possible strategies for preventing medication errors.
Defining Medication Errors
A medication error is a failure occurring during treatment that injures or is capable of harming the patient. Medication administration is an all-encompassing process that embodies several steps including prescription, transcription, dispensing, and administration of drugs and monitoring of patients’ response (Lavon, Ben‐Zeev, and Bentur 288). Medication errors can occur at any of these steps. The leading medication errors occur at the administration level. Keers et al. reveals that the faults occurring in this stage contribute to approximately 30% of the incidences in the United States (1050). It is fatal and usually not easily intercepted (Keers et al. 1050). Researchers argue that the prescription stage presents a higher chance for medication errors. However, the medical staff including pharmacists and nurses among others intercepts errors emanating from drug prescription. Most of the medication errors result in the wrong dosage, where the patient gets too little or excess of the prescribed dose (Anderson and Townsend 27). Additionally, wrong transcription and wrong labeling have the potential to cause serious consequences that are not easily intercepted. These errors can also involve a mix-up of drugs or the patients themselves, a wrong application route.
Reasons for Medication Errors Occur and Responsibility
Medication errors occur on varied grounds as underpinned by several factors. According to the Institute of Safe Medicine (ISMP), ten key elements influence medical practice (Anderson and Townsend 25). Any mistakes committed when handling them often results in medication error (Lavon, Ben‐Zeev, and Bentur 288). They include patient education, nursing competency, and storage of medications. Others relate to the ecological features, drug packaging, and tagging among others (Idemoto et al. 1481). The right identification of patient is the first step of the medication process. Nurses who fail to identify the right patient information are likely to administer wrong drugs. Patient information often includes age, gender, birth date, and weight. Other information entails conditions such as allergies, current lab results, and accurate diagnosis. Medication errors occur when the medical staff overlooks any of such patient information components.
One of the most endangering causes of medication errors is poor packaging, labelling and nomenclature. Failure to distinguish between similarly packaged or labeled drugs can cause harm to patients. The harm can be more endangering if the drugs mistaken belong to the high-alert groups (Fallik 360). Moreover, look-alike or sound-alike medications can be easily confused, hence resulting in errors.
Medication storage, stock standardization, and distribution present another area of medication errors. Availing a floor-stock of medication can easily lead to confusion among nurses especially where high-alert drugs are stacked together. Staff education and competency have been correlated with the incidence of medication errors. Lack of teaching nurses on the use newly introduced medications can pose a risk of errors (Keers et al. 1050). When nurses and pharmacists fail to update themselves on changes regarding the medication-related policies, procedures, and protocols, they can easily use outdated administration methods that can be harmful to the patients.
In some cases, the patients use medication at home away from the caregivers. In the event that they lack adequate information regarding those medications, errors such as overdose, under dose, or even confusion of look-alike drugs are likely to occur (Keers et al. 1050). Experts hold that some environmental factors create room for medication errors. These conditions include poor lighting, cluttered work environments, increased patient acuity, and distractions when preparing drugs or administration. Dispensing errors usually occur at the pharmacies or at the hands of health care professionals who dispense medications (Anderson and Townsend 25). These errors comprise negligence and other mistakes that lead to the dispensing of wrong drugs, doses, and/or entries in cases where pharmacists use computer software. Such occurrences are referred to as errors of commission (Fallik 359). Errors of omission often entail the failure to offer counseling to patients, use of ambiguous language, and lack of engaging them in interactive sessions (Idemoto et al. 1482). Furthermore, errors of omission result from the failure to include the recommended dose in the patients’ medication program.
Another cause of medication errors is the lack of communication between the nurses and patients. Sometimes patients may fail to take instructions carefully or are unaware of errors that can occur. Similarly, medication faults can spring from poor monitoring of complex clinical processes or devices. For instance, when patients are shifted from one bed to another, chances of overdose are likely to happen when the devices are mishandled.
Various parties including manufacturers, pharmacists, nurses, and patients can cause medication errors. Manufacturers who label different drugs similarly or package them in identical containers contribute to medication errors. Nurses are responsible for medication errors too. Factors inherent in nursing that contribute to errors include personal neglect, heavy workload, unfamiliarity with new medication, new nursing staff, complicated orders initiated by doctors, unfamiliarity with the patients’ condition, and inadequate training (Lavon, Ben‐Zeev, and Bentur 288). Other elements that cause errors amongst nurses include solving other problems while administering drugs to other patients, stress and burnout, the length of nursing shift, duration of hospital stay, and poor quality checking for damaged or expired medication (Lavon, Ben‐Zeev, and Bentur 288). Pharmacists are responsible for all errors emanating from dispensing errands. Sometimes poor communication between pharmacists and patients result in errors. Particularly, pharmacists are responsible for dispensing errors. On the other hand, patients are accountable for medication errors, especially those that involve failure to adhere to doctor’s prescription (Idemoto et al. 1482). For instance, patients can make decisions that contradict prescriptions including under-dose, over-dose or ignoring to take drugs altogether.
