Preventing Medication Errors
Medication errors are all too common, jeopardizing the safety of patients; it may be a misinterpretation of a prescription, not having a complete history of a patient and dispensing drugs that could interact with other drugs adversely, or a patient administering the medication incorrectly, which are all preventable.
There are numerous ways of preventing medication errors; therefore, the Institute for Safe Medication Practices (ISMP) has recognized ten important factors that lead to errors. Anderson & Townsend, (2010) list them as: “patient information, drug information, adequate communication, drug packaging (labeling, nomenclature), medication storage (stock, standardization, and distribution), drug device acquisition (use and monitoring),
environmental factors, staff education and competency, patient education, and quality processes and risk management” (pg. 1). Now that we have identified what leads to errors we need to figure on how to prevent them. There is a “Do Not Use” list for the abbreviations that most physicians or pharmacists may use. Some abbreviations modify drug forms, some that give instructions on how to administer and when to take the medication, and some that tell how much and how long to take a drug. There is some healthcare professional that still use the abbreviations on this list, why, that’s a valid question. According to the ISMPs Error-Prone list, it is indicated that the abbreviations on their list are the same that’s included on the Joint Commission’s “minimum list” of dangerous abbreviations, acronyms, and symbols that must be on an organization’s “Do Not Use” list. Health care professionals continue to use what is known as having been previously abbreviated, frequently misrepresented and are now using the corrections in its place. An example of a misrepresented abbreviation – “pg”, intended meaning – microgram, misrepresentation – mistaken as “mg,” correction – use “mcg.”
Because the consequences of the continued use of the “Do Not Use” list could increase medication errors instead of decrease the error rate. It is imperative that healthcare professionals be diligent in staying focused and avoid bypassing safety systems. Anderson & Townsend says “they can be conscientious about performing the “five rights” of administration every time – right patient (using two identifiers), right drug, right dosage, right time, and right route.” Taking this a little further with an extended list: “right reason for the drug, right documentation, right to refuse medication, and right evaluation and monitoring” (pg. 4) along with these rights they should be meticulous in preventing future errors.
-Carmen Nash
There are numerous ways of preventing medication errors; therefore, the Institute for Safe Medication Practices (ISMP) has recognized ten important factors that lead to errors. Anderson & Townsend, (2010) list them as: “patient information, drug information, adequate communication, drug packaging (labeling, nomenclature), medication storage (stock, standardization, and distribution), drug device acquisition (use and monitoring),
environmental factors, staff education and competency, patient education, and quality processes and risk management” (pg. 1). Now that we have identified what leads to errors we need to figure on how to prevent them. There is a “Do Not Use” list for the abbreviations that most physicians or pharmacists may use. Some abbreviations modify drug forms, some that give instructions on how to administer and when to take the medication, and some that tell how much and how long to take a drug. There is some healthcare professional that still use the abbreviations on this list, why, that’s a valid question. According to the ISMPs Error-Prone list, it is indicated that the abbreviations on their list are the same that’s included on the Joint Commission’s “minimum list” of dangerous abbreviations, acronyms, and symbols that must be on an organization’s “Do Not Use” list. Health care professionals continue to use what is known as having been previously abbreviated, frequently misrepresented and are now using the corrections in its place. An example of a misrepresented abbreviation – “pg”, intended meaning – microgram, misrepresentation – mistaken as “mg,” correction – use “mcg.”
Because the consequences of the continued use of the “Do Not Use” list could increase medication errors instead of decrease the error rate. It is imperative that healthcare professionals be diligent in staying focused and avoid bypassing safety systems. Anderson & Townsend says “they can be conscientious about performing the “five rights” of administration every time – right patient (using two identifiers), right drug, right dosage, right time, and right route.” Taking this a little further with an extended list: “right reason for the drug, right documentation, right to refuse medication, and right evaluation and monitoring” (pg. 4) along with these rights they should be meticulous in preventing future errors.
-Carmen Nash