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25 Most Common Medication Errors in Nursing + How to Prevent Them


Written By: Darby Faubion BSN, RN

Are you a nurse or nursing student interested in measures to promote patient safety and improve outcomes? One of the most significant things nurses can do to ensure patients are safe and the profession of nursing is protected is to be diligent with care and prevent errors. The U.S. Food and Drug Administration receives more than 100,000 reports annually related to medication errors. Each nurse has a responsibility to provide safe, effective care, including preventing medication errors.

Perhaps you have wondered, “What are the most common medication errors in nursing?” or asked yourself how to safeguard yourself and your patients from them. In this article, I will address the 25 most common examples of medication errors in nursing + how to prevent them. As you continue reading, you will find descriptions of possible medication errors, preventive measures