Reducing medication errors in nursing practice, part 2

Introduction

Medication errors remain one of the most common causes of harm to patients (Roughead et al 2013).

Definition

Medication error: a preventable event related to medication which results in ‘a failure in the treatment process that leads to, or has the potential to lead to, harm to the patient’ (Ferner and Aronson 2006).

• The medication treatment process includes all aspects of medication handling (Aronson 2009, National Coordinating Council for Medication Error Reporting and Prevention 2014).
• A review of medication error incidents reported between 2005 and 2010 to the National Reporting and Learning Service indicated that 526,186 such incidents had occurred in England and Wales during this period (Table 1) (Cousins et al 2012).
• A total of 86,821 (16%) of these incidents caused actual patient harm, of which 822 (0.95%) resulted in death or severe harm (Cousins et al 2012).

Table 1

• The cost to the NHS of hospital admissions related to medication errors in 2007 was £770 million and between 1995 and 2007 £5 million was spent on litigation costs (Frontier Economics 2014).
• In the UK, one third of medication errors occurring in general medical practices related to prescribing errors.
• Many of these were the result of poor communication, particularly with regard to the prescription of antibiotics to which patients are known to be allergic (National Patient Safety Agency (NPSA) 2007).

Medication errors contribute to adverse events that compromise patient safety and place a large financial burden on health systems (Roughead et al 2013). In addition to the financial costs, individual patients and their significant others are affected physically, emotionally and psychologically when errors occur (Figure 1) (Deans 2005).

Therefore, the prevention of medication errors is essential to maintaining a safe healthcare system (Roughead et al 2013).

Figure 1

Medication processes are complex in nature, involving multiple interactions, and are high-risk activities (Nursing and Midwifery Council (NMC) 2010). Although errors occur at every stage of the medication preparation and distribution process (Aspden et al 2006, McBride-Henry and Foureur 2006, Maricle et al 2007, Biron et al 2009), one third of those that harm patients are attributed to the administration phase (Leape et al 1995).

Most medication administrators are nurses and, therefore, when errors occur, nurses are often deemed accountable (Burke 2005). Medication administrators can provide a safeguard against errors made at any of the previous stages, however, and are thought to intercept around 86% of errors made by prescribers or pharmacists (Leape et al 1995). Therefore, nurses provide a safety defence against medication errors but, at the same time, have the potential to place patients at risk (Pape et al 2005).

This module discusses types of medication errors and the contributing factors that occur in clinical practice. It then concentrates on specific problems that nurses can encounter during the administration process.

Learning points

1. A medication error is defined as a preventable event related to medication which results in ‘a failure in the treatment process that leads to, or has the potential to lead to, harm to the patient’ and remains one of the most common causes of harm to patients.
2. In the UK, one third of medication errors occurring in general medical practices related to prescribing errors. Many of these were the result of poor communication, particularly with regard to the prescription of antibiotics to which patients are known to be allergic.
3. Health professionals who administer medication can provide a safeguard against errors made at any of the previous stages and are thought to intercept around 86% of errors made by prescribers or pharmacists.