Podcast
Questions and Answers
What is the recommended action if there is uncertainty about a medication order?
What is the recommended action if there is uncertainty about a medication order?
Which of the following practices helps prevent medication errors?
Which of the following practices helps prevent medication errors?
If a nurse has drawn up a medication but is unsure about the orders, what should be done?
If a nurse has drawn up a medication but is unsure about the orders, what should be done?
What could happen if a 'trailing zero' is used in a medication order?
What could happen if a 'trailing zero' is used in a medication order?
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What are the general categories of events caused by adverse drug events?
What are the general categories of events caused by adverse drug events?
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What is a 'near miss' in relation to medication errors?
What is a 'near miss' in relation to medication errors?
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Which of the following types of drugs is particularly associated with severe medication errors?
Which of the following types of drugs is particularly associated with severe medication errors?
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Which of the following describes 'SALAD' in the context of medication errors?
Which of the following describes 'SALAD' in the context of medication errors?
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What should prescribers focus on to help prevent medication errors?
What should prescribers focus on to help prevent medication errors?
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What is one significant finding from the follow-up study conducted in 2010 regarding preventable medication errors?
What is one significant finding from the follow-up study conducted in 2010 regarding preventable medication errors?
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Which of the following is NOT a contributing factor to medication errors?
Which of the following is NOT a contributing factor to medication errors?
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What is the primary responsibility of a nurse before administering medication?
What is the primary responsibility of a nurse before administering medication?
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Which of the following should NOT be used in documentation of medication errors?
Which of the following should NOT be used in documentation of medication errors?
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In the case of time critical scheduled medications, within how many minutes should they be administered if not at the exact time?
In the case of time critical scheduled medications, within how many minutes should they be administered if not at the exact time?
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During the medication reconciliation process, when should medications be reconciled?
During the medication reconciliation process, when should medications be reconciled?
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Which of the following is a priority for a nurse when responding to medication errors?
Which of the following is a priority for a nurse when responding to medication errors?
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What is expected from patients during the medication reconciliation process?
What is expected from patients during the medication reconciliation process?
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What is the time frame for administering medications prescribed more frequently than daily but no greater than Q4H?
What is the time frame for administering medications prescribed more frequently than daily but no greater than Q4H?
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What should be avoided in documentation when reporting medication errors?
What should be avoided in documentation when reporting medication errors?
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What must be consulted to prevent medication errors?
What must be consulted to prevent medication errors?
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When documenting medication administration, what type of words should be avoided?
When documenting medication administration, what type of words should be avoided?
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Study Notes
Medication Errors: Preventing and Responding
- A landmark study by the Institute of Medicine (IOM) in 1999 showed medication errors,
- A follow-up study in 2010 revealed no significant change in the rate of preventable medication errors since the IOM study.
General Impact of Errors
- Medication errors are often system-related rather than individual mistakes.
- A culture of accountability and remediation is needed.
- Workplace culture, reporting structure, and management behavior influence error rates.
- When professionals repeatedly fail to follow policies, remedial education is required.
Just Culture
- Systems are often a significant factor in errors.
- Accountability and remedial education are important components of error prevention.
Adverse Drug Event
- Adverse drug events (ADEs) are encompassing clinical problems stemming from medication use.
- Medication errors, allergic reactions, and idiosyncratic reactions are all types of ADEs.
Textbook Figure 6-1
- Medication errors are a subset of adverse drug events.
Medication Errors
- Medication errors are a frequent cause of adverse health care outcomes.
- Central nervous system drugs, anticoagulants, and chemotherapeutic drugs are commonly involved in severe medication errors.
Medication Errors Continued
- "High-alert" medications, including sound-alike and look-alike drugs (SALAD), are particularly prone to errors.
- LASA (look-alike, sound-alike) drugs are of importance
- Tall man lettering is used to help distinguish similar drugs.
Issues Contributing to Errors
- Errors can arise at any stage in the medication process, from procurement to monitoring.
- Errors can arise from issues within the prescribing process, dispensing, administration, and monitoring.
- Organizational, educational, and sociological factors, along with abbreviation use play a role.
Types of Medication Errors
- Near misses are errors that do not result in harm to the patient.
- No harm events reach the patient but do not cause harm
- Medication errors cause harm
- Critical incidents lead to serious patient harm.
Preventing Medication Errors
- Multiple systems of checks and balances must be implemented.
- Prescribers need to write legible orders with accurate information.
- Electronic order entry and authoritative resources are crucial.
Preventing Medication Errors Continued
- Nurses should triple-check medication orders prior to administration
- Faculty members should not be the student's main source of information regarding medications
- Medication administration rights should be applied consistently
Responding to, Reporting, and Documenting Errors
- Nurses must prioritize patient safety and follow facility policy.
- Follow-up procedures and tests are needed.
- Thorough and accurate documentation is essential, avoiding subjective language like "error."
Responding to, Reporting, and Documenting Errors Continued
- Documenting factual information about observed patient changes and implemented actions.
- Maintaining ongoing patient monitoring is vital
- Prescribers need to be informed of any errors and follow-up actions.
- Patient monitoring should be ongoing.
Recommended Guidelines for Timely Medication Administration
- Time-critical medications should be administered precisely or within 30 minutes of schedule
- Non-critical medications should be administered within two hours of schedule
- Medications given more frequently than daily, and no more frequently than every four hours (Q4H) need to be administered within one hour of schedule.
Medication Reconciliation
- Continuous assessment and updating of patient medication information are necessary.
- Verification, clarification, and reconciliation of medications are crucial for safe patient care.
- Medication reconciliation should occur at entry into the facility, transfer into or out of the facility, and on discharge.
- Patients provide a list of medications, and the prescriber assesses which ones to continue during hospitalization.
Ethical Issues
- Notification of patients is crucial.
- Possible consequences for nurses should be considered.
Preventing Medication Errors
- Assessment of patients is essential
- Two patient identifiers help avoid errors and improve safety for the patient.
- Medication should not be administered if the nurse did not prepare or draw up the medication.
- Minimize reliance on verbal or telephone orders and follow up with the prescriber when necessary.
Preventing Medication Errors Continued
- Spell out drug names.
- Speak slowly and clearly.
- Indicate the indication next to each order
- Avoid abbreviations
- Question any aspect of the order that is unclear
Preventing Medication Errors Continued
- Never use trailing zeros in medication orders Avoid using 1.0 mg; use 1 mg.
- Always use leading zeros in decimal dosages. Avoid using .25 mg; use 0.25 mg.
- Learn technique for specific drug forms
Preventing Medication Errors Continued
- Learn technique for specific drug dosage forms.
- Verify new medication administration records.
- Honor patient concerns about medications.
- Check patient allergies and identification.
Practice Question
- If a student nurse administers a double dose of medication, following steps including notifying the physician or preceptor, taking patient's blood pressure, and then monitoring the patient is advised. This is a practice question with an answer choice to consider.
Preventing Pediatric Medication Errors
- Report all medication errors.
- Know the drug thoroughly.
- Follow the Ten Rights of medication administration.
- Avoid verbal orders when possible, and communicate with everyone.
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Description
Explore the critical issues surrounding medication errors and their prevention. This quiz covers landmark studies, the impact of workplace culture, and the importance of accountability in reducing medication errors. Gain insights into adverse drug events and the role of remedial education in fostering a safer healthcare system.
