Medication errors continue being a major cause forconcern among the nursing profession. While many efforts have been put forth toeradicate this preventable cause of patient harm, the incidence of medicationerrors still continues to climb. According to an article in American NurseToday (2015), “medication errors account for more than seven thousand deathsannually and each error cost anywhere from $2,000 to $8,750 dollars” (Anderson, & Townsend, p.18). This statistic is alarming and does not even consider the medicationerrors that go unreported. Doctors, nurses and pharmacist play a vital role in catchingand preventing these errors.
Along with research, I was able to have a face toface interview with Ademola Adekunle, PharmD, a pharmacist at Texas Health Resourcesin regard to preventing medication errors, our policy on reporting errors, andmethods to promote reporting. Preventing Medication ErrorsMultiple factors contribute to the cause of medication errors.Errors can occur at any stage of medication management, ranging fromprescription, preparation, and administration. For this reason, it is essential that everyoneinvolved in the medication cycle be aware of prevention methods used to reducethe occurrence of error. One critical tool in preventing medication errors, is usingthe five rights to medication administration and barcode scanning. These toolshelp make sure the right medication at the right time is going to the rightpatient. Ademola explained the benefits to computer ordering versus handwrittenorders. “Being able to obtain orders through the computer has help tremendouslyin reducing errors due to handwriting that is difficult to read” (Adekunle,personal communication, January 15, 2018).
According to a study held by Kumas,Madhwar, Pathak, & Saiki (2016), transcription related errors were 72.4 permonth and drastically dropped to 2.2 per month after applying the ComputerizedPhysician Order Entry (CPOE) tool (p. 1003).
Finally, Ademola and I talkedabout the significance of correctly labeling look alike medications to helpavoid confusion. MedicationError ReportingMostfacilities have a policy in regard to reporting medication errors. By reportingthese errors, mistakes can be explored and prevented in the future. Accordingto the World Health Organization (2014), “Although each event is unique, there are likely to be similaritiesand patterns in sources of risk which may otherwise go unnoticed if incidentsare not reported and analyzed” (p. 7).
The facility that I work for uses theReliability Learning Tool (RLT) in the case of reporting medication errors. TheRLT is an online detailed form describing the medication error. The form rangesfrom information on the nurse, patient, medication involved, equipmentinvolved, others present, and more. The tool has been proven to be very effectivewhen used.
Methodsto Encourage Reporting Medication Errors It is imperative that nurses are knowledgeable about theimportance of reporting both potential and actual medication errors. Reportingmedication errors was unintended to punish the error maker, but to help recognizemistakes and find ways to prevent future errors. “In order to increasereporting, it is essential nurses are supported during the reporting process” (Kavanagh, 2017, p. 162).
Ademolastated, “I feel like many staff do not use the RLT in fear of getting introuble for making the error and also because they are unaware of the purposeof the tool” (Adekunle, personal communication, January 15, 2018). Assistingstaff with more education on using the RLT and the purpose will help increasereporting. ConclusionInconclusion, it is vital that medication errors are identified and interventionsset in place to improve patient safety.
By using the Reliability Learning Toolto report medication errors, safety teams can identify was to improve andprevent future errors. Anyone involved in the management of a patient’smedication should use the various tools presented to help reduce error andimprove patient safety.