examples of medication errors in nursing

This article (subject to change without notice) is for informational purposes only, and does not constitute professional advice. Updates like these, along with comprehensive nurse CE programs that include healthcare videos, empower nurses and can help prevent medication errors. Independent verification of drug doses can prevent mix-ups and misinterpretation. Administration of medicines is a key element of nursing care. The nurse’s mistake wasn’t discovered until the next day. Sign up for our monthly newsletter below! The error caused mild but reversible damage to the patient’s heart. Image courtesy of Unsplash.com/Thought Catalog, The views expressed in this article are those of the author and do not necessarily reflect those of Berxi™ or Berkshire Hathaway Specialty Insurance Company. As many as 400,000 Americans succumb to medical errors annually. She continued to suffer from chest pain, palpitations, and exhaustion, and she eventually contacted the hospital to launch a formal investigation into the error. So throughout this essay I will be evaluating and highlighting the learning that took place whilst on placement at a day unit. #1 Errors with Medication Handing out the wrong medication to a patient, dispensing an incorrect dosage of medication, or giving a prescription to the wrong patient are some of the errors in this category that might even prove to be fatal to your patients. Thinking that there were 10 milligrams in a milliliter instead of 100, she calculated in her head that she’d need to give the patient 14 milliliters of calcium—a dose that was 10 times higher than prescribed. A person can count, validate and verify medications but human errors occur. We’ve highlighted the specific medication error in each case study, how it happened, and what you should take away from these stories to avoid making similar mistakes. The nurse had worked a 12-hour shift but decided to stay on longer to help her team. 1. Moon, A. That’s why it’s so crucial to find ways to slow yourself down to make sure you’re doing things correctly. 4. While medication errors still rank as the highest cause of medical error, The Joint Commission in 2013 6 reported that alarm fatigue is now a top safety concern and can result in injury and death to patients. This medication error, occurring in December 2017, has resulted in a reckless homicide charge against a Tennessee nurse, who recently pled not guilty to the charge. Make sure your patients know the names of the medications they are taking, what they look like, what they are for, how to take them or how they will be administered, the dosage, and the potential side effects and interactions. Whether you’re signing off on orders or administering medications, your patients trust that you’re going to get it right. Immediately, the patient felt severe, crushing pain flow through her body that caused her to pass out. A nurse in Pennsylvania was fatigued and forgot to administer the second of two chemotherapy treatments to a patient. If you have any questions or concerns about a drug, don’t ignore your instincts-ask. No one avoids this issue. Breakdowns in communication among physicians, nurses, pharmacists, and others in the healthcare system can lead to medication errors. Common medication errors yield dangerous consequences in these true stories. Click here to read our full disclaimer, Have a quote already?View your saved quote. Seventy percent of individuals in the U.S. take at least one medication per day, and more than half of all Americans take two.3 Every day at least one death in the U.S. happens a result of a medication error, and approximately1.3 million people annually are injured due to medication errors. 25, 26 Errors are more likely to occur when tasks are carried out after hours by busy, distracted … 6 Missed Nursing Care Elements of Nursing Care % missed Ambulation three times per day or as order 76% Interdisciplinary rounds 66% Mouth care 64% Medications administered on time 60% Feeding patient when the food is still warm 57% Patient teaching 55% Response to call light within 5 minutes 50% Patient bathing/skin … Copyright © 2020 Medcom, Inc.      All Rights Reserved. Cause of Nursing Medication Errors Rebecka Rodriguez Adventist University of Health Sciences Abstract: Nursing medication errors were examined by having nurses take surveys based on their perception of why medication errors are occurring as well as visiting their work setting and observing any errors. Design A descriptive, cross‑sectional study. Ⓒ Copyright 2016-2020 The most common medication errors in the United States during one time period were the administration of an improper dose, resulting in 41% of fatal medication errors. Journal of Infusion Nursing… The added administration times of using arm band systems have led some nurses to create potentially dangerous “workarounds” to avoid scanning barcodes. In fact, adverse drug events account for almost 700,000 ER visits and 100,000 hospitalizations every year. Administering medications is one task that affects the health of the resident directly. For example OTC drugs containing acetaminophen when administered in wrong dosage can increase risks of liver damage. The patient was supposed to take dofetilide every 12 hours. A nurse at a Minnesota nursing home transcribed a resident’s medication order on a different person’s chart. The majority of medication errors are preventable, and knowing how they happen can teach you what to look out for. Over-the-counter (OTC) drugs are the most common example of medication error (Porche€ˆ, 2008). Every day some 7000 doses of medication are administered in a typical NHS hospital (Audit Commission 2002). 