Question

what are the strategies that can be used to prevent the medication errors of nurses in the emergency department?. You should then decide upon the best paradigm (Qualitative, Quantitative) to answer this question and the specific design that is most appropriate.

Answer 1

A 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.

It is important for all nurses to become familiar with various strategies to prevent or reduce the likelihood of medication errors. Here are some strategies to help you.

1. Ensure the five rights of medication administration.

Nurses must ensure that institutional policies related to medication transcription are followed. It isn’t adequate to transcribe the medication as prescribed, but to ensure the correct medication is prescribed for the correct patient, in the correct dosage, via the correct route, and timed correctly (also known as the five rights).

2. Double check—or even triple check—procedures.

This is a process whereby another nurse on the same shift or an incoming shift reviews all new orders to ensure each patient’s order is noted and transcribed correctly on the physician’s order and the medication administration record (MAR) or the treatment administration record. Some institutions have a chart flag process in place to highlight charts with new orders that require order verification.

3. Have the physician (or another nurse) read it back.

This is a process whereby a nurse reads back an order to the prescribing physician to ensure the ordered medication is transcribed correctly. This process can also be carried out from one nurse to the next whereby a nurse reads back an order transcribed to the physician’s order form to another nurse as the MAR is reviewed to ensure accuracy.

4. Consider using a name alert.

Some institutions use name alerts to prevent similar sounding patient names from potential medication mix up. Names such as Johnson and Johnston can lead to easy confusion on the part of nursing staff, so it is for this reason that name alerts posted in front of the MAR can prevent medication errors.

5. Place a zero in front of the decimal point.

A dosage of 0.25mg can easily be construed as 25mg without the zero in front of the decimal point, and this can result in an adverse outcome for a patient.

6. Document everything.

This includes proper medication labeling, legible documentation, or proper recording of administered medication. A lack of proper documentation for any medication can result in an error. For example, a nurse forgetting to document an as needed medication can result in another dosage being administered by another nurse since no documentation denoting previous administration exists. Reading the prescription label and expiration date of the medication is also another best practice. A correct medication can have an incorrect label or vice versa, and this can also lead to a med error.

7. Consider having a drug guide available at all times.

Whether it’s print or electronic is a matter of personal (or institutional) preference, but both are equally valuable in providing important information on most categories of medication, including: trade and generic names, therapeutic class, drug-to-drug interactions, dosing, nursing considerations, side effects/adverse reactions, and drug cautionaries such as “do not crush, or give with meals.”