Causes for errors:Too many telephone callsOverload/ week endsToo many PatientsLack of concentrationNo one available to double checkStaff shortageSimilar drug namesNo time to counselIllegible prescriptionMisinterpreted prescription
ADVERSE DRUG EVENT :Any injury caused by the use (or non use) of a drug. AN ERROR OF COMMISSION:Is something that happen from administration of the medication for example : giving the wrong medication
An error of omission occurs whenthe administration process is not completed for example: not administering an ordered medication.
TYPE OF MEDICATION ERROR1. PRESCRIBING ERRORS .2. OMISSION ERRORS.3. WRONG TIME ERRORS.4. UNAUTHORIZED DRUG ERRORS.5. IMPROPER DRUG ERRORS .6. WRONG DOSE FORM ERRORS.7. WRONG DOSE PREPARATION ERRORS.8. WRONG ADMINISTRATION TECHNIQUE ERRORS .9. DETERIORATED DRUG ERRORS .10.MONITORING ERRORS .11.COMPLIANCE ERRORS .
Occurs when prescriber orders drug for specific patientdrugdosedosage formroute of administrationlength of therapynumber of dosesadministrationdrug concentrationinadequate or incorrect instructions for useillegible handwriting
Failure to administer an ordered dose (not late dose). Omitted dose is not an error when: cannot take anything by mouth (NPO). providers are waiting for drug level results. patient refuses.
Standardized administration times Acceptable interval surrounding scheduled time. Occasionally unavoidable: patient is away care area for test. medication is not available at time it is due.
Administration of medication to patient without proper authorization by prescriber. Medication for patient given to another patient. Nurse gives medication without prescriber order. Patients “share” prescriptions.
Dose that is greater or less than prescribed dose. Can occur when additional dose is administered Delay in documenting dose Absence of documentation Inaccurate measurement of oral liquid Exclusions from this error type
Doses administered as different form than ordered.
Using bacterio static saline instead of sterile water to reconstitute lyophilized powder for injection.
Examples: Subcutaneous injection that is giventoo deep Intravenous (IV) drug is allowed to infuse via gravity instead of using an IV pump. Instilling eye drops in wrong eye.
Monitoring expiration dates is very important. Refrigerated drugs stored at room temperature may decompose & lose efficacy.
Inadequate drug therapy review. Examples: Ordering serum drug levels but not reviewing them. Not ordering drug levels when required. Prescribing antihypertensive agent & then failing to check blood pressure.
Failure to adhere to prescribed drug regimen.Example:Patient does not complete antibiotics therapy-saves a few doses.
Errors that cannot be placed into category.Examples: Medication dispensed without adequate patient education.
Abbreviation Intended Misinterpretation> and < Greater than Less than Often used the OppositeΜg Microgram Mistaken as mgIU international Unit Mistaken as IVqd, QD or QOD Every day or every Often confused for other day each othercc cubic centimeter Misread as ‘u’Zero after decimal(1.0) 1 mg Misread as 10 mgZero not written before Half mg (0.5) Misread as 5 mgdecimal (.5mg)
Types of Verbal Order ErrorsWrong DrugClonidine misheard as KlonopinAmiodarone misheard as amrinoneWrong Dose15 mg misheard as 50 mg2 mg misheard as 20 mgWrong LabsBlood glucose misheard as 257 instead of 157 patient received 6 units of insulin instead of 2.
NURSING RESPONSIBILITIESOnly administer meds you have prepared.Know the purpose and expected outcomes.Do not leave meds at bedside.Check ID band before administering.Some meds need checking by another nurse.Consult with supervisor or Dr if dosage is outside ofrecommended range .Do not administer medications calculated by someoneelse except pharmacist .
STANDARD PRECAUTIONWash hands before beginning medicationWear gloves for parenteral injectionsWear gloves if helping put pills in mouth
HOW TO PREVENT MEDICATION ERROR?????When your doctor gives you a prescription, ask him or her totell you the name of the drug, the correct dosage, and whatthe drug is used for. Be sure you understand the directions forany medications you may be taking including the correctdosage, storage requirements, and any special instructions.Finally, never be hesitate to ask questions. If the name of thedrug on your prescription looks different than you expected, ifthe directions appear different than you thought, or if the pillsor medication itself looks different, tell your doctoror Pharmacist right away. Asking questions if you have anysuspicions at all is a free and easy way to ensure that youdont become the victim of a medication error.
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