Medication Errors

Every year in the UK there are an estimated 237 million medication errors, ranging from prescribing to administration. Medication errors are one of the leading causes of harm to patients and are not only being detrimental to their physical wellbeing, but also to their emotional and psychological health.

How often do they occur?

Out of all of the 237 millions errors mentioned above, 72% of these will cause either no or little harm, 26% moderate harm and 2% severe harm. Different areas of healthcare also see different types of medication errors – in primary care, the most common cause of error is during the prescription, accounting for just under 50%, while in both secondary care and care homes, the most common mistakes are made during drug administration, 92% and 78%, respectively. Roughly one third of errors overall occur during the administration process, a task typically associated with nurses *.

Area Prescription Monitoring Dispensing Transition Administration
Primary Care 47.9 15.9 36.2
Secondary Care 8.5 2.9 2.9 78.6
Care Homes 3.0 0.6 3.6 7.1 92.8

Percentage of errors in each sector at each stage of the medicine use process (Elliott et al., 2018).

A Case study

I came across this video that talks about a real life scenario:

What happened: a nurse intended to administer a patient with a medication called Versed, which is a trade name for midazolam, to reduce a patient’s anxiety during a scan. The nurse went to get the drug from her dispensing area which utilised an automated electronic system where the name of the drug is typed in and is then dispensed for you. It appears that the nurse was unable to find the prescription under the patient’s name, so overrode the system and typed in the first two letters of Versed: V and E. At this point the system filled in the rest of the name, she dispensed and administered it to the patient. The nurse takes the patient down to the scanner for her scan, leaves the room and after the scan returns to the patient to find them pulseless.

What remained unnoticed was that the system didn’t fill in the name Versed, instead it selected a generic name. Vecuronium.

For anyone who hasn’t had a theatres or recovery placement yet, anything ending in ‘onium’ refers to a group of drugs that act as neuromuscular inhibitors, allowing a patient under anaesthesia to be mechanically ventilated. What had occurred during this incident was that the nurse didn’t administer a drug that would ease the patient’s anxiety, but instead paralysed her muscles, including the diaphragm, causing her to loose consciousness in the scanner and arrest. The patient was declared brain damaged the following day and was disconnected from life support soon after.

How can errors be prevented?

Know your five rights of drug administration – if I remember rightly this was the second thing we learnt in clinical skills, right after how to wash your hands properly.

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These five rights are a key guide to administering medication, but not only that, nurses have a legal obligation to know the drug their administering. This includes what the drug is for, side-effects and the normal doses. Just because something has been prescribed, doesn’t mean it’s automatically safe to give.

There are also drug specific considerations: do you give a patient with a heart rate of 40 digoxin or a patient with a blood pressure of 90/40 bisoprolol**? And don’t forget about those pesky PEG’s and NG’s.

So what?

Any nurse prescribing or giving medication is both responsible and accountable for it. They are the person that must check the medication is safe to give to the patient and ensure all of the five rights are correct and accounted for. However, mistakes do happen: human error is a thing and people have written whole books and made careers researching how to stop it. Ensuring that you always follow guidance, policies and procedures will minimise any risk of harm to patients; and if you do make a mistake, the quicker you own up to it, the quicker it can either be fixed or acted upon. By treating all drugs carefully, nurses can also act as a safety barrier to any prescribing or distribution mistakes.

Now, hopefully this will never be a scenario during your nurse training, as any medication you give will be done under the direct supervision of a registered nurse, but it’s still something everyone needs to be aware of, particularly the implications for the patient.

*I couldn’t find a specific breakdown of errors caused just by nurses, so all of the statistical data includes everyone involved: doctors, pharmacists, carers and nurses etc.

** unless there’s an actual clinical reason for this that has been clearly explained by the prescriber and documented.

References

Elliott, R. A. et al. (2018) Prevalence and Economic Burden of Medication Errors in the NHS in England. Available at: http://www.eepru.org.uk/wp-content/uploads/2018/02/eepru-report-medication-error-feb-2018.pdf (Accessed: 15 January 2019).

NHS Improvement (2017) Medication Errors. Available at: https://improvement.nhs.uk/about-us/corporate-publications/publications/foi-numbers-medication-errors-recorded-harm-level-death/.

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