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How to Avoid Medication Errors

From mistakes in prescribing to poor patient education, medication errors can negatively affect your patients’ health. Unfortunately, medication errors occur far more often than anyone would like — an estimated 1.5 million preventable adverse drug events happen each year in the United States.

Fortunately, the actions you take can greatly reduce the risk of medication errors. Read on to learn more about medication errors and some best practices on preventing them from ever happening.

What Are Medication Errors?

Medication errors are preventable events that occur when medication is used or given inappropriately. These errors can have serious consequences for patients. They could die or be placed into life-threatening reactions, need hospitalization, end up with permanent disabilities, or risk birth defects. 

A medication error doesn’t have to cause serious consequences to be counted as a medication error. Even if nothing negative happens as a result of the error, it’s still considered a medication error, but what you call it in an incident report might use different terms.

On one hand, errors that cause harm are referred to as preventable adverse drug events. Meanwhile, those errors that don’t cause harm are called potential adverse drug events.

Examples of Medication Errors

One example of a medication error is when a patient takes an over-the-counter product that has a certain ingredient while at the same time taking a prescription medication with the same ingredient. 

If this type of double-dosage goes unnoticed, it could lead to the patient taking more than the recommended dose of that drug and putting them at risk for associated adverse effects.

Other examples of medication errors include the patient receiving the wrong dosage or prescription or taking a drug that interacts negatively with an existing prescription.

How Do Medication Errors Happen?

Medication errors can happen to anyone. Children especially are at high risk for being affected by medication errors, as their dosage requirements typically differ from adult dosages. 

The most common causes of medication errors are:

  • Miscommunications between health care workers. If team members don’t communicate with one another regarding a patient’s medication, including drug interactions and changes to prescription, there’s a much higher risk for an error to occur.
  • Miscommunications between doctors and their patients. Patients who don’t receive proper education about a specific drug and its side effects or potential interactions may take the medication inappropriately. Similarly, if patients don’t disclose certain conditions or existing prescriptions, it could lead to a health care professional prescribing the wrong or unnecessary medication.
  • Medical abbreviations aren’t read correctly. There are countless medical abbreviations that can mean different things in different specialties or can easily be misread. Additionally, patients who don’t work in the medical field are unlikely to know what these abbreviations mean. Confusion of abbreviations can lead to confusion in appropriate medication prescribing.
  • Similar-sounding drug names. Medications can often be confused with each other if they look or sound similar, even if they serve completely different functions. In these cases, not only does this mean the patient’s underlying condition isn’t being treated, but the incorrect prescription can have a negative impact. 

Ways to Prevent Medication Errors

There are many actionable steps you can take to reduce the risk of medication errors. Here are a few strategies to practice.

Record Patient Information

Having accurate, up-to-date patient information is the top priority in medication safety. Using patient-specific identifiers, such as name and date of birth, can prevent medication from being given to a different patient with a similar name.

You should also ensure you have an accurate medical history for each patient. Ask about any allergies or reactions to medications, latex, or food before administering medication. Highlight any diagnoses and conditions that impact medication requirements. These include a medical history of diabetes, kidney or liver disease, mental illnesses, pregnancy, and smoking status or alcohol consumption.

When recording patient information, use full names instead of abbreviations to prevent misunderstandings between health care professionals.

Keep Up With Drug Information

About 35% of preventable adverse drug effects were caused by insufficient drug information, like outdated or limited references. The medical field can change quickly, and health care professionals and their organizations have to prioritize keeping up with the most current knowledge.

However, memorizing information on tens of thousands of available medications isn’t a feasible task. With that in mind, health care professionals should have easy access to current drug information and support resources, including guidelines that outline correct dosages, contraindications, and other precautions. 

“High-alert” medications, or those that can cause serious adverse effects if used incorrectly, should also be identified and reviewed before prescribing. Many electronic medication records have tools to identify these high-alert medications and other issues, like drug interactions, and it’s important to follow up on prompts from the software every time they appear. 

Communicate With Staff

Effective communication between health care professionals is one of the easiest ways to reduce the occurrence of medication errors. Staff members should monitor new prescriptions, medical records, or drug deliveries for any potential errors and act on them accordingly. Not only is it important for them to act, but they should share information with other team members regularly. 

Another way to quickly reduce errors is to require medication orders to be read back and confirmed immediately, spelling out the drug name as well as the dosage strength.

Handwritten prescriptions should be written clearly, with full names rather than abbreviations, to avoid any potential misreading. Including the indication type can also prevent professionals from accidentally administering a drug with a similar name. Electronic systems can be an effective workaround for handwriting miscommunications.

Label and Store Correctly

Any drug storage area should be well-organized and checked on a regular basis with any expired drugs being appropriately discarded. The storage area should be maintained between 57- and 84-degrees Fahrenheit with good lighting and visibility to prevent staff from misreading labels.

Drugs that look alike or have similar names and different injectable products should be kept apart from each other to prevent inadvertent mix-ups. High-alert medications should also be kept separately from other drugs and labeled appropriately.

Finally, medications should all have controlled access as well as rigorous documentation protocols. Dispensed medications and vaccines should be properly labeled, dated, and logged with all pertinent information.

Educate Patients

Providing appropriate education can help patients better understand their medications and potential interactions, reducing the risk of preventable errors. Take as much time as necessary to provide medication counseling, keeping in mind each patient’s health literacy.

You should give patients both oral and written instructions on how to use their medications. They or their caregivers should be able to repeat back the information. 

Providers should also ensure that patients are able to pay for their medication. A lack of insurance or high co-pays may prevent necessary prescriptions from being filled or refilled. In this case, you should work with your patient to develop a plan that they can carry through while still protecting their health.

There are many ways that medication errors can happen and just as many ways to prevent them. By keeping a conscious eye on issues before or as they happen, you can help to reduce medication errors for your patients and help fellow health care professionals do the same. 

Michelle Paul

Michelle Paul is an RN Content Specialist at Clipboard Health. She has worked with a variety of patient demographics, ranging from young adults in foreign countries, to elderly residents in skilled nursing facilities, to healthy blood donors in her community. Her experience in content creation gives her a unique perspective on communication within the healthcare field.

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