5 Tips to Preventing Medication Errors in Nursing
By Erin Wallace, contributor
Medication errors in nursing are unfortunate events at best. At worst, they can severely affect a patient’s health — and a nurse’s career.
The response to medication errors has been long and storied, with the FDA and other regulators weighing in overtime. Learning how to prevent medication errors in nursing is critical for RN success, and you can find out more about the history of medication error prevention and strategies to keep patients safe below.
Preventing Medication Errors: A Recent History
In 1999, the Institute of Medicine released a report that estimated between 44,000 and 98,000 deaths per year stemmed from medical errors in hospitals alone. More than 7,000 of those fatalities were related to medication errors.
In response, the FDA and other government organizations dedicated more resources to drug safety in an effort to help reduce medical errors. While regulatory efforts have helped in many instances, errors do still occur and staff have to be vigilant in reducing those risks.
Nurses, in particular, have the odds stacked against them due to the nature of the job. They manage multiple patients and multiple responsibilities on a daily basis, leaving very little room for other necessary duties.
Nurses are also often fatigued and tired from working long or overnight shifts. A 2016 study, published in the Global Journal of Health Science, sought to identify “the causes of medication errors and strategies to prevent them from a nurse’s viewpoint.” Ninety-seven percent of the nurses in the study identified “fatigue due to high workload” as the leading influencing factor of medication errors.
5 Tips for Preventing Medication Errors in Nursing
1. Ensure the five rights of medication administration are adhered to
Every time you administer a dose, it’s important to keep the five rights of medication in mind. This is one of the easiest ways to prevent medication errors in nursing and should be reviewed upon each administration of medication. These “rights” include:
The right patient: Are these medications prescribed to this patient and not the one next door? Double check names.
The right drug: Be sure the medicine you’re giving aligns with the doctor’s orders and patient treatment plan. If something doesn’t seem right — such as a drug you’ve never seen used for a specific diagnosis before — don’t be afraid to double check with the prescribing doctor.
The right dose: Double and triple check the dosage amount before administering.
The right route: Should pills be crushed or given whole to swallow? Is the medication administered via IV or an NG tube? These details matter.
The right time: Be sure the medication is being given at the right scheduled time, whether morning, afternoon or evening. If it’s being given in intervals, such as every four hours, this should be recorded appropriately to avoid double dosing.
2. Pay close attention to drug packaging, labeling and nomenclature
According to American Nurse Today, the packaging for many drugs look similar. Pamela Anderson, an adult nurse practitioner at Clarian Health in Indianapolis, says, “Healthcare organizations should ensure that all medications are provided in clearly labeled unit-dose packages for institutional use.”
Anderson goes on to recall a tragic example that occurred in 2007, when several pediatric patients received massive heparin overdoses due to misleading packaging and labeling, and three infants died as a result.
In response, the manufacturer of heparin, Baxter Healthcare, has enhanced the labels on heparin packaging and other high-alert drugs, including a 20 percent larger font size, tear-off cautionary labels and different colors to distinguish dosage differences.
3. Double check — or even triple-check — individual patient procedures
This is one of the simplest ways to avoid medication errors in nursing. It usually involves having another nurse review all new medication orders to ensure that each patient’s medication is noted and transcribed correctly on the physician’s order and the medication administration record. Some hospitals may have similar procedures in place already, so be sure to follow those.
Paying close attention to high-alert medications in particular is important. A nurse should be independently double-checking themselves before administering them.
4. Put a zero in front of the decimal point
It sounds overly simplistic, but this simple action may help save a life. A dosage such as .25 mg can easily be misconstrued as 25mg, which results in a potentially adverse outcome for the patient.
5. Document everything
Proper documentation includes: Proper medication labeling and legible documentation on charts or medication administration records.
A lack of proper documentation can result in an error. For example, if a nurse forgets to write down a dosage that was given for an as-needed medication, it can result in a second dosage being administered by another nurse because no record of the previous dose exists.
It’s a nurse’s job to put patients first, and preventing medication errors in nursing is important to patient success and improved overall health. As Kathy Malloch, a member of the American Nurses Foundation Board of Trustees said, “medication errors are preventable, and nurses are in an optimal position to make a difference.”