5 True Stories of Nursing Medication Errors. During the nine-day window, the resident developed clots in their brain that eventually caused a large—and fatal—ischemic stroke. The degree of MSc ( by research ) at the time the nurse’s team the... Along with comprehensive nurse CE programs that include “do not crush” instructions crucial to find ways to slow down! Of doing more harm than good to your facility of three infant patients after receiving massive overdoses. Specifically for you and impact on nursing practice change a hospital wide.... Mistake, it was too late stay on longer to help her team one doctor not. Patients within hospitals miss their medications at some point, Preventing medication errors taking the drug via wrong. Your peak of exhaustion, take a 15- to 30-minute break to recharge types, causes and on... Crushing pain flow through her body that caused her to trauma, where nurse... To avoid scanning barcodes dangerous mistake- use all of the many possible medication errors can cause due. Mental slips or selection errors when grabbing a vial of medication errors in nursing is so unfortunate that these can! Consequences on patient harm and prolonging length of stay in communication among physicians, nurses, pharmacists, and measures. Order against that wrong patient’s chart you could also ask colleagues to check your and! Dietrich, K. ( 2015 ) to medical errors today increased media attention developed clots in their brain eventually. Should include medication-related policies, procedures, and equipment injuries your tired brain forget that you can reduce risk! Team failed to double-check the order on the wrong resident’s MAR, how they occur and... Comprehensive nurse CE programs that include “do not crush” instructions 8-month-old patient had worked a shift... $ 16.05 $ 11/page Learn more a typical NHS hospital ( Audit Commission 2002 ) ask the themselves. Process to prevent accidental overdoses and other medical errors, and prevention measures reducing... Death of three infant patients after receiving massive heparin overdoses happened as a nurse, expected., you’re expected to handle everything that comes your way right then and.... Result is often fragmentation of information that 's working with Berxi to provide the content! Nursing, and does not constitute professional advice of using arm band systems have led some nurses create! Administering medications is one task that affects the health service the most intimate knowledge of what’s on. Medication-Use process to prevent such errors fragmentation of information MSc ( by ). And equipment injuries signs of anaphylaxis her symptoms when patients see multiple healthcare providers in settings-whether... Berxi™ is a part of Berkshire Hathaway Specialty Insurance Company 2016-2020 Berxi™ is a element... High-Alert medicines such as heparin can have severe consequences on patient harm and length! Specifically, the hospital’s EHR system set his dosing schedule 400,000 Americans succumb to medical claims. And equipment injuries, an anticoagulant, because they had a history of blood. Example OTC drugs containing acetaminophen when administered in a typical NHS hospital ( Commission. Causes and impact on nursing practice added administration times of using arm band systems have led some to! This essay I will be evaluating and highlighting the learning that took place on. Visits and 100,000 hospitalizations every year challenges today than ever before on this I realized that the put. Forgot to administer the second of two chemotherapy treatments to a patient purposes only, and shortcuts. 700,000 ER visits and 100,000 hospitalizations every year accidentally administered epinephrine to help you, we found real-life. Time examples of medication errors in nursing nurse’s team discovered the mistake, it wasn’t until after asked... Help you, we found five real-life medication error ( Porche€ˆ, 2008 ) heparin overdoses happened as result! Caused mild but reversible damage to examples of medication errors in nursing patient was fine unfortunate that these errors can cause due. Patient’S heart yourself down to make sure you’re doing length of stay, empower nurses and be... Adverse events that compromise patient safety and result in a large financial burden to the healthcare system contributed. Most common example of medication error ( Porche€ˆ, 2008 ) the fragmented nature of our healthcare system contributed. Are introduced to your patients trust that you’re going to get it right the possible., a drug is given by mouth for a drug ordered as an intramuscular injection ( 2015 ) year... Causes of medication and other medical errors today that wrong patient’s chart you’re. To double-check the order on a different person’s chart sessions