Processes that Follow Medical Errors
Medication errors result in adverse effects on patients. As such, when they occur immediate reporting should be done for corrective action to be taken. Some medication errors can be intercepted if they are timely reported. Medical professionals do not commit errors deliberately (Idemoto et al. 1482). However, the occurrence of medication errors sometimes puts those responsible in undesired circumstances. In some instances, a blame game erupts where the professionals do not intend to admit responsibility (Roy, Gupta, and Srivastava 62). Some punishment processes serve as disciplinary actions on the responsible professionals. In the event of medication errors, the question of who takes responsibility has been associated with resulting in additional devastating effects on the patients, the organization, and the professionals themselves.
When errors occur, the quality assurance department in the medical facility should embark on an evaluation process to prevent future incidences. The delivery channels of the particular drug and its use in the healthcare organization should also be analyzed properly. It is recommended that health organizations should strive to create a non-threatening, non-punitive, and confidential environment that allows medical professions to report medication errors voluntarily and timely for an immediate interception. The primary role of the quality improvement program is the assessment of the possible causes of errors in medications through data analysis with a view of identifying the trends of occurrence to prevent future incidences. The focus is on improving quality while eluding room for pitfalls that result in medication errors.
Recommendations on Preventing Medication Errors
The escalation of medication errors in the United States has resulted in various adverse effects such increased deaths, illnesses, and morbidity rates. In light of this insight, the entire health care system is responsible for leading the way in prevention strategies. These strategies entail identifying the key areas from which errors emanate (Anderson and Townsend 26). First, providing patient education regarding the appropriate use of the prescribed medications can prevent errors. Providing therapeutic education ensures that patients play a part in ensuring their safety from medication errors. Patient education helps in proper identification of the information given by pharmacists, proper drug use, keeping drugs to avoid contamination, checking expiry dates, and taking recommended doses. Authorization programs also play a vital role in the provision of superior care and enhancement of cost-effectiveness in drug prescription. These authorization programs can reduce errors through ensuring that certain patients are not given specified medications.
Electronic Bar Coding technology can help prevent medication errors. The purpose of the bar medication device is to ensure that only the appropriate drug and amount is issued to patients with recognized illnesses. Information regarding dose and medication and the patient conditions should be embedded in the bar medication tool to help in proper administration (Roy, Gupta, and Srivastava 63). An electronic prescription record (EPR) is software that contains data including labeling, dispensing, and payment such that only the right prescription is provided. It helps in preventing dispensing errors. In addition, the utilization of E-prescribing can ensure that all errors stemming from the prescription of drugs are prevented. With the advancement in prescription technology, pharmacists can use the Internet to carry out drug utilization reviews (DUR) (Roy, Gupta, and Srivastava 63). Other prevention strategies include providing medical training for new staff prior to job placement (Fallik 361).
Conclusion
In conclusion, medical professionals should be trained in immediate reporting of medication errors from timely interception. Drugs should be labeled to prevent errors emanating from look-alike or sound-alike drugs. Ensuring the right documentation and the patients’ right to refuse medication are additional ways of preventing errors. Furthermore, adequate evaluation and monitoring should be highly exercised to note in time any incidences that are likely to result in medication errors. Proper staffing should be done to ensure an appropriate number of nurses per bed and room to avoid stress and overload-related medication errors.
References
Anderson, Pamela and Terri Townsend. “Medication errors: Don’t let them happen to you.” American Nurse Today 5.3 (2010): 23-27. Print.
Fallik, Bruce. “The Academy of Managed Care Pharmacy’s concepts in managed care pharmacy: prior authorization and the formulary exception process.” Journal of Managed Care Pharmacy 11.4 (2005): 358-361. Print.
Idemoto, Lori, Barbara Williams, Joan Ching and Craig Blackmore. “Implementation of A Custom Alert To Prevent Medication-Timing Errors Associated With Computerized Prescriber Order Entry.” American Journal of Health-System Pharmacy 72.17 (2015): 1481-1488. Print.
Keers, Richard, Steven Williams, Jonathan Cooke and Darren Ashcroft. “Causes of Medication Administration Errors in Hospitals: A Systematic Review of Quantitative and Qualitative Evidence.” Drug Safety 36.11 (2013): 1045-1067. Print.
Lavon, Ben‐Zeev, and Bentur, Ophir, Adi Ben‐Zeev and Yedidia Bentur. “Medication errors outside healthcare facilities: a national poison center perspective.” Basic & Clinical Pharmacology & Toxicology 114.3 (2014): 288-292. Print.
Roy, Vijay, Paneet Gupta and Shouryadeep Srivastava. “Chapter-14 Medication Errors: Causes & Prevention.” Health Administrator 19.1 (2006): 60-64. Print.