Medication Errors: A Quick Review

Anything can go wrong at any time in health care. Busy caseloads, patients with more chronic illnesses, and staffing issues can sometimes distract even the most seasoned nurse on any given day. Medication errors and the adverse drug reactions caused by them are very real problems in many different clinical settings. An Institute of Medicine report concluded that medication errors account for nearly 7,000 deaths per year in long-term care alone. Many medication errors occur due to inadequate procedures which in turn create opportunities for mistakes to happen. Preventing errors involves designing and following procedures that limit the possibility of errors. Thankfully, most medication errors do not end in injury or death. The extensive use of medications in senior care, though, makes this population especially vulnerable.

Adverse Drug Events

The letters ADE stand for “Adverse Drug Events” and represent injuries related to medication errors. There are many types of drugs that are involved in ADEs, but typically they involve antipsychotics, antidepressants, sedatives, anticoagulants, anti-epileptics, cardiovascular, hypoglycemic, anti-infectives and analgesics.

Typical Outcomes of ADEs

While many adverse outcomes can occur due to medication errors, the following are commonly seen in long-term care. The outcomes range from mildly bothersome to severe and deadly.

• Change in mental status
• Allergic reaction
• Hypotension
• Nausea and/or vomiting
• Bleeding
• Diarrhea
• Arrhythmias
• Renal failure
• Respiratory failure
• Hypoglycemia
• Bowel obstruction

8 Categories of Medication Errors

The literature has identified eight different categories of medication errors. They are as follows:

• Unauthorized Drug
• Extra Dose
• Wrong Dose
• Omission of a Dose
• Wrong Route
• Wrong Form
• Wrong Techniques
• Wrong Time
• Wrong Preparation

As you can see, there are a number of ways to make medication errors. Unauthorized drug involves administering a medication without a physician’s order or giving the medication to the wrong resident. Extra dose and wrong dose are self-explanatory, as is omission of a dose. Wrong route can occur by putting drops in the left eye instead of the right. Wrong form may involve crushing a tablet prior to administration without an order. Making errors due to wrong techniques may involve failure to wash one’s hands or using unsanitary techniques. Wrong time involves failure to administer a medication within a predefined interval from its scheduled administration time. And, lastly, wrong preparation can involve incorrect dilution or crushing a medication that shouldn’t be crushed.

Final Words on Medication Errors

We need great nurses in long-term care. Most of the nurses I know are professional, clinically competent, and compassionate. They are good people. But, everyone makes mistakes. Some mistakes, though, are worse than others and medication errors can be deadly to seniors living in long-term care.

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