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Following the Patient Rights of Medication Administration: Are These Enough to Guarantee Patient Safety?

Donna Felber Neff, PhD, RN, Assistant Professor

UF College of Nursing

According to the Institute of Medicine of the National Academies, the most common medical errors are medication errors and annually account for injuries to approximately 1.5 million Individuals. Additionally, hospital medical costs related to medication injuries exceed $17 billion a year and in outpatient settings, costs surpass 880 million dollars annually. Because of these astounding numbers, prevention of medication errors is the number one priority of the Joint Commission National Patient Safety Goals. Why do Medication Errors Occur? One third of a nurse’s time is spent administrating medications to patient in the hospital setting. However, the nurse is not alone in this process: It involves multiple individuals and disciplines including the hospital system, physicians and pharmacists. Because medication administration is complex, there is great potential for error. Medication errors may occur in multiple medication administration processes including: prescribing, documenting, transcribing, dispensing, administering, and monitoring. In a study of adverse drug events, Bates et al. (1995) found that the largest percentage of medication errors (48%) occurred through ordering or prescribing of the wrong drug, dosage, or route. Overall, nurses caught and prevented 58% of all medication errors. (See Table 1)

Additional causes of medication errors include; communication difficulties such as illegible handwriting, vague instructions, incomplete prescription order; inadequate patient information; patient’s compromised health status (co-morbidities); failure to conduct the necessary laboratory follow-up testing to monitor treatment effects; administering intravenous medications too rapidly; inaccurate dosing due to crushing, splitting or discontinuing a medication etc. (Hughes & Ortiz, 2005). Specific to nurses, knowledge and performance deficits may result in medication administration errors. Performance deficits related to fatigue due to long hours and understaffing, interruptions by patient call bells and other providers, and complex technology are all potential sources of medication errors (Cohen, 1997). The list of possible root causes of medication errors is endless. Medication Error Prevention The most logical step to reducing medication errors is to have hospital system safety nets in place to prevent errors from ever reaching patients. However, nurses play a key role in the first line of defense in this process. According to Pepper (2006), there are 2 important nursing roles to prevent medication errors: 1) check the medication order chain to assure that other healthcare providers have not made errors, 2) prevent their own medication errors. In addition, following the “10 Patient Rights” of Medication Administration listed in Table 2 can prevent errors. These rights are more comprehensive than the “5 Rights” nurses may have learned in nursing school. This checklist addresses key strategies to intercept and prevent possible errors. Table 3 lists additional specific strategies useful to nurses at the bedside to reduce medication errors.

Table 3. Medication Error Risk Reduction Strategies for the Nurse (Chilton, 2006) Conclusion: Medication administration is a complex process that involves interactions between diverse health care providers. Transparent health care systems, timely reporting of errors by providers and a shared dialogue will lead to system changes and improved performances and possible solutions to reduce and prevent medication errors. References Bates, D., Cullen, D., Cooper, J., et al. (1995). Systems analysis of adverse drug events. JAMA, 274, 1599-1603. Chilton, L.L. (2006). Medication error prevention for healthcare providers. Program and abstracts of the National Conference of Gerontological Nurse Practitioners 25th Annual Conference; September 27-October 1, 2006; Jacksonville, Florida. Cohen, M.R. (1997). Learning from medication errors. Nursing. Retrieved, September 22, 2008 at http://findarticles.com/p/articles/mi_qa3689/is_199710/ ai_n8774770?tag=rbxcra.2.a.4 Hughes, R.G., & Ortiz, E. (2005). Medication errors: Why they happen, and how they can be prevented. American Journal of Nursing, 105, 14-24.