Medication Errors: Types and Contributing Factors

• Medication errors are any error in prescribing, dispensing, or administering a drug, regardless of whether it leads to adverse consequences.
• A medication error is a preventable event that may cause inappropriate medication use or client harm when the medication is controlled by healthcare professionals, clients, or consumers.

Classification of Medication Errors

• Medication errors are classified, based on where they occur in the medication use cycle:
• Prescribing errors
• Dispensing errors
• Administration errors

Contributing Factors to Medication Errors

• Lack of knowledge of the prescribed drug, its recommended dose, and patient details can contribute to prescription errors.
• Illegible handwriting is a contributing factor.
• Inaccurate medication history taking is a contributing factor.
• Confusion with drug names is a contributing factor.
• Using inappropriate decimal points, such as leading zeros (e.g. 0.1), is important, but using trailing zeros (e.g. 1.0) is not.
• Using abbreviations is a contributing factor.
• Verbal orders are prone to error.

Risk Factors for Prescribing Errors

• Work environment
• Workload
• Lack of knowledge
• Organizational factors like inadequate training

Approaches for Reducing Prescribing Errors

• Electronic prescribing may reduce the risk of prescribing errors due to illegible handwriting.

Dispensing Errors

• Dispensing errors occur from receiving the prescription in the pharmacy to supplying a dispensed medication to the patient.
• Primarily occurs with drugs having similar names or appearances.
• Example: Confusing Lasix (furosemide) and Losec (omeprazole).
• Potential dispensing errors include wrong dose, wrong drug, or wrong patient.

Approaches for Reducing Dispensing Errors

• Ensure a safe dispensing procedure.
• Separate drugs with similar names or appearances.
• Minimize interruptions during medicine administration and maintain a manageable nurse workload.
• Be aware of high-risk drugs like potassium chloride and cytotoxic agents.
• Use safe systematic procedures for dispensing medicines in the pharmacy.

Administration Errors

• A discrepancy between the drug received by the patient and the drug therapy prescribed.
• Errors of omission occur when the drug is not administered.
• Incorrect administration technique and using incorrect or expired preparations are errors.
• Deliberate violation of guidelines is an error.

Causes of Administration Errors

• Lack of perceived risk
• Poor role models
• Lack of available technology
• Lack of knowledge of preparation or administration procedures for complex equipment

Contributing Factors to Drug Administration Errors

• Failure to check the patient's identity before administration
• Environmental factors like noise, interruptions, and poor lighting
• Incorrect calculation of the correct dose

Dangerous or Confusing Abbreviations and How To Fix

• QOD (every other day) can be mistaken for QID/QD, so write "every other day."
• Trailing zeros (X.0 mg) should be written "X mg" since the decimal point can be missed.
• Lack of leading zeros (.X) shoul be written "0.X mg" since the decimal point can be missed.
• MS can be morphine sulfate or magnesium sulfate; write out the full name to avoid confusion.
• MSO4 and MgSO4 can be confused with "morphine sulfate" or "magnesium sulfate"; write the full name.
• QD (daily) can be mistaken for QID; write "daily."
• IU (international unit) should be written "international unit."
• U (unit) can be mistaken for zero or four; write "unit."