Apr 23 2004
Some 7,000 U.S. hospital patients die each year and more than 750,000 are injured as a result of medication mistakes. These errors have many causes, and many potential solutions, according to a Rutgers-Camden
nursing scholar who has studied the topic extensively.
“It’s a major problem. What we’re seeing is just the tip of the iceberg,” says Kathleen Ashton, a clinical associate professor of nursing at Rutgers-Camden, who adds that many more medication errors are never reported, and some aren’t even detected.
“I don’t think enough is being done about it. We need to look at the entire system and redesign it to make errors unlikely,” she says.
For an article published in Nursing Leadership Forum, Ashton and co-author Patricia Iyer examined the existing research on medication errors in hospitals, such as giving the wrong medicine or incorrect dose. They found that such mistakes occur due to a combination of flaws in the healthcare system and human error.
Such causes of drug errors include:
- Poor communication, including verbal and written misunderstandings between doctors, pharmacists, nurses and other hospital staff;
- Confusion over the 17,000-plus medicines available in North America, including drug names that sound or look alike;
- Inadequate labeling, including similar or misleading container labels;
Human factors, such as sleep deprivation, distractions, lack of knowledge, or poor performance by hospital personnel.
Other system factors that contribute to errors include bad lighting, lack of an effective double-check system for high-risk drugs, and poorly designed medical devices (such as intravenous –- or IV -- pumps that allow an unlimited flow of fluids into the body), according to studies that Ashton reviewed.
“The act of giving a medication isn’t a simple technique, but a complex series of actions,” says Ashton, who also is a nursing administrator at Cooper University Hospital in Camden. “It requires a series of judgments: assessing the patient, evaluating the drug’s effects, communicating with the patient, careful documentation… It’s a very high responsibility.”
Many studies reveal potential ways to reduce the frequency of medication errors, according to Ashton’s article. For example, in some hospitals, doctors enter drug orders directly into a computer system, reducing mistakes due to illegible handwriting.
Computers are also being used to bar-code medications, as well as patient and nurse wristbands, which helps ensure that the right drug is being given to the right patient at the right time.
Nurses play an especially vital role, says Ashton.
“The nurse is the last person to give the patient the medication, so they’re the last hope of keeping the patient safe,” she notes. “Nurses shouldn’t assume that the physician has prescribed correctly or that the pharmacy has fulfilled correctly. The nurse must play ‘cop’ at the end.”
Some specific recommendations for nursing units include:
- Keep up-to-date drug reference books on nurses’ medication carts, for easy checking;
- Have clinical pharmacists meet regularly with patients and nurses – an activity that has been shown to dramatically reduce errors;
- Encourage nurses to question and double-check the appropriateness of drug orders;
- Require nurses to carefully check the patient’s ID band and the drug label before giving a medication;
- Encourage nurses and others to report medication errors by eliminating punishment for errors and providing incentives for reporting.
Reporting of all medication errors is essential in order to improve safety, notes Ashton, who has co-written a curriculum on drug safety for hospitals.
“We have to be able to identify the problems before we can fix them,” says the Rutgers-Camden educator. “Medical errors occur because we’re all human. We should look at making the system as safe as it can be.”