What Are Medication Errors?
The medication administration error definition is a preventable event due to the inappropriate use of medication. If a medication error could harm the patient, it will be labelled a preventable adverse drug event. If a medication occurred but did not cause harm to anyone, then it will be defined as a potential adverse drug event.
Examples of medication errors in care homes or nursing homes include not recording the resident’s last dose of medication, and then another nurse double-dosing a patient due to the lack of information. Or, a resident taking an over-the-counter product that contradicts their current medication. Dangerous drug interactions or patients missing or taking too many doses can be serious and potentially life-threatening.
Causes of medication errors in Care Homes
There are many reasons medication errors in nursing homes and care homes occur. There are often human factors that contribute to medication errors, such as poor communication between doctors, nursing and care staff, drug names that sound alike, medications that look similar and medical abbreviations. The main types of medication errors include:
- Dose errors – e.g. an inappropriate dose
- Route error – e.g. route not specified or inappropriate route
- Formulation error – e.g. formulation omitted
- Frequency error – e.g. frequency omitted
- Strength error – e.g. inappropriate strength
- Administration error – e.g. carelessness, confusion or neglect
- Substitution error – e.g. wrong drug given
10 Strategies to Reduce Medication Errors
All nurses working in care should become familiar with a variety of strategies to prevent and avoid the likelihood of medication errors occurring. So, here are 10 strategies to reduce medication errors in nursing homes and care homes.
1. Ensure the 5 R’s of Medication Are Being Followed
The 5 R’s of medication, also known as the 5 rights of medication, is a system that can reduce medication administration errors in care homes. They help to ensure nurses consider the key aspects of medicine safety which can prevent medication errors from occurring. The 5 R’s are:
- The right drug – make sure the actual name of the medication is checked rather than the brand name and that medication is reviewed regularly.
- The right dose – double-check the dose on the prescription and confirm the accuracy with local or BNF Guidelines
- The right route – check that the drugs are being administered in the correct order and in the correct way.
- The right time – the frequency and the best time to give someone their medication (e.g. before bed or after a meal) should always be reviewed.
- The right person – ensure the right person is being medicated by asking them to identify themselves rather than telling them their name.
2. Follow Proper Medication Reconciliation Procedures
When people are transferred between homes or facilities, mechanisms for medication reconciliation should be in place. Medication must be reviewed and verified, following the 5 R’s rule listed above. Nurses should then confirm this information against the medication administration record (MAR).
In some cases, it may be difficult to verify all the elements of a medication record, but they must be compared against every possible source. Various facilities will offer several forms of medication reconciliation.
3. Thoroughly Check Procedures Regularly
Nurses on an incoming shift or the same shift must review all medication records to ensure that every person has had their treatment ordered, noted and transcribed correctly. This should be compared against the doctor's order, the MAR or the treatment administration record. Some nursing homes will have a chart flag process, which will highlight new orders that require verification.
4. Have Other Nurses Read Back Treatment
Working as a team is essential when it comes to reducing medication errors. By having another nurse read back treatment or an order to the prescribing physician, the chances of wrongly transcribed medication are greatly reduced. This process can also be used among nurses, as this can ensure that the MAR has been reviewed and is as accurate as possible.
5. Consider a Name Alert
Name alerts can be used to help prevent medication mix-ups for people with similar sounding names or even the same names. Without the right procedure in place, this can lead to confusion within the nursing staff. A name alert can be posted on the MAR, so when a file is reviewed, it will pop up that there is another person or people in the nursing home with the same or similar names.
6. Record Numbers Clearly
The wrong dosage is a common medication error seen in care and nursing homes. When numbers aren’t recorded clearly, it can lead to another nurse administering the wrong dose. To prevent these errors, you should write numbers clearly and place zeros in front of decimal points.
For example, a dosage of 0.50mg can easily be mistaken for 50mg without a zero in front of the decimal point. This could lead to a very serious outcome for the patient but can easily be avoided.
7. Document Everything You Do
You can reduce errors by documenting everything you do. This includes labelling medication correctly and the proper recording of medication administration. When there is a lack of documentation, it can lead to missed or double doses, as no documentation of the previous treatment exists. Reading the expiration date and prescription label of the medicine is also best practice.
8. Ensure Medication is Stored Properly
Every medicine will require a different method of storage. For example, some will need to be kept in cold temperatures, like in a fridge, whereas others can be stored in cool, dry conditions. Storing medication correctly will maintain efficacy. Most biological will need to be refrigerated and if multidose vials are used, they must be labelled to avoid use beyond the expiration date.
9. Learn Proper Medication Administration Guidelines
Learning the medication administration policies, regulations and guidelines are essential. Nurses must follow the medication policy in institutions and become familiar with the policy’s content. This is where education plays a part. Policies often contain crucial information about medication orders, prescriptions, documentation and administration.
10. Consider Using a Drug Guide
Whether it’s written or electronic, using any kind of drug guide is highly recommended and extremely effective at reducing medication errors. Both types provide important information when it comes to:
- Medication names (trade and generic)
- Drug interactions
- Dosing
- Side effects and adverse reactions
- Drug cautionary e.g. give with meals, don’t crush
Learning From Medication Errors
The risks associated with medication errors can threaten people’s lives, cause serious illness or have a significant impact on their quality of life. With errors in medication management increasing in care and nursing homes, the main risks and concerns lie with the managers and owners of these facilities.
However, it’s really important that your care home’s culture encourages learning from medication errors. This means instead of trying to understand who is to blame, you try to understand what caused the medication error to occur in the first place.
It is rare that medication errors will be due to a single person’s negligence. Professor Nicholas Barber was the main author of the Care Home Use of Medicine Study (CHUMS), which remains the most influential report into medication errors in care homes. Professor Barber is clear that improving medicines safety in care homes and nursing homes is a ‘systems issue’.
This means we have to look at the whole process of medicines management, where and how safety breaks down at each point in the medicines management chain, and how shortcomings in one part of that chain can lead to failure in another area.
Learning from medication errors, means understanding why an error occurred and taking steps to prevent errors recurring. It requires that you:
- document medication errors
- assess the causes of errors
- put an action plan in place to take steps to prevent different errors
- review whether those steps have had the desired effect, in improving medicines safety
Your next step in preventing medication errors
Reducing medication errors can be a daunting challenge but with the right approach, attitude and culture it is entirely achievable.
Learn more about why medication errors occur and the steps you can put in place to prevent the most common medication errors in care home and nursing homes in our free guide: Medication errors: Causes, Consequences, Solutions.
Digital systems such as medication management software can solve many of the systemic and informational issues that lead to errors in care and nursing homes.
If you’re interested in how medication management could help you, the residents and the staff in your care home, then look no further. Whether you specialise in home, residential or nursing care, you can discover how to embed medication management software into your care home with us.
We know how effective medication management can be and we desire to assist others, so they can experience the benefits of it too. Don't just take it from us, here are some quotes and stats from Erskine, who use the system:
To help residential care providers better understand the benefits of medication management software, we interviewed some leading operators of care homes and nursing homes to gain their perspectives on electronic medication management. Read their challenges and benefits, so you can better understand how it could help your care home or nursing home too.