Reducing medication errors in nursing practice part 3

Errors and contributing factors

The types of errors that can occur are listed in Box 1 (Lassetter and Warnick 2003, McBride-Henry and Foureur 2006, Biron et al 2009). The two most common medication errors are (Barker et al 2002):

• Incorrect time of administration.
• Medication omission for no acceptable clinical reason.

Complete time out activity 1

A patient’s intravenous antibiotic is delayed by two hours because the patient was away from the ward undergoing an investigative procedure. Would this delay constitute a medication error? Discuss this with a colleague or describe strategies that could be employed to prevent such an occurrence.

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Box 1. Types of medication error

Wrong time of administration or delayed administration. Medication omission without acceptable clinical reason. Unauthorised medication administration. Wrong dose administered. Extra unauthorised dose administered. Medication administered via incorrect route. Medication administered at the incorrect rate. Medication administered in incompatible fluid or in conjunction with another incompatible medication. Medication calculation error. Medication administered to the incorrect patient. Allergy-related error. (Lassetter and Warnick 2003, McBride-Henry and Foureur 2006, Biron et al 2009)

Various studies have identified factors that contribute to medication errors; these are broadly classified as (Grandell-Niemi et al 2003, Greenfield 2007, Mrayyan et al 2007, Wright 2007):

• Patient.
• System.
• Personal factors.

Patient factors relate to the characteristics or attributes of patients that place them at risk of experiencing a medication error (World Health Organization (WHO) 2009a) (Box 2).

System and personal factors relate to institutional and individual practitioner characteristics that contribute to the relative risk of medication errors.

System factors include:

• The safety culture of an organisation.
• Management and leadership.
• Workplace communication.
• Workplace policies and procedures.

Examples:

• Addressing the educational needs of staff (including agency nurses).
• Having accessible, succinct step-by-step guidelines and protocols for the operation of equipment.

Personal factors include the (WHO 2009b):

• Cognitive ability and skill.
• Situational awareness.
• Decision-making ability.
• Personal resources (including responses to stress and fatigue) of individual practitioners.

The system approach, while acknowledging the individual practitioner’s role in, and responsibility for, errors, recognises that many medication errors could be prevented by greater attention being placed on the system and less on apportioning blame to individuals (Reason 1990, Biron et al 2009). Nurses, however, should continue to reflect critically on the potential for improving their own practice. The following sections will discuss the system and personal factors that may result in medication errors.

Box 2. Patient factors that increase the risk of medication errors

Multiple medication use: Complex disease process. Multiple medical problems. More than one prescribing doctor. Poor communication: Children and babies. Confused or unconscious state. Language difficulties. Passive involvement: Culturally determined passive relationship towards health professionals. Lack of interest in being informed about health and medications. Complicated drug calculation requirement: Titrated medications. Weight-based medications (children and babies). (World Health Organization 2009a)

Complete time out activity 2

Reflecting on your practice, can you remember a circumstance where any of the patient factors given in Box 2 could have contributed to a medication error? Consider the strategies that could be used to minimise the risk of an incident for each factor.

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Learning points

1. The most common medication errors are incorrect time of administration and medication omission for no acceptable clinical reason. The different factors that contribute to medication errors are patient, system and personal factors.
2. Patient factors relate to the characteristics or attributes of patients that place them at risk of experiencing a medication error. The different patient factors that increase the risk of medication errors are attributed to multiple medication use, poor communication, passive involvement and complicated drug calculation requirement.
3. The different system factors include the safety culture of an organisation, management and leadership, workplace communication and workplace policies and procedures while the personal factors include cognitive ability and skill, situational awareness, decision-making ability and personal resources.
4. Patient factors that increase the risk of medication errors are multiple medication use (complex disease process, multiple medical problems, more than one prescribing doctor); poor communication (children and infants, confused or unconscious state, language difficulties); passive involvement (culturally-determined passive relationship towards health professionals, lack of interest in being informed about health and medications); complicated drug calculation requirement (titrated medications, weight-based medications).