Monday, March 28, 2005

Avoiding Medication Errors in a Medical Office

Definition of a medication error:
Medication error is an avoidable mistake in the administration of a medication. The error can produce, or start the action of, harm to a patient whiles the medication. Medication errors are a common cause of malpractice claims against physicians. Factors that can play a role in medication errors are: not knowing about patients' allergies, other medicines they are taking, previous diagnoses, and lab results; poor handwriting on the part of the prescribing person, confusion between drugs similar names; misuse of zeroes and decimal points; using inappropriate abbreviations; interruptions when preparing medicines; unclear verbal orders; and failure to follow policies.

How medication errors can be avoided:
1. Always clarify an order if not readable, not a correct dosage, not a correct route.
2. Check the 5 rights of medication administration when administrating medication. Clarify orders if there is any question about the order; never assume it is correct just because a physician wrote the order.
3. Check with the formulary on alike or sound drugs.
4. Provide both the generic and brand name in communications of drug orders.
5. Write the purpose for the medication on the prescription.
6. Provide patients with documentation about their medications.
7. Write in block letters, using upper-case (not cursive).
8. Avoid use of abbreviations and Latin directions for use (e.g., q.i.d., b.i.d.), and instead write it out, e.g., four times a day, twice a day.
9. Use a leading zero if a number is less than one (0.1), and don't use a trailing zero after a decimal (5.0).
10. Prescriptions should include: date, drug name, dosage, route of administration, frequency of administration, and signature and professional designation of authorized prescriber.
11. PRN orders should indicate a specific time interval.
12. Orders written by medical students (including sub-interns) should be countersigned by an authorized prescriber.
13. Include all known patient allergies in admission and transfer orders. The designation "no known allergies" should be used as appropriate.
14. Use only approved abbreviations.
15. Follow institution approved medication protocols.
16. Medication orders sheets should have the patient's name and other identification such as patient ID #, date of birth.
17. Orders for medication should include: date and time ordered, drug name, dosage, route of administration, frequency of administration.
18. An existing order may not be corrected, altered added to, or modified in any way. If change is necessary, the order must be discontinued and a new order written by the authorized prescriber. When discontinuing a medication, the prescriber should write the name of the drug being discontinued and not an order number.
19. The registered nurse (RN) is responsible for checking orders transcribed by a non-RN for accuracy. The RN initials or countersigns the signature of the non-RN transcribing the order as part of the verification for accuracy.

Contributed with permission by author:
LEIGH ANN TOVAR, Nursing Student (LPN) Student: Basic Concepts of Pharmacology

1 comment:

Patricia Z said...

I like the idea that the DEA controls medications, but would be nice is an agency that could regulate all medications that a person takes, expecially the elderly. So much abuse is happening with the elderly. They are taking the wrong medication, they don't discuss with their various doctors what they are taking, etc. In our office (Cardiology), we make that patients bring in all their bottles of medication that are taking at each visit. We will not take a written list. We want to make sure that what that patient is taking is correct and to make sure that medications are not the same, etc. We have found a lot of patients not taking their medications correctly or are taking 2-3 medications that do the same thing.