The Critical Role of Nurses in Avoiding Medication Errors

In May 2011, Dr. Pamela Brown, a Ph.D., RN nurse manager of a pediatric intensive care unit, gave a presentation on fatal medication errors at a conference for critical care nurses. The information she provided was timely and important and provides a great deal of insight into how medication errors occur. While we tend to think first of individual errors on the part of medical providers, system flaws can also play a part in medical negligence.

Medication errors are far more common than most people imagine. Commonly cited statistics are that 1.3 million people are injured and approximately 7,000 people die from medication errors each year in the U.S. It is estimated that as many as one in five doses of medication given in a hospital is in some way incorrect. It’s no wonder that medication errors often find their way into medical malpractice cases.

Until recently, the process of administering medication presented two opportunities for errors to be detected. If a doctor made an error when ordering a medication, a pharmacist or nurse might catch it. If a pharmacist made an error in filling the prescription, a nurse was the only person who could identify it. If a nurse made a mistake, the patient was affected.

Unfortunately, nurses do make errors. Their jobs are increasingly complex. With so many hospitals understaffing their nurses, those who are on duty are pulled in many directions, often working long hours. Given this working environment, it’s particularly important that hospitals create systems that safeguard against medication errors.

Dr. Brown talked about the five “rights” of medication administration:

• The right patient
• The right drug
• The right dose
• The right route (system of delivering the drug)
• The right time

Bar code medication administration is one such system. The nurse checks the bar code on the patient’s wrist to make sure he or she has the right patient. The nurse checks the bar code on the medication to ensure it matches the doctor’s prescription (right medication, route, dosage and time), administers the drug and then signs the medical record. This system is becoming more common in hospitals. Routines like this can ensure consistency and quality and can improve patient safety.

But Dr. Brown feels a few additional “rights” should be added – rights involving system administration. “Too often,” she said, “nurses ‘work around’ systems problems, thinking they are acting in the patient’s best interest, but in fact, a work-around increases the risk to patient safety.” Incorrect and incomplete orders being sent to the floor and long waits for delivery of medication mean nurses are rushing and possibly skipping steps along the way.

Hospital administration has an important role to play in creating a medical care system that minimizes the chances of injurious or even fatal medication errors.