chapter 5: Medication Error

Question 1

Which statement most clearly defines an error in drug administration?

Answer 1

Preventable event that leads to inappropriate drug use or patient harm

Question 2

A drug administration error occurred; after investigation, it was determined the error was category D. Which statement accurately describes the error?

Answer 2

An error occurred that resulted in the need for increased patient monitoring but no patient harm

Question 3

A nurse administers metoprolol 100 mg to a patient with hypertension but does not check the patient’s apical pulse before administration. The patient develops bradycardia, becomes dizzy with standing, and falls, resulting in a fractured lumbar vertebra. Which process of drug delivery does this involve?

Answer 3

Monitoring

Question 4

Drug administration errors can result from which factors in the process of drug administration?

Answer 4

Drug administration errors can result from which factors in the process of drug administration?

1.Human factors
Drug administration errors may result from human factors (e.g., poor equipment design).

2.Individual factors
Drug administration errors may result from individual factors (e.g., failure to adhere to the five-plus-five rights).

3.System-level factors
Drug administration errors may result from system-level failures such as understaffing.

Question 5

System-level failures leading to drug administration errors include which factors?

Answer 5

Heavy workload
Distractions
Fatigue

Question 6

Computerized health care provider order entry in place of handwritten orders is an example of which strategy for preventing errors in drug administration?

Answer 6

Transcribing

Question 7

Six RIGHTS for Nurses

Answer 7

• Right to a complete and clear order.
• Right to have the correct drug, route and dose dispensed.
• Right to have access to information.
• Right to have policies to guide safe drug administration.
• Right to stop, think, and be vigilant when administering drugs.

Question 8

Just Culture

Answer 8

Encourages health care personnel who make errors to report them.

Question 9

Culture of safety

Answer 9

Encourages everyone in the organization to keep patients free from harm

Question 10

Sentinel event

Answer 10

Unanticipated event that results in death or serious harm

Question 11

Root cause analysis

Answer 11

Identifies opportunities for learning

Question 12

A drug administration error occurred resulting in myocardial infarction; after investigation, it was determined the error was category H. Which statement accurately describes the error?

Answer 12

An error occurred that resulted in a near-death event.

“An error occurred that resulted in a near-death event” (e.g., anaphylaxis, cardiac arrest) is category H.

Question 13

A nurse listens to the patient’s lungs before administering albuterol for asthma control. The nurse notes wheezing on expiration. After drug administration, the nurse checks the electronic health record (EHR) to see what the patient’s lungs sounded like last shift before the administration of the drug. Nothing is noted. Which process of drug delivery does this involve?

Answer 13

Documenting

In this case, a documentation error occurred when the nurse on the previous shift failed to document pre-administration assessment.

Question 14

The nurse caring for a patient receiving cisplatin notes extravasation of the intravenous (IV) fluid when the patient reported IV site pain. Even though the antidote (sodium thiosulfate) to cisplatin was administered, the patient experienced extensive tissue necrosis around the insertion site and required multiple skin grafts. Which feelings might the nurse experience after the drug administration error?

Answer 14

Self Doubt
Suicide Ideation
Posttraumatic stress disorder (PTSD)

Question 15

The electronic health record indicates that a patient’s continuous infusion of heparin intravenously was to be stopped at 1000. At 1900, the nurse notices that the heparin is still running. Which type of error in drug administration is this?

Answer 15

Wrong dose

Question 16

After 10 hours on the job, a novice nurse struggles to program the intravenous (IV) pump; to avoid hanging the IV drug late, the nurse decides to let the drug run in by gravity, after calculating the drip rate then adjusting the roller clamp on the tubing. Which individual factors set the situation up for a drug error?

Answer 16

Long workdays
Difficulty using equipment
Clinical experience of the nurse

Question 17

The nurse draws up insulin into a syringe and calls across the nurses’ station for a coworker to double-check. The second nurse, who is charting, looks up from across the room and says, “It’s okay”; the first nurse notes the initials for the second nurse in the electronic health record (EHR). In this situation, which factor may contribute to an error in drug administration?

Answer 17

Human factors

Technology “work-arounds” (entering the second nurse’s initials into the EHR for them) fall under the heading of human factors.

Question 18

Which orders are written inappropriately according to the Joint Commission’s official “Do Not Use” list?

Answer 18

1. Digoxin .25 mg PO daily
2. Mirtazapine 15.0 mg PO every day at bedtime

Question 19

Which statement describes how drug errors are addressed in a system that operates according to principles associated with Just Culture?

Answer 19

Individuals are encouraged to report drug errors so that the system may be repaired.

Question 20

Issues Contributing to Errors

Answer 20

Errors can occur during any step of medication process
* Procuring
* Prescribing
* Transcribing
* Dispensing
* Administering
* Monitoring
* Organizational issues
* Educational system issues
* Sociologic factors
* Use of abbreviations

Question 21

Near Miss

Answer 21

• Event or situation that did not produce patient injury, but only because of chance
• Must still be reported so that safety issues can be addressed, and future incidents are prevented

Question 22

Types of Medication Errors

Answer 22

• No error, although circumstances or events occurred that could have led to an error
• Medication error that causes no harm
• Medication error that causes harm
• Medication error that results in death

Question 23

Strategies to Minimize Errors

Answer 23

• Awareness (“speak-up”)
• Computerized prescriber order entry (CPOE)
• Bar codes and scanning devices
• Automated dispensing machines
• Effective communication
• T.A.C.I.T.

Question 24

Preventing Medication Errors

Answer 24

• Prescribers must write legible orders that contain correct information
• Nurses need to always check the medication order three times before giving the drug.
• The Rights of medication administration should be used consistently
• Two patient identifiers
• Do not administer if you did not draw up or prepare yourself.
• Minimize verbal or telephone orders.
• Repeat order to prescriber.
• Spell drug name aloud.
• Speak slowly and clearly.
• List indication next to each order.
• Always verify new medication administration records.
• Read labels carefully.
• Use generic names to avoid sound-alike trade names.
• Always listen to and honor any concerns expressed by patients regarding medications.
• Check patient allergies and identification.
• Know where to find information on medications, preparation, side-effects; Use only current sources.
• Mandatory second nurse verifications for high-risk medications and/or patient
  population
• Minimize interruptions when preparing/delivering medications.

Question 25

Preventing Medication Errors
(continued)

Answer 25

• Never use a “trailing zero” with medication orders.
• Do not use 1.0 mg; use 1 mg.
• 1.0 mg could be misread as 10 mg, resulting in a 10-fold dose increase.
• Always use a “leading zero” for decimal dosages.
• Do not use .25 mg; use 0.25 mg.
• .25 mg may be misread as 25 mg

Question 26

Reporting Medication Errors

Answer 26

• Report to prescriber and nursing management.
• Document error per policy and procedure.
• Factual documentation only
• Medication administered
• Actual dose
• Observed changes in patient condition
• Prescriber notified and follow-up orders
• External reporting of errors
• United States Pharmacopeia Medication Errors Reporting Program
• MedWatch, sponsored by the Food and Drug Administration
• Institute for Safe Medication Practices
• The Joint Commission or other accreditation agencies

Question 27

Medication Reconciliation

Answer 27

The process of making sure the hospital’s list of a patient’s medications matches what the patient is actually taking.

Question 28

Computerized Provider Order Entry (CPOE)

Answer 28

Allows MDs to electronically enter and send treatment instructions for patients.

This includes medications, labs, radiology tests

Question 29

High Alert Medication

Answer 29

Drugs that can harm patient when used with error.