Medication Errors

Question 1

What constitutes a medication error?

Answer 1

Any PREVENTABLE event that MAY CAUSE or lead to INAPPROPRIATE MEDICATION USE OR PATIENT HARM while the medication is in the control of the health care professional, patient, or consumer. Can be related to Professional practice, health care products, procedures, and systems, including prescribing; order communication; product labeling, packaging, and nomenclature; compounding; dispensing; distribution; administration; education; monitoring; and use.

Question 2

What are the types of medication errors?

Answer 2

Prescribing error, omission error, commission error, wrong time error, unauthorized drug error, improper dose error, wrong dose form, wrong drug preparation error, wrong administration technique error, deteriorated or expired drug error, monitoring error, compliance error, other medication error.

Question 3

The abbreviation for Units is?

Answer 3

U - commonly mistaken for zero; four; cc

Question 4

What methods can be used to reduce medication errors?

Answer 4

5 rights (right patient, right medication, right does, right time, right route), system of checks and balances

Question 5

What are the causes of medication errors?

Answer 5

Problems with labels or in drug packaging, LOOK-ALIKE OR SOUND-ALIKE NAMES, use of lettered or numbered prefixes and suffixes in drug names, equipment failure or malfunction, ILLEGIBLE HANDWRITING, improper transcription, INACCURATE DOSAGE CALUCULATION, INADEQUATELY TRAINED PERSONNEL.
Inappropriate ABBREVIATIONS used in prescribing, labeling errors, EXCESSIVE WORKLOAD, lapses in individual performance, medication unavailable.

Question 6

The abbreviation for Micrograms is?

Answer 6

(μ g) commonly mistaken for milligrams

Question 7

The abbreviation for every day is?

Answer 7

Q.D. commonly mistaken for QID(four times daily)

Question 8

The abbreviation for every other day is?

Answer 8

Q.O.D commonly mistaken for QD(daily) and QID(four times daily)

Question 9

The abbreviation for subcutaneous is?

Answer 9

SC or SQ commonly mistaken for SL(sublingual)

Question 10

The abbreviation for three times a week is?

Answer 10

TIW commonly mistaken for TID(three times a day) or twice a week

Question 11

The abbreviation for discharge or discontinue is?

Answer 11

D/C commonly mistaken prematurely discontinued medications

Question 12

The abbreviation for half strength is?

Answer 12

HS commonly mistaken for HS (hour of sleep)

Question 13

The abbreviation for cubic centimeters is?

Answer 13

cc commonly mistaken for U(units)

Question 14

The abbreviation for ears, both left and right, is?

Answer 14

AU, AS, AD commonly mistaken for OU (both eyes), OS (left eye), and OD (right eye)

Question 15

The abbreviation for international unit is?

Answer 15

IU commonly mistaken for IV(intravenous); 10(ten)

Question 16

The abbreviation for Morphine sulfate is?

Answer 16

MS commonly mistaken for magnesium sulfate (MS04 and MgSO4)

Question 17

Can error-prone abbreviations be used in print?

Answer 17

NOOOO!!! It may still be confused and may be copied into written orders. It also perpetuates the impression that they are acceptable.

Question 18

What are the 5 rights of medication administration?

Answer 18

Right patient
Right medication
Right dose
Right time
Right route

Question 19

How can a system of checks and balances be instituted?

Answer 19

Patient medication counseling
Reduced environmental barriers-workload, clutter, etc.
Separate look-alike, sound-alike drugs
Read the label 3 times (R3)
Use of electronic prescriptions/CPOE (computerized physician order entry)
Do not use single use dosage forms on multiple patients
Tall Man lettering for look-alike names

Question 20

What are the high-alert medications?

Answer 20

Parenteral chemotherapy
IV insulin
potassium chloride for injection concentrate
IV unfractionated heparin
epidural//intrathecal drugs
neuromuscular blocking agents
potassium phosphates injection
methotrexate
warfarin
narcotics

Question 21

Where do you report a medication error?

Answer 21

ISMP, FDA, Medical Event Reporting System for Transfusion Medicine (MERS-TM), MERP, The Joint Commission, USP’s MEDMARX Reporting System.

Question 22

Health care organizations should….

Answer 22

encourage thorough reporting of errors & near misses, develop systems & procedures to collect information, and analyze medications errors

Question 23

What are the barriers to not reporting?

Answer 23

blame for negative outcome, being considered incompetent, reprimand from supervisor, “telling” on someone else, patients developing negative attitudes, lawsuits, reporting that is not anonymous, displeasure with extra work to complete reporting, too busy to report, forget to report, disagreement on organization’s definition of an error.

Question 24

What information should be toted when reporting errors?

Answer 24

Patient Info (age, gender, weight), Event information (date of error, weekend, holiday, time, setting/location), Description of Event (free text, narrative entry, error perpetuation, error discovery, other relevant information), Patient outcome (select error category), Product Information (Name, strength, dose frequency, route, status, manufacturer, dosage form, packaging), Personnel involved, Type of error, Cause, Contributing factors (systems related).

Question 25

What categories are used for NCC MERP when no error occurs?

Answer 25

Category A - circumstances or events that have the capacity to cause error

Question 26

What categories are used for NCC MERP when an error but no harm occurs?

Answer 26

Category B, C, and D.

Question 27

What categories are used for NCC MERP when an error and harm occurs?

Answer 27

Category E, F, G, and H.

Question 28

What categories are used for NCC MERP when an error and death occurs?

Answer 28

Category I

Question 29

How can we develop a system and policies that will prevent errors?

Answer 29

Work with the medication safety team to develop a fail-safe for the future, advocate for error/near-miss reporting, practice safe-medicine through appropriate abbreviations, precautions, checks and balances.