MEDICATION ADMINISTRATION ERRORS

Medication Administration Errors

Medication Administration Errors

Introduction

Medication errors, broadly defined as any error in the prescribing, dispensing, or administration of a drug, irrespective of whether such errors lead to adverse consequences or not, are the single most preventable cause of patient harm. Medication errors may be classified according to the stage of the medication use cycle in which they occur (prescribing, dispensing, or administration) although a recent classification of medication error into mistakes, slips, or lapses has been proposed. Incidences of medication error rates vary widely, as a result of the variety of different study methods and definitions used.

The majority of medication errors occur as a result of poor prescribing and often involve relatively inexperienced medical staff, who are responsible for the majority of prescribing in hospital. Electronic prescribing may help reduce the risk of prescribing errors owing to illegible handwriting, although such systems can in turn lead to further problems such as incorrect drug selection, and their effect on patient outcomes requires further study. A multidisciplinary approach to solving the problem of medication errors is required which adopts an attitude of 'no blame', since incident reports have often been used as instruments of punishment, thereby creating a fear of discipline. This fear may be lessened by creating an open and safe environment for detecting and reporting medication errors. Current approaches to preventing medication errors are inadequate and require a shift in emphasis to a scientific investigation of preventable patient harm.

Background

The multiple steps in the medication chain, from when a drug is prescribed to when a patient receives the drug, leads to significant scope for error. However, significant improvements can be achieved from the prevention of medication errors, in terms of reduced patient morbidity, length of hospital stay, and healthcare costs. A classification system based on a psychological approach has been proposed which allows one to identify broad categories of error, quantify them, and develop an intervention to prevent them. This classification system divides errors into mistakes, slips, or lapses (see Figure 2). Mistakes may be defined as errors in the planning of an action and may be knowledge-based (e.g. giving a medication without having established whether the patient is allergic to that medication) or rule-based. Rulebased errors can further be classified as either the misapplication of a good rule (e.g. injecting a medication into the non-preferred site) or the application of a bad rule or the failure to apply a good rule (e.g. using excessive doses of a drug). Slips and lapses are errors in the performance of an action - a slip through an erroneous performance (e.g. writing the more familiar 'chlorpropramide' instead of 'chlorpromazine') and a lapse through an erroneous memory (giving a drug that a patient is already known to be allergic to). Technical errors are the result of a failure of a particular skill (e.g. in the insertion of a cannula) and are therefore a subset of slips (skill-based errors). Medication errors may also be classified according to where they occur in the medication ...