Lecture By Sr.Rahima M salendab NQMC,,MGH Madina

1. RAHIMA M . SALENDAB
NQMC,MGH, MADINA

3. Causes for errors:
Too many telephone calls
Overload/ week ends
Too many Patients
Lack of concentration
No one available to double check
Staff shortage
Similar drug names
No time to counsel
Illegible prescription
Misinterpreted prescription

4. ADVERSE DRUG EVENT :
Any injury caused by the use (or non use) of a drug.
AN ERROR OF COMMISSION:
Is something that happen from administration of the
medication
for example : giving the wrong medication

5. An error of omission
occurs when
the administration process is not completed
for example: not administering an
ordered medication.

6. TYPE OF MEDICATION ERROR
1. PRESCRIBING ERRORS .
2. OMISSION ERRORS.
3. WRONG TIME ERRORS.
4. UNAUTHORIZED DRUG ERRORS.
5. IMPROPER DRUG ERRORS .
6. WRONG DOSE FORM ERRORS.
7. WRONG DOSE PREPARATION ERRORS.
8. WRONG ADMINISTRATION TECHNIQUE ERRORS .
9. DETERIORATED DRUG ERRORS .
10.MONITORING ERRORS .
11.COMPLIANCE ERRORS .

7.  Occurs when prescriber orders drug for specific patient
drug
dose
dosage form
route of administration
length of therapy
number of doses
administration
drug concentration
inadequate or incorrect instructions for use
illegible handwriting

8.  Failure to administer an ordered dose
(not late dose).
 Omitted dose is not an error when:
cannot take anything by mouth (NPO).
providers are waiting for drug level results.
patient refuses.

9.  Standardized administration times
 Acceptable interval surrounding
scheduled time.
 Occasionally unavoidable:
patient is away care area for test.
medication is not available at time it is
due.

10.  Administration of medication to patient
without proper authorization by
prescriber.
 Medication for patient given to another
patient.
 Nurse gives medication without
prescriber order.
 Patients “share” prescriptions.

11.  Dose that is greater or less than prescribed
dose.
 Can occur when additional dose is
administered
Delay in documenting dose
Absence of documentation
 Inaccurate measurement of oral liquid
Exclusions from this error type

12.  Doses administered as different
form than ordered.

13.  Using bacterio static saline instead of
sterile water to reconstitute lyophilized
powder for injection.

14.  Examples:
Subcutaneous injection that is given
too deep
Intravenous (IV) drug is allowed to
infuse via gravity instead of using an IV
pump.
Instilling eye drops in wrong eye.

15.  Monitoring expiration dates is very
important.
 Refrigerated drugs stored at room
temperature may decompose & lose
efficacy.

16.  Inadequate drug therapy review.
 Examples:
Ordering serum drug levels but not
reviewing them.
 Not ordering drug levels when
required.
 Prescribing antihypertensive agent &
then failing to check blood pressure.

17.  Failure to adhere to prescribed drug
regimen.
Example:
Patient does not complete antibiotics
therapy-saves a few doses.

18.  Errors that cannot be placed into
category.
Examples:
 Medication dispensed without
adequate patient education.

20.  1. Human factors.
 2. Systems.
 3. Abbreviations.
 4. Oral orders.
 5. Look-alike and sound-alike drugs.
 6. Dosage calculation.
 7. At-risk drugs

21. Abbreviation Intended Misinterpretation
> and < Greater than Less than Often used the
Opposite
Μg Microgram Mistaken as mg
IU international Unit Mistaken as IV
qd, QD or QOD Every day or every Often confused for
other day each other
cc cubic centimeter Misread as ‘u’
Zero after decimal(1.0) 1 mg Misread as 10 mg
Zero not written before Half mg (0.5) Misread as 5 mg
decimal (.5mg)

22. Types of Verbal Order Errors
Wrong Drug
Clonidine misheard as Klonopin
Amiodarone misheard as amrinone
Wrong Dose
15 mg misheard as 50 mg
2 mg misheard as 20 mg
Wrong Labs
Blood glucose misheard as 257 instead of 157 patient
received 6 units of insulin instead of 2.

23. NURSING RESPONSIBILITIES
Only administer meds you have prepared.
Know the purpose and expected outcomes.
Do not leave meds at bedside.
Check ID band before administering.
Some meds need checking by another nurse.
Consult with supervisor or Dr if dosage is outside of
recommended range .
Do not administer medications calculated by someone
else except pharmacist .

24. STANDARD PRECAUTION
Wash hands before beginning medication
Wear gloves for parenteral injections
Wear gloves if helping put pills in mouth

25. LOOK ALIKE MEDICINE

27. SAMPLE OF ILLEGIBLE HAND WRITING

29. 7 RIGHTS OF MEDICATION
ADMINISTRATION
 RIGHTPATIENT
RIGHT DRUG
RIGHT DOSE
RIGHT ROUTE
RIGHT TIME
RIGHT FREQUENCY
RIGHT DOCUMENTATION

30. SOUND ALIKE
Folinic Acid Folic Acid
Amidaron Amlor
Zinnat Zantac
Concor Zocor
Tazocin Prazocin
Kafocid Keflex
Lasix Losec
Aldactone Aldomet
Ranitidine Loratidine
voltarin ventolin

31. HOW TO PREVENT MEDICATION
ERROR?????
When your doctor gives you a prescription, ask him or her to
tell you the name of the drug, the correct dosage, and what
the drug is used for. Be sure you understand the directions for
any medications you may be taking including the correct
dosage, storage requirements, and any special instructions.
Finally, never be hesitate to ask questions. If the name of the
drug on your prescription looks different than you expected, if
the directions appear different than you thought, or if the pills
or medication itself looks different, tell your doctor
or Pharmacist right away. Asking questions if you have any
suspicions at all is a free and easy way to ensure that you
don't become the victim of a medication error.

32. NO ONE CAN
MOTIVATE…. Just because you cannot
do it TODAY
IF YOU ARE NOT WILLING
TO DO YOUR SELF… Does NOT mean you will
not do it SOMEDAY
If you are not willing to learn, No
one can
help you.
If you are determined to learn, No
one can
stop you …!!