Running Head: A DISCUSSION CONCERNING MEDICATION ERRORS 1

A Discussion Concerning Medication Errors

Ramsey Valdes

University of South Florida

A DISCUSSION CONCERNING MEDICATION ERRORS 2

A Discussion Concerning Medication Errors

A medication error is considered a preventable instance in which a medication was not

administered appropriately to a patient leading to possible harm, injury, or even death. It was

estimated by the Institute of Medicine that 1 in every 854 inpatient deaths can be linked to a

medication error (Wittich, Burke, & Lanier, 2014). Due to the high possibility of patient injury

and because nurses strive above all for patient safety, it is imperative that they recognize types of

medication errors, and ways to avoid administration errors.

Medication Error Factors

A medication error can be made at any time during the process of prescribing and

administering a medication and is influenced by the type of medication, the individual patient,

and healthcare professional communication (Wittich, Burke, & Lanier, 2014). Because so many

factors influence the medication process there are many different types of medication errors.

One type of error is giving medications to the wrong patient. The wrong patient medication error

occurs during the administration process, and is influenced mostly by the healthcare professional

(the nurse). It is the nurses job to critically evaluate and check that she/he is administering the

drugs to the correct patient. This error often occurs because the nurse is not paying critical

attention to what she/he is doing, or she/he did not verify the patient’s identity, allergies, and

discuss the medications with the patient before administration. Wrong patient is a particularly

negligent error as each patient will be on medications for their specific illness and body, and no

two patients will have the exact same regimen or side effects, leading to increased possible

adverse reactions.

Nursing Intervention
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Nurses are equipped with many tools and interventions to avoid medication error and

increase patient safety. One tool nurses are taught to avoid errors is called the triple check; the

nurse is to verify the drug, dose, and correct patient against the medical record three times before

handing the medication to the patient to take. Triple checking decreases the possibility that the

nurse will give the patient the incorrect medication. This specific intervention will significantly

decrease the possibility that a nurse will make a wrong patient medication error as discussed.

Another tool nurses are taught is to know the patients five rights of medication (right drug, dose,

time, patient, and documentation) in order to know how the medication should be correctly given

and to keep the patients safety on the forefront of the nurse’s mind. The final prevention tool for

the nurse to reduce medication error is to know his/her own rights of the process and having a

just culture (Jones & Treiber, 2018). A just culture is the concept of having accountability

without harsh punishment. This means that nurses are more apt to report errors and the patient’s

likelihood of harm decreases. Other items that might be employed by the hospital to avoid

medication errors include bar scan systems and the pyxis dispensing machine. These machines

decrease errors as they verify medication throughout the process and notify the nurse of

discrepancies. If a nurse remembers to triple check, knows and informs the patients of their 5

rights of medication, and knows his/her own rights in a just culture there would be less

medication error.

Personal Discussion

An error that I am personally afraid of making is the wrong dose/drug error. I am most

afraid of this error because of the possibility of extreme adverse reactions such as anaphylactic

shock and possible toxicity as both of these can lead to death of the patient. As a nurse, it is my

responsibility to keep my patients safe from harm. Since this type of error is completely under
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my control, I would feel extreme guilt if my administration process causes harm or death to my

patient. I can prevent this medication error through my own knowledge. It is my responsibility

to triple check my medication, know its intended use, the safe dosage, side effects, possible

contraindications, and to understand why my patient is taking the medication. My knowledge

and critical thinking is the key to avoiding medication errors.

Summary

Medication errors, such as giving a medication to the wrong patient, are preventable. A

nurse should remember to triple check medication, know the patients 5 rights, and know her/his

own rights during the process of administration to avoid making errors. The nurse’s utmost

priority is the safety of her patient; therefore, it is imperative that she/he critically thinks about

the administration process and continues to build knowledge to be able to provide safe, effective

care.
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References

Jones, J. H., & Treiber, L. A. (2018). Nurses’ rights of medication administration: including

authority with accountability and responsibility. Nursing Forum. doi:10.1111/nuf.12252.

Wittich, C. M., Burkle, C. M., & Lanier, W. L. (2014). Medication errors: an overview for

clinicians. Mayo Clinic Proceedings, 89(8), 1116-1125.

doi:10.1016/j.mayocp.2014.05.007.