Medication errors: Causes, Types and Prevention

Medication errors are any preventable events that may cause or lead to inappropriate medication use or patient harm. This is the definition by the national coordinating council for medication error reporting and prevention (nccmerp).

Medication is in the control of the health care professional practice, health care products, procedures, and systems including prescribing, order communication, product labeling, packaging, nomenclature, compounding, dispensing, distribution, administration, education, monitoring, and use.

Categories of medication errors

Medication errors can be categorized into the following classes;

    An omission error occurs when a dose is not given or when the next dose is due and the previous dose was not given.
    A wrong dose error occurs when the dose is given is either below or above the correct dose by more than 5%.
    An extra dose error occurs when a patient receives more dose than was prescribed by the prescriber.
    A wrong dose form error happens when any dose form or formulation is given to the patient that is not the accepted interpretation of the prescriber order. for example, a drug is given by mouth for a drug ordered as an intramuscular injection.
    A wrong time error occurs when any drug is given 30 minutes or more before or after it was prescribed, up to the time of the next dose.
Another way of categorizing medication errors is to define them by what caused the failure of the desired result, this helps in clearly identifying the cause of the error. This classification is:
    Human failure. These are failures that occur at an individual level. Human errors include those made by the patient such as non-compliance to the prescribed drug therapy. They can also be caused by a technician such as no cross-referencing.
   Technical failure. This is a failure that results from location or equipment i.e. failure to properly operate automated equipment.
    Organizational failure is a failure due to organizational rules, policies and procedures.

Route cause analysis of medication errors

This refers to a logical and systematic process used to help identify what, how and why something happened in order to prevent a recurrence.

Identification of specific potential causes allows a person to take specific actions to prevent potential error.

Actions are then taken to improve the quality of work being done and therefore improve patient outcomes.

Causes of medication errors

    Assumption error occurs when an essential piece of information cannot be verified; therefore an assumption is made.

    A selection error occurs when there are two or more options available, and the wrong option may be selected.

    A capture error is the one that occurs when focus on the task is diverted elsewhere and therefore the distraction captures the person’s attention, preventing the person from detecting the error or causing an error to be made.

    Physiological causes. Each individual is genetically unique and the rate at which a person can metabolize drugs from the body varies greatly. for instance, g6pd (glucose 6 phosphate dehydrogenase) is an enzyme that helps to remove medications from the body. a patient with this enzyme deficiency taking a medication that depends upon this enzyme for metabolism could result in serious harm or even death.

    Social causes are kind of failure to follow medication instructions because of cost, non-compliance or misunderstanding of the instruction, forgetting to take the medication, taking too many doses, dosing at the wrong time, not getting the prescription filled or refilled in a timely manner.

    Patient response. Most patients will have the intended response a prescriber expects from the medication selected; however, an individual’s unique physical and social circumstances make it impossible to predict which medication may result in no substantial harm and which may result in death.

    Similar product name – e.g. quinidine and clonidine, cisplatin and carboplatin.

    Abbreviations – e.g. qid vs qod

    Poor illegible handwriting leading to assumptions

    Labeling and packaging

    Miscalculation and improper dosage

    Medication order that is written on the wrong patient’s chart.

    The wrong route, patient, time.

    Failure to document the drugs administered to a patient; another provider then checks the medication chart and sees no medication and gives the patient another second dose.

    Poor patient assessment without attention to the areas covered in medication history.

    Complication due to drug incompatibilities.

    A poor working environment like job stresses, excessive noise, poor lighting, excessive heat, constant interruptions,

    Poor attitudes by health care workers

    Access of drugs by non-qualified persons. Patients even take their family member/friends medication

    Lack of patient information such as incomplete patient information, with no patient allergies, other medications the patients are taking, previous diagnosis and previous lab result.

    Lack of information to the prescribers due to unavailable drug information such as updated drug warnings.

    The wrong diagnosis can lead to inappropriate treatment. errors in interpreting the lab results.

    Too many telephone calls.

    Work overload and staff burn out.

    Lack of patient medication counseling.

Medication error prevention

    Patient education. Both the patient and the caregiver need basic knowledge to administer, handle and support safe medication use. Patients should understand the key pieces of information about every medication taken. Patient education assists patients in becoming more informed and empowers them to be advocators of their own safety.

    Innovation to promote safety. Adequate space and clean, well-lit conditions are just some of the basics. These minimize the possibility of medication errors. Automate and barcode fill procedures maintain clean, organized and orderly

work areas, provide adequate storage areas with clear drug labels on the shelves. Provide adequate computer applications and hardware.

    Repeat verbal orders such as spelling the drug name aloud and speak slowly and clearly.

    Have the indication or purpose for use with each product.

    Avoid dosage abbreviations and product abbreviations.

    Always read the label three times and check with the medication order before administering the medication.

    Use 5 rights of drug administration.

    Never use trailing zeros with medication orders and transcription orders e.g. 25 instead of 25.0

    When in doubt, always check order with the prescriber, a pharmacist, or the literature. Do not assume anything.

    Do not try to decipher illegibly written orders.

    Always be alert; never be too busy to stop, learn or inquire.

    Encourage the use of brand names and generic names with orders for medications.

    Question the medication if the patient states “that it isn’t what I usually take” etc.

What are the steps to take with medication administration errors?

    Check the patient by assessing all parameters e.g. vital signs and documents accordingly.

    Assess for the effects of the drug.

    Complete medication error report forms after contacting the physician and nurse in charge.

    Monitor patients accordingly.

    Think and act critically; modify the nursing practice to prevent further errors.

    Do not leave the medication by the bedside.

    Use the reliable formula for calculating doses.

    Take precautions in high-risk groups e.g. pregnant, elderly and pediatrics.