Question

As a nurse practitioner, you prescribe medications for your patients. You make an error when prescribing medication to a 5-year-old patient. Rather than dosing him appropriately, you prescribe a dose suitable for an adult.

Answer 1

1) Ans )medication (a medicinal product) is ‘a product that contains a compound with proven biological effects, plus excipients or excipients only; it may also contain contaminants; the active compound is usually a drug or prodrug, but may be a cellular element’
Error:
An error is ‘something incorrectly done through ignorance or inadvertence; a mistake, e.g. in calculation, judgement, speech, writing, action, etc.’or ‘a failure to complete a planned action as intended, or the use of an incorrect plan of action to achieve a given aim’.

medication error

With these definitions in mind, a medication error can be defined as ‘a failure in the treatment process that leads to, or has the potential to lead to, harm to the patient.

Medication errors can occur in:

choosing a medicine—irrational, inappropriate, and ineffective prescribing, underprescribing and overprescribing;

writing the prescription—prescription errors, including illegibility;

manufacturing the formulation to be used—wrong strength, contaminants or adulterants, wrong or misleading packaging;

dispensing the formulation—wrong drug, wrong formulation, wrong label;

administering or taking the drug—wrong dose, wrong route, wrong frequency, wrong duration;

monitoring therapy—failing to alter therapy when required, erroneous alteration.

scenarios presented, prescription errors can have detrimental outcomes to all parties involved in the transaction. When a prescription error is made, the possibility of harm coming to the patient is something the practitioner must consider. Medical professional’s guide their practice around non-maleficence and a “do no harm” mentality. As such, disclosure to the patient should occur, not only as an ethical obligation, but also in an attempt to thwart any damage that could result, enhance patient trust and avoid lawsuit,and as an opportunity for process improvement

Knowledge-based errors (through lack of knowledge)communication problems with senior staff and difficulty in accessing appropriate drug-dosing information contributed to knowledge-based prescription errorsone achieves ‘balanced prescribing’, defined as the use of a medicine that is appropriate to the patient's condition and, within the limits created by the uncertainty that attends therapeutic decisions, in a dosage regimen that optimizes the balance of benefit to harmAvoiding medication errors is important in balanced prescribing, which is the use of a medicine that is appropriate to the patient's condition and, within the limits created by the uncertainty that attends therapeutic decisions, in a dosage regimen that optimizes the balance of benefit to harm. In balanced prescribing the mechanism of action of the drug should be married to the pathophysiology of the disease.

We all make errors from time to time. There are many sources of medication errors and different ways of avoiding them. However, we must start by being aware that error is possible and take steps to minimize the risks. The essential components of this are monitoring for and identifying errors, reporting them in a blame-free environment, analysis of their root causes, changing procedures according to the lessons learnt and further monitoring

Education, to be taken as often as possible (a repeat prescription—learning should be lifelong).

℞ Special study modules for graduates and undergraduates, to be taken as required.

℞ Proper assessment: in the final undergraduate examination, to be taken once or twice; in postgraduate appraisal, to be taken occasionally; this could be linked to a licence to prescribe.

℞ A national prescription form for hospitals, to be applied uniformly and used as a training tool.

℞ Guidelines and computerized prescribing systems, to be taken if indicated

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