Our primary duty as nurses is to do no harm. But when harm does happen, it’s likely unintentional and preventable, as in the case of medication errors. Although there is a team of healthcare professionals involved in getting a patient’s medication into your hands, as the one giving the medication directly to the patient, all eyes are on you first if something goes wrong.
It’s a heavy responsibility. It can also be difficult when you are working at a facility for the first time and still figuring out new software, a new floor layout, and new patients. While you can’t be prepared for every situation, there are some preventative measures you can learn how to take, so you can be confident in knowing you’ve done everything you can to protect your patient.
There are many aspects of patient care that you can’t control during your shifts. But there are many skills you have developed and choices you can make at the start of every shift to help you identify when medication errors in nursing commonly happen and how to prevent them.
Plan Ahead to Use Your Time Wisely and Prioritize
Time is a valuable resource for nurses, and there are many shifts when sometimes it feels like you have no time at all. At the beginning of your shift, take the time to plan and prioritize your time. There are many best practices that you likely do already, but as a reminder:
- Check records: Look over your patients’ medical records at the start of your shift. Check diagnoses and prescriptions and see if there are medications you recognize as high priority.
- Know the software: Be sure you understand how to use the electronic medical record (EMR) or electronic medication administration record (eMAR). If you aren’t familiar with the system that the facility is using, take some time to learn.
- Plan your day: Have a plan for your day. Most software systems will let you sort medications by when they are due. If your facility uses the hour before, hour after policy, then that combined with the software will give you an idea of where you need to be and when.
- Adapt, as needed: Not all plans made at the beginning of a shift will stay the same throughout. Emergencies happen, or you may find that what you thought would work because it worked at another facility might not be the best strategy at this one. Be ready to change your strategy as needed.
- Use best practices: It may be tempting sometimes to pull medications for two patients at the same time, especially if you have worked at a facility before. But it can be so easy to misplace or mix up medications if an interruption happens. Always use best and safe practices.
It’s unfortunately normal to feel rushed many times during your day, but learning best practices to manage your time can help you give the confidence to prioritize and take the time you need to prevent errors.
Decide Now How to Handle Interruptions
Every nurse knows the feeling of a busy day when it seemed they couldn’t get anything done without being interrupted. Nurses are routinely interrupted during the medication administration process, and when you’re interrupted, the chance of making a mistake increases.
Whether you’re going to a facility for the first or tenth time, many sources of interruptions will be the same: patients, fellow coworkers, or not being familiar with the facility layout or software. If you find yourself routinely interrupted in the middle of pulling medication, decide what you will do before it happens:
- Put the medication back into its proper containers in the med cart or med room if it’s an emergency
- Or, preferably, finish pulling the medication and get it to where it needs to go.
Whatever you decide, remember that your responsibility is to do no harm. Leave your work where you can easily pick it up. If the interruption takes longer than you expected, you don’t want to come back to a cup with a bunch of unfamiliar pills and no idea what you’re missing.
Health care is constantly evolving. Medications that were once used specifically for one type of diagnosis are now routinely prescribed to treat completely different conditions.
As a result of all this change, you are responsible to make sure your knowledge and skills are up to date. Don’t let your learning stop. If you know what you’re doing, you can then teach your patients safe medication behaviors and prevent them from making medication errors after they leave your care.
If You See Something, Say Something
Many medication errors have been prevented or caught by a nurse paying attention. It might be an IV bag of insulin wrongly labeled as protonix by the pharmacy. Or it could be a doctor in her first year of residency forgetting to follow the department’s procedures and prescribe a preventative antibiotic for a new patient with symptoms of pneumonia.
In some facilities, depending on the speciality, the patients you care for will be taking the same medication they’ve been taking for years. At other facilities, new prescriptions are the norm. Whenever you look through the patient’s medical record, keep your attention open to details that stand out. If something seems missing or incorrect, speak up. If you have questions, ask a fellow nurse, or call the doctor or pharmacy to verify. As the last line of defense before a patient receives medication, you owe it to yourself and your patient to take the time to double check.
In the five rights of medication administration, the first right is very often listed as “the right patient.” Your patient is the most important person during medication administration. Without them, there would be no medications to give, and lasting and harmful effects from a medication error will affect them directly.
Who Is the Patient?
Imagine you are in a new facility where two (or more patients) share a room. You walk into a shared room with medication, having never met either of the patients and maybe having only seen them from their tiny photo next to their name in the eMAR. As you ask for the patient by name, one of the two comes up, grabs the medication from you because he thinks it’s his, and takes it before you can verify he’s the right patient.
While not a particularly common scenario, it’s safer for you and the patient if you introduce yourself first and verify a patient’s identity before bringing in any medication. Your patient may be gone from their room for a procedure or busy with family and not want to take their medication until later. The patient may be new to the facility and have a lot of questions you need to answer before bringing in medication.
