Medication Errors and Administration
Definition of Medication Errors
Described as "any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer."
Sources of the definition include:
National Coordinating Council for Medication Error Reporting and Prevention
Institute for Safe Medication Practices (ISMP)
The Joint Commission (TJC)
US Food and Drug Administration (FDA)
The Health and Medicine Division of the National Academies of Sciences, Engineering and Medicine (HMD, formerly known as IOM).
WHAT CONTRIBUTES TO MEDICATION ERRORS?
Key Contributing Factors to Medication Errors
Lack of Knowledge
Failure to Follow Rights
Refers to the necessary checks in medication administration (explored later).
Wrong Transcription
Calculation Errors
Lack of Assessment
Documentation Errors
Abbreviations
Look-Alike, Sound-Alike Medications
Incomplete delivery of medications
HOW CAN YOU PREVENT MEDICATION ERRORS?
Strategies for Prevention of Medication Errors
Communication: Emphasizes the need for clear dialogue among healthcare team members.
Education: Continuous learning about medications and their effects is crucial.
Reporting of Errors: Encourages a non-punitive culture where mistakes can be reported and learned from.
Know your Patient: Familiarity with a patient’s history, allergies, and current medications can prevent errors.
Legal Reminder: Nurses can be held legally responsible for medications given, even if there was an error in the order or dose.
Note: Nurses serve as the last line of defense against medication errors.
SIX RIGHTS OF MEDICATION ADMINISTRATION
Overview of the Six Rights
Right Drug: Ensure the correct medication is administered.
Right Dose: Verify that the dosage is accurate.
Right Patient: Confirm the identity of the patient.
Right Route: Administer the medication using the correct route (oral, intravenous, etc.).
Right Time: Ensure that medication is given at the correct time.
Right Documentation: Record the administration details accurately.
Additional Concepts
Right Reason: Understand the rationale for prescribing the medication.
Right Education: Ensure that the patient is informed about their medication, including risks and benefits.
Right to Refuse: Patients have the right to refuse medication.
ROUTES OF MEDICATION ADMINISTRATION
Nonparenteral (Non-injectable) Routes
Ophthalmic (Eye)
Otic (Ear)
Buccal
Sublingual
Topical
Intradermal
Subcutaneous
Intramuscular
Intravenous
Epidural
Parenteral (Injectable) Routes
Oral
Enteral
Inhalation
Rectal
Vaginal
MEDICATION ORDERS
Types of Medication Orders
Written Orders: Prescribed in written format.
Verbal/Telephone Orders: Given orally, require careful documentation.
Standing Orders: Routine orders followed until cancelled.
One-Time Orders: Administered only once.
PRN Orders: Administered on an as-needed basis.
Stat Orders: Immediate administration required.
Essential Components of Medication Orders
Client’s full name
Date and time of order
Name of medication
Form of medication
Dosage of medication
Route of administration
Time and frequency of administration
Signature of ordering healthcare provider
MEDICATION ADMINISTRATION RECORD (MAR)
Components of the Medication Administration Record (MAR)
Order Date
Medication
Administration Time
Nurse’s name signing off
Special Instructions related to medication administration
MEDICATION STORAGE
Importance of proper medication storage for safety and efficacy.
24 HOUR CLOCK/MILITARY TIME
Overview on Reading an Analog Clock:
Explanation of intervals such as quarter to, quarter past, and how the hour begins as the minute hand points to 12.
Different times are illustrated based on understanding military time.
Military Time Chart:
Midnight: 0000 or 2400
1 AM: 0100
2 AM: 0200
3 AM: 0300
4 AM: 0400
5 AM: 0500
6 AM: 0600
7 AM: 0700
8 AM: 0800
9 AM: 0900
10 AM: 1000
11 AM: 1100
Noon: 1200
1 PM: 1300
2 PM: 1400
3 PM: 1500
4 PM: 1600
5 PM: 1700
6 PM: 1800
7 PM: 1900
8 PM: 2000
9 PM: 2100
10 PM: 2200
11 PM: 2300
REMEMBER…
Key Reminders for Safe Practice
Accurate Calculations are essential for medication administration.
Be an Autonomous Thinker to apply critical thinking in clinical practice.
Safe Administration practices must be prioritized.
Document properly and accurately to maintain clear records.
Use military time to avoid confusion in scheduling medication.
Understand common abbreviations to minimize miscommunications.
Always Check, Check, and Re-check before administering medications.