Adverse drug events (ADEs) are a serious public health problem. It is estimated that12:
- 700,000 emergency department visits and 120,000 hospitalizations are due to ADEs annually;
- $3.5 billion is spent on extra medical costs of ADEs annually;
- At least 40% of costs of ambulatory (non-hospital settings) ADEs are estimated to be preventable.
The numbers of adverse drug events will likely grow due to12:
- Development of new medications
- Discovery of new uses for older medications
- Aging American population
- Increase in the use of medications for disease prevention
- Increased coverage for prescription medications
Nurses are most likely to be blamed for medication errors because they are involved at the administration point. However, medication errors are complex and are rarely the result of one person’s actions. The medication system in hospitals is complicated. There are multiple steps and many individuals involved. Every time a document or medication changes hands, there is an increased potential for error
Administering medication is a crucial nursing responsibility. To ensure safe and effective drug therapy, the nurse must be familiar with indications, usual dosages, and intended effects of drugs. Remember the 5 rights: right patient, right drug, right dose, right route, and right time. Each patient must be assessed before administration, and the medication should be delayed or withheld if indicated.
One study found adherence by nurses to standard medication administration practice was very low. This adherence is reported below as ratios per item.
Only 45.6% of nurses verified the amount of medication indicated on the vial at least once for at least one second. In addition, only 6.5% read the name of the patient from the wristband. Administering the medication at the correct time guideline was observed 41% of the time. The guideline regarding hand washing before external and oral medications was followed only 4.5% of the time, although this figure was much higher for intravenous medications at 96·6%. Overall, among 31 categories regarding drug administration, 17.2 (± 3.6) items per person were followed, whereas 5.7 (± 1.2) items per person were violated. We found key instances in which nurses did not follow the guidelines, including many from the Five Rights. About one in four elements were violated overall.13
Nurses’ medication error interception practices are associated with lower rates of medication errors. One study defines these interceptive practices as14:
- independent comparisons between the medication administration record and patient record at the beginning of a nurse’s shift;
- determining the rationale for each ordered medication;
- requesting that physicians rewrite orders when improper abbreviations are used;
- and ensuring that patients and families are knowledgeable regarding the medication regimen so that they can question unexplained variances
The types of medication errors include: prescribing, omission, wrong time, unauthorized drug, improper dose, wrong drug preparation, wrong administration techniques, deteriorated drugs, improper monitoring and compliance, product errors, process errors and human errors. Areas that are particularly error-prone are:
- Verbal orders
- Handwritten orders
- High-alert drugs
- Infusion pump errors
- Confusing drugs names
Handwritten and manually transcribed physician orders leave a lot of opportunity for errors. A computerized physician order entry, in which the physician must enter all orders by computer, eliminates handwriting and transcription errors. It also makes it possible to automatically check doses, drug-drug interactions, allergies and significant patient characteristics, like allergies and impaired renal function.
Meta-analysis of the research revealed that computerized physician order entry decreases the likelihood of error on that order by 48%. Given this effect size, and the degree of adoption of computerized order entry and use in hospitals in 2008, we estimate a 12.5% reduction in medication errors, or 17.4 million medication errors averted in the USA in 1 year.15
A computerized order entry system presents its own set of problems. There is a significant expense that smaller facilities may not be able to afford. Cost prohibitions or lack of space may limit the number of PCs to the point that practitioners have long wait times for computer access. It seems slow and inconvenient at times. In addition, physicians who are less computer savvy may be resistant to change.
A listing and resource for confusing drug names (look alike/sound alike) can be found at the following website.