According to the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) , a medication error is:
"Any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer."
These errors can occur at any stage of the medication use process: prescribing , transcribing , dispensing , administering , monitoring , and documentation .
Categories of Medication Errors
1. By Type of Error
- Omission error: Failure to administer a prescribed dose before the next scheduled dose.
- Wrong dose error: Administering a dose that differs from the prescribed dose by more than ±5%.
- Extra dose error: Administering a dose not authorized by the prescriber.
- Wrong dosage form error: Using an incorrect formulation (e.g., giving oral instead of intramuscular).
- Wrong time error: Administering a drug ≥30 minutes early or late.
2. By Causal Factor
- Human error: Non-compliance, poor communication, inattentiveness.
- Technical error: Equipment malfunction or automation failure.
- Organizational error: Faulty systems, staffing issues, poor protocols.
Causes of Medication Errors
Cognitive and Environmental Factors
- Assumption errors – Acting without verifying critical information.
- Selection errors – Choosing an incorrect option among multiple similar ones.
- Capture errors – Distractions that lead to bypassing correct steps.
Patient-Specific Factors
- Genetic differences – e.g., G6PD deficiency increasing drug toxicity.
- Physiological variation – Age, renal/hepatic function.
- Non-compliance – Due to cost, misunderstanding, or forgetfulness.
- Unpredictable responses – Due to unique patient characteristics.
Systemic and Communication Issues
- Look-alike/sound-alike drugs (e.g., quinidine vs. clonidine ).
- Dangerous abbreviations (e.g., qid vs. qod ).
- Illegible handwriting.
- Labeling/packaging confusion.
- Misplaced orders (wrong chart, patient).
- Failure to document prior administration.
- Poor patient assessment/history.
- Inadequate drug knowledge or lab result interpretation.
- Environmental stressors – noise, heat, interruptions.
- Staffing issues – burnout, high workload.
- Unauthorized drug access.
- Incomplete or outdated patient/drug data.
Root Cause Analysis (RCA)
RCA is a structured approach used post-incident to determine the underlying "what, how, and why" an error occurred. It aims to implement system-based corrective actions and prevent recurrence .
Medication Error Prevention Strategies
Educational and Behavioral
- Educate patients and caregivers on drug use.
- Encourage patients to advocate for their safety.
Environmental and Technological
- Maintain organized, well-lit, and clean medication areas.
- Use barcoding, automated systems, and computer-based order entry (CPOE).
Communication and Practice Standards
- Repeat and verify verbal orders.
- Avoid non-standard abbreviations.
- Use both generic and brand names .
- Employ the Five Rights of medication administration:
- Right patient
- Right drug
- Right dose
- Right route
- Right time
- Read labels three times before administration.
- Avoid trailing zeros (e.g., use "25" not "25.0").
- Seek clarification— never guess unclear orders.
- Promote open communication for patient concerns.
What to Do After a Medication Administration Error
- Assess the Patient:
- Monitor vitals and look for adverse effects.
- Document the Event:
- Report to the physician and nurse-in-charge.
- Complete an institutional medication error report.
- Monitor Continuously:
- Observe for delayed effects or complications.
- Correct the Error Safely:
- Use critical thinking to adjust care as needed.
- Prevent Recurrence:
- Reflect on the event and improve practice.
- Avoid Unsafe Practices:
- Never leave medications at bedside.
- Use standardized formulas for dose calculations.
- Exercise caution in high-risk populations: elderly, pediatric, pregnant women.
