What is Medication Error
What is a Medication Error?
A medication error is any preventable event that causes the inappropriate use of medicine or patient harm while the medication is being used. American Society of Health-System Pharmacists' definition of medication Error includes such errors as prescription, dispensing, medication administration, and patient compliance error.
Preventing Medication Error
Follow the rights of medication
administration
Right Patients
Right Drug
Right Dose
Right Time
Right Route
Right recording
Right assessment
Right education
Right to refuse medication
Right prescription
Right time and frequency
Right Drug drug interaction
Type of medication Error
- Prescription Error
- Transcribing Error
- Dispensing Error
- Administration Error
- Monitoring Error
- Wrong drug, wrong strength
error, wrong dose error,
- Wrong Patient Error, wrong
route of administration Error.
- Near Miss
Source of Medication Error
Medication Error is the most common
error in hospitals. Explain some sources of medication error, such as.
- Inaccurate recording and
transcribing of the order.
- Unclear or erroneous labeling
of drugs.
- Misidentification of the client
- Incomplete delivery of the drug
- Verification Error by nursing
staff
- Use of inadequate knowledge or
inaccurate.
- Time and Performance pressure
- Staff handover
Prescription Error
Prescription Error contributing
factor including lack of knowledge of prescription drug it's recommend dose and
patients details contribute to prescription errors.
- Illegible handwriting
- inaccurate medication history
- Confused with drug name
- Confused with brand name
- Inappropriate use of decimal
points
- Use of verbal order.
Risk factors for prescription error
Prescription medication errors are a significant risk factor, playing a main reason.
- Work environment
- Over workload
- Communication within the team
- Physical and mental well-being
- Lack of knowledge
- Absence of self-awareness of
error
- Low perceived importance of prescription
How is reduced prescription Error
Electronic prescription may help to
reduce the risk factors of prescription errors resulting from illegible
handwriting. The computerized physician order entry system eliminates the
need for transcription of orders by nursing staff.
Dispensing Error
A dispensing Error is a discrepancy between a prescription and the medicine that the pharmacy delivers to patients or distributes to the ward on the basis of this prescription, including the dispensing of medicine with inferior pharmaceutical quality.
Prevalent Dispensing Error
1- Dispensing incorrect medication or dosage strength.
2- Dosage miscalculations
3- Failure to identify drug
interactions.
4- LASA drugs Look Alike Sound Alike
Reducing dispensing errors includes
- Ensuring a safe dispensing
procedure.
- Separating drugs with a similar
name or appearance.
- Keeping interruptions in the
medicine administration procedure to a minimum and maintaining
the workload of the nurse at a safe and manageable level.
- Awareness of high-risk drugs
such as potassium chloride and cytotoxic agents.
- Introducing safe, systematic procedures for dispensing medicine in the pharmacy.
LASA Look-alike and sound-alike drugs
Generic name
Clonidin
Clomipramin
Codein
Etodolac
Cotrimazol
Clotrimazol
Trade name
Catapresan
Anafranil
Codein knoll
Lodin
Bactrim Cotrim, Nopil
Canesten, Corisocoris
Administration Error
Medication errors are common in the hospital setting and can lead to adverse drug events. Administration Error is defined as a deviation from the physician's medication order as written on the patient's chart. Administration is the final step of the medication process. It's directly concerned with nurses and patients, and the last barrier before a possible consequence for the patients. The clinical impact of administration Error can be evaluated using the general classification of the American Society of Health-System Pharmacists and the National Coordinating Council for Medication Error Reporting and Prevention. Some administrative Error such as
1- Discrepancy occurs between the
drug received by patients and the drug therapy intended by prescription.
2- Error of omission
3- Deliberate violation of guidelines
Causes of Administration Error
- Lack of perceived risk
- Poor role model
- Lack of available technology
- Lack of knowledge of the
prescription or administration procedures, and the complex design of
equipment.
- Failure to check the patient's
identity prior to administration.
- The wrong calculation to determine
the correct dose.
Reduce Drug Administration Error.
- Checking the patient's identity
- Ensuring the dosage calculations
are checked independently by another healthcare professional before the drug is administered
- Ensure that the prescription
drug and patients are in same place in order that they may check against
one another.
- Ensuring the medication is
given at the correct time.
- Minimizing interruption during the drug round.
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