The statistics are enough to make patients and their loved ones cringe. On average, every hospitalized patient in the United States is subjected to one medication error every day. Every year, such medication errors contribute to some 7,000 patient deaths across the United States.
The number 1 cause of inpatient deaths? You guessed it: medication errors.
In addition to the harm they cause patients, medication errors hurt nurses, too. Nearly one-third of medication errors occur during medication administration—a routine nurse duty (the rest occur during prescribing, transcribing and dispensing of the drug). Medication errors can result in loss of a job, disciplinary action by the board of nursing and even legal charges. Then there’s the emotional toll. Caregivers, sometimes called the “second victims” of medical errors, can experience sleeping problems, anxiety, and even suicidal thoughts following a medical mistake. Many doubt their professional ability.
After dispensing 1,400mg of calcium chloride to a fragile baby who was supposed to receive just 140 mgs, a veteran nurse wrote: “I messed up…I was talking to someone while drawing it up. Miscalculated in my head the correct mls according to the mg/ml. First med error in 25 years of working here. I am simply sick about it. Will be more careful in the future.”
After losing her job and receiving highly-publicized sanctions from the state board of nursing, that nurse eventually committed suicide. The baby, too, died, although it is not known whether the medication error or her critical condition caused the death.
A host of factors can lead to medication errors: drugs with similar-sounding names and similar-looking packaging, poor communication among caregivers, miscalculations, and heavy workloads that keep nurses away from the bedside, just to name a few.
"Medication errors usually occur because of multiple, complex factors," says Carol Holquist, RPh, director of the division of medication error prevention and analysis in FDA's Center for Drug Evaluation and Research.
Nurses can adopt smart strategies, however, to reduce the likelihood of medication errors.
Following rules for medication administration may sound obvious, yet one-third of nurses admitted to sometimes bypassing established safety systems. Even more troubling is the fact that nurses most likely to do so worked in units with some of the most vulnerable patients: critical care and pediatrics. In critical care units alone, one in five medication errors are potentially life-threatening. Don’t endanger patients or yourself by skimping on safety. If you have an issue with a safety procedure, address it with management. Rules exist for a reason and should not be ignored.
Shift rotations and lengthy shifts take a toll on a nurse’s body and mind. Compared with nurses in their 20s, older nurses on 12-hour shift rotations in one study were less able to maintain their performance throughout the shift, according to an article in American Nurse Today. Studies suggest that staying awake for 17 hours is similar to having a blood-alcohol level of 0.05%. Going without sleep for 24 hours is like having a blood-alcohol level of 0.10%. Know your limits. Conscientious care necessitates being alert enough to intercept potential errors that happen before medication administration as well as avoiding administration errors yourself. At the end of a 16-hour shift, one nurse reportedly grabbed a vial of potassium chloride instead of furosemide. When she read the label aloud, she incorrectly read “furosemide” despite the label correctly stating “potassium chloride”—because her brain expected to read “furosemide.” She was simply too fatigued to see the difference.
Since administering medications is such a commonplace nursing duty, it is easy to overlook the potential weight it carries. But safe medication administration demands focus. One study found that each interruption experienced by a nurse during medication administration increased the risk of error by 12%. To avoid this, nurses at Virginia Mason Medical Center, Seattle, marked the area around their automated medication dispensing cabinet with red tape and posted a sign prohibiting conversation with nurses in the indicated zone. The move provides a visual reminder to colleagues, patients’ families and nurses, too, of the consistently high stakes of medication administration—and likely prevented mistakes with potentially disastrous consequences.