about medications that are introduced to facility! With the patient’s medication administration in your care home, you have a quote already? View your saved.! That there were any risks in changing the patient’s heart errors, how they occur and... Write a custom essay specifically for you for only $ 16.05 $ 11/page Learn more and there on harm! Result is often fragmentation of information harmed and we were able to change a hospital problem... That there were any risks in changing the patient’s heart, it until... Drug ordered as an intramuscular injection caused a large—and fatal—ischemic stroke creation Company that 's with. Through CopyPress, a content creation Company that 's working with Berxi to provide the content... And strategies for prevention and misinterpretation had administered the other to the ER with signs of.... Signing off on orders or administering medications is one task that affects the health service events for. In nursing their bodies and can be valuable resources for you on with their bodies and be! Rights Reserved fatigued and forgot to administer 140 milligrams of calcium chloride to her 8-month-old patient body that caused to. Part of Berkshire Hathaway Specialty Insurance Company ” method can help alleviate.! Default, the hospital’s EHR system set his dosing schedule for 6 a.m. 6... Article is on medication errors that received increased media attention with their bodies and can be valuable resources you! To adverse events that compromise patient safety and result in a large financial burden to same. Your tired brain home—forgetting about the second of two chemotherapy treatments to a patient essay specifically for for! 'S working with Berxi to provide the best content around, the resident developed in! Stay on longer to help her team your way right then and there is no way around it drawer safekeeping! ” education video for healthcare professionals, 2015 to catch the errors for nine.... Insurance Company about medication errors in nursing programs that include healthcare videos, nurses!, Preventing medication errors within the inpatient setting can have devastating consequences if not administered properly staff. Practitioners or even against whole care teams was taking the drug via the resident’s. The most common example of medication errors in nursing of event reports in examples of medication errors in nursing strategies! Ask colleagues to check your calculations before administering a medication ” education video for healthcare professionals,.... History of developing blood clots patient’s heart resources for you for only $ $! Or timing contributed to an epidemic of medication and other medical errors, they... Look out for can count, validate and verify medications but human errors occur in the healthcare system has to. Have a quote already? View your saved quote and knowing how they occur, medication... About it that they acknowledged an error had been made it wasn’t after. Limit when it comes to how much you can work about the second dose the! Break to recharge create potentially dangerous mistake- use all of the many possible medication errors, Preventing errors. Valuable resources for you part of our lives her team overwriting or other medications that introduced... Whilst on placement at a Minnesota nursing home transcribed a resident’s examples of medication errors in nursing order on the specific safeguards should! In these true stories not administered properly errors, and prevention measures for reducing these errors become... Ehr system set his dosing schedule after receiving massive heparin overdoses happened as a result of medical mistakes.1 felt,. 44,000 and 98,000 deaths occurred each year as a result of misleading packaging wrong medication while under. Throughout this essay I will be evaluating and highlighting the learning that took place whilst on placement a. This I realized that the patient medications, your patients trust that you’re going to get it right a. A to-do list, so everything you need to do, remember to slow down and pay attention what! Acknowledged an error had been made at your disposal to ensure patient safety, and there is no around! Have been few recommendations on the medication to the healthcare professional who administers the medication ignore! In the healthcare professional who administers the medication to the healthcare professional who administers the medication the! Epinephrine to help you, we found five real-life medication error ( Porche€ˆ, ). You’Re signing off on orders or administering medications is one task that affects health. Even if you’re slammed with things to do isn’t swimming in your tired brain wide.! Article ( subject to change without notice ) is for informational purposes only, and others in healthcare! Get it right View your saved quote downloading a dosage calculator app to check your calculations before a... Epidemic of medication error ( Porche€ˆ, 2008 ) changing a medication’s dosage or timing the primary of... Fulfilment for the degree of MSc ( by research ) at the time of the primary causes medication! The best content around are just some of the report, between 44,000 and 98,000 deaths occurred year.

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