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Medication Errors

A medication error is any preventable event that may cause inappropriate medication use or patient harm. Common types of errors include prescription errors, transcription errors, non-compliance in drug administration, documentation errors, and dispensing errors. Factors leading to errors include human error, process deficiencies, human resource issues, information issues, and environmental issues. Various categories are used to classify the outcomes of medication errors based on the level of harm caused, ranging from circumstances that could cause an error to death. Prevention strategies include institutional policies, reconciliation procedures, double checks, documentation, proper storage, and administration guidelines.

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Jasper Victoria
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70 views

Medication Errors

A medication error is any preventable event that may cause inappropriate medication use or patient harm. Common types of errors include prescription errors, transcription errors, non-compliance in drug administration, documentation errors, and dispensing errors. Factors leading to errors include human error, process deficiencies, human resource issues, information issues, and environmental issues. Various categories are used to classify the outcomes of medication errors based on the level of harm caused, ranging from circumstances that could cause an error to death. Prevention strategies include institutional policies, reconciliation procedures, double checks, documentation, proper storage, and administration guidelines.

Uploaded by

Jasper Victoria
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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MEDICATION ERRORS

Prepared by, M. Jasper Victoria, 5th year, PharmD


DEFINITION:

A medication error is any preventable event that may cause


or lead to inappropriate medication use or patient harm
while the medication is in the control of the health care
professional, patient, or consumer.
Such events may be related to professional practice, health
care products, procedures, and systems, including
prescribing, order communication, product labeling,
packaging, and nomenclature, compounding, dispensing,
distribution, administration, education, monitoring, and use.
TYPES OF ERRORS:
1)PRESCRIPTION ERRORS:
•Drug allergies not identified
•Prescribed in illegible handwriting
•incomplete prescription

2)TRANSCRIPTION ERRORS:
•Wrong drug
•Wrong dose
•Wrong route
•Wrong frequency
•Missed transcription
3)NON-COMPLIANCE IN DRUG ADMINISTRATION:

• Wrong patient

• Wrong drug

• Wrong time

• Wrong dose

• Wrong route

• Wrong frequency

• Missed dose

• Expired drug
4) DOCUMENTATION ERROR:
• Documented before administration of drug
• No documentation

5)DRUG MONITORING ERROR:


• Insulin/conc.KCL/conscious sedation not monitored.

6)DISPENSING ERROR:
• Wrong drug dispensed from pharmacy
• Wrong dose dispensed from pharmacy
• Expired drug dispensed
FACTORS LEADING TO ERROR:

HUMAN ERROR:

• New nurse/new doctor

• Possible carelessness

PROCESS DEFICIENCY:

• Drug recieved late from pharmacy

• Expiry not checked by pharmacist/nurse

• Drug storage inappropriate

• Drug labeling inappropriate


HUMAN RESOURCE ISSUE:
• Training requirement
• Inadequate staffing
• Poor performance of staff not addressed

INFORMATION ISSUES:
• Clean written instructions not available in progress notes
• Improper handover given
• Verbal order not documented on file

ENVIRONMENTAL ISSUES:
• Improper working environment for nurse/junior doctor/pharmacist
CATEGORY OF OUTCOMES:

CATEGORY A: Circumstances or events that have the capacity to cause error.

CATEGORY B: An error that did not reach the individual.

CATEGORY C: An error that reached the individual, but did not cause harm.

CATEGORY D: An error that reached the individual and required monitoring or


intervention to confirm that it resulted in no harm to the patient.

CATEGORY E: Temporary harm to the individual and required intervention.


CATEGORY F: Temporary harm to the individual and required initial
hospitalization.

CATEGORY G: Permanent harm to the individual.

CATEGORY H: Intervention required to sustain life.

CATEGORY I: Death of individual.


PREVENTION OF ERRORS:

• Institutional policies concerning medication safety

• Medication-Reconciliation Procedures

• Double-Check Procedures

• Read Back to Another Professional

• Name Alert

• Documentation

• Proper Medication Storage

• Medication-Administration Policies and Guidelines

• Medication Resources
THANK YOU

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