by Spalding, Katrina
Medication errors have become an increasing problem in the hospital setting. It is estimated that medication errors also known as "adverse drug events (ADE) increase the cost of hospitalization by $ 2,200 to $ 3,200 per stay and prolong stays by 2 days on average" (Manno, 2006). Complications of medication errors range from mild discomfort to death. "Medication errors are the eighth leading cause of death in the US" (Banning, 2006). 
Causes of medication errors are varied, ranging from inappropriate orders to failure of the nurse to follow the five rights of medication administration. Many people believe that medication errors are a direct result of poor nursing. However, they "are usually the consequence of breakdown in a system of care" (Mayo & Duncan, 2004). Many facilities rely on nurses to discover potential errors and bring them to the attention of the appropriate person prior to the error occurring. There are several factors that can increase the incidence of medication errors (1) illegibly written orders, (2) dispensing errors, (3) calculation errors, (4) monitoring errors, and (5) administration errors (Mayo & Duncan, 2004).
Because an error can occur at any of the above stages, it is important for physicians to write or print their orders legibly and for the dispensing pharmacist and nurse to question and clarify any misleading, incomplete or illegible orders. Dosage calculations should be double checked by two nurses or another pharmacist, verification of a dose, rate or amount is not questioning the abilities or competencies of the dispensing or administering individual it is simply a way to further verify and protect the patient and staff involved.
Administration of medications by the nurse is the last chance for detection of a potential drug error. While preparing the medications for administration it is imperative the nurse utilizes the patient specific medication administration record and verifies drug name, dose and time. Nurses also need to be certain they are able to identify the drugs and "understand a drug's intended effect" prior to administration (Cohen, n.d.).
Utilization of the five rights of medication administration is required of nurses prior to drug administration and is a large part of the Institute for Healthcare Improvements 100,000 Lives initiative.
To help decrease the incidence of medication errors nurses need to step up to the plate, and realize the importance of this issue, following the five rights of medication administration is simply not enough. Nurses need to continually educate themselves and their peers as new medications are introduced. Reporting of medications errors as they occur needs to be encouraged regardless of the potential outcome to the nurse or patient, double and sometimes triple checking drug calculations must be done routinely to assure accuracy. Utilization of web based drug books, and medication information sites will give timely, accurate and current information. Verification of unclear orders needs to occur by the nurse or pharmacist, and including the patient in the medication administration process is another way nurses can help decrease the incidence of medication errors.
By being proactive, nurses and other health care workers can drastically decrease the number of medication errors, save thousands of dollars and thousands of lives.
For references please contact the AzNA office at 480.831.0404 or info@aznurse.org.