It takes a few extra minutes that may add up, but knowing who your patient is so you can keep track of where they are can prevent losing medication or harming another patient and all the time spent afterwards trying to figure out what happened.
Why Are They Taking the Medication?
Although you don’t want to reduce a patient to just their diagnosis, knowing their medical history and why they are taking each medication can help catch mistakes before they happen. If a patient has a urinary tract infection but no antibiotics prescribed in the chart, then the attending doctor may have been in a hurry and forgot to order the prescription.
As a nurse, you act as your patient’s advocate. Knowing your patient’s diagnosis can help you identify any missing medications or wrongly prescribed ones before they do lasting damage.
Is the Patient Taking a New Medication?
When the medication arrives for the first time, verify that it is the right medication and labeled correctly. For any fast-acting drugs, like those given through IVs, keep a close watch on the patient for any reactions as per your facility’s procedures. The patient might have a common, recognized reaction to the medication. Or the pharmacy may have labeled the medication wrong, and the patient’s reactions are severe.
In the case of the bag of insulin labeled incorrectly as protonix by the pharmacy, the nurse followed every procedure correctly when she administered the medication. When she returned several minutes later for the first check on the patient, she found him catatonic with a blood glucose level nearing zero.
Fortunately, the patient was saved, but such a simple medication error could have ended in tragedy. As a nurse, be aware of the normal side effects you might see from medications so you can identify if any patient reactions to a new medication are unusual.
You may remember learning about hundreds of the most commonly used medications during nursing school, only to begin working in the field and realize how few you really knew. The third most important variable in preventing medication errors is knowing the ins and outs of the medication itself.
Look Up Every Medication You Don’t Know
If there’s one question most nurses get asked often, it’s a patient or a family member of the patient asking, “What’s that medication for?” For any medication on your list, you should have an answer to that question and the less common follow-up question, “How does it work?”
It’s almost a guarantee that you will come across new medications during your career that you’ve never heard of. Perhaps it’s a generic name for a well-known brand name or a completely new type of medication recently approved by the FDA for use.
In addition to looking up every medication you don’t know, look up any familiar medication being used in a way you haven’t seen used before. Over time, any medications initially approved for use for one health problem are now being routinely used to treat other problems. One recent example is spironolactone. That medication is still listed to treat high blood pressure as its primary function, but many doctors prescribe it to treat hormonal acne.
Have a Medication Reference Resource on Hand
Most of the time, you can find the basic information on each medication prescribed to a patient in the eMAR. Many facilities also keep medication reference books on hand in the med room. These books are great for looking up medications already well established for use in patient care.
For a more up-to-date option, look to your smartphone. If you absolutely cannot find the information you need elsewhere, verify with the nurse supervisor if you can use your phone as a medication reference resource. Popular apps like Epocrates and Medscape let you type in any medication name to pull up all the information you need. For each medication, the app will list dosage information, warnings, and monitoring requirements if necessary.
Many apps also include pictures of the front and back of the pill. Did a medication fall out of its container, or did a confused patient hand you a mysterious pill they found and ask what it’s for? The apps have a tool for that — take a picture of the pill or search for it by identifying features, like its color, shape, or markings.
Read Administration Information Carefully
Most of the five patient rights of administration have to do with the medication itself — is it the right dosage given at the right time through the right route? Many commonly used medications come in various forms, like lorazepam, which can be given as a pill or as a liquid through the mouth or through an injection. In a hurry, you may waste time looking for them in the wrong place or form or using the wrong route to administer them, like an oral medication through an IV.
Bring All the Equipment You Need
Some prescriptions need you to take certain monitoring parameters. If you’re using an eMAR, the software will normally ask you to enter a measurement before you can chart that you gave the medication.
Pay attention to what medications you are preparing and double check if there is a vital sign you need to take first. Before you take any medication to the patient, gather all the related equipment you need. If you forget and have to leave to get something, you risk being interrupted and delayed, or you may forget an important step.
However, if you must make several trips, plan them with patient safety in mind. If you need the vital sign reading before you know if you can give the patient the medication, and the patient has multiple medications scheduled at the same time, do the exam before preparing any medications. This minimizes the chance of accidentally giving the patient the medication with the rest.
Use the Right Supplies
In addition to monitoring equipment, double check that you’re using the right supplies. This goes back to reading the administration information carefully. Often, the medication is prepared in syringes by the pharmacy before it gets to you. Sometimes the pharmacy may not have the right syringe for the right route and may use substitutes. A nurse in a hurry and unfamiliar with a particular liquid medication may mistake an oral syringe for an IV syringe and give a patient something meant for the mouth through an IV line.
Don’t be the nurse to make that same mistake. If something feels wrong or you need to administer a medication in a syringe, take a moment to double check you are using the right supplies the right way. A little bit of time now might save you and your patients a lot of time trying to treat a preventable issue later.