USANT Nurses Forum

Source: Nursing Link

Medication errors are on the rise, says a recent study. According to the National Coordinating Council for Medication Error Reporting and Prevention, medication errors include everything from a situation that can potentially cause an error, to events that cause patient death. Nearly 10% of lawsuits brought against hospitals involve a nurse who made a medication error. But, to simply state that there was an error made is only half of the story. Understanding why the error was made tells the complete account of the incident.

Nurses, from the time they begin school, are taught the "Five Rights" of medication administration. They are:

The right drug A prescriber's bad handwriting, a pharmacy error or a nursing mistake can lead to administering the wrong drug. For your part, check the medication administration record for ordered drugs, be on guard for sound-alike or look-alike drug names and ask the pharmacist or the prescriber if you have any questions. Don't hesitate to call the prescriber for clarification. Document the date and time of your conversation and with whom you spoke along with the outcome of the discussion.

The right patient Before giving a medication, check your patient's ID. If the patient is alert, ask them to state their name. Overlooking the ID, misreading the name and "hearing" the name you expect are all potential sources of error.

The right dose Miscalculation by the prescriber, the pharmacist or the nurse is another major concern. For unfamiliar doses, check a reference. Question the prescriber about any dose that's higher or lower than the recommended amount and have another nurse check your figures, if you are unsure. Make certain you are familiar with the standard abbreviations your institution uses when writing prescriptions.

The right route Each prescribed drug should specify the administration route. Given by the wrong route, some medications are fatal. If you're unsure of the route, don't administer the medication.

The right time Various factors can affect the time a medication is administered. Some drugs must be given at precise intervals to maintain therapeutic levels, while others can be affected with the timing of meals or other medications. Always check with the prescriber or the pharmacist if the schedule changes.

So, why are there errors? Even when a nurse applies the five rights, errors can happen due to external forces. In a survey conducted by Nursing 2003 magazine, participating nurses stated what they believed to be the top five causes of medication errors. They are:

1. distractions and interruptions during medication administration
2. inadequate staffing and high nurse/patient ratios
3. illegible medication orders
4. incorrect dosage calculations
5. similar drug names and packaging.

No matter what the case may be, never make a "judgement call." You'll open yourself up to the risk of making an error and possibly being named in a lawsuit. Whenever you are in doubt, always ask your supervisor or call another staff member with prescriptive authority if the prescriber is unavailable. As a nurse, you are an advocate for your patient's safety and it could be your discovery of error that saves a patient's life. And remember, always document your actions. Be sure to include the date and time of your conversation. Note with whom you spoke along with the outcome of the discussion.

By following the five rights, understanding why medication errors occur, and documenting your actions, you and your colleagues can begin to put preventative measures into effect and help reduce the risk of being sued. Hospitals are using technology more and more to prevent errors, but remember that technology is no substitute for the watchful eye of a nurse. As the old saying goes, "An once of prevention is worth a pound of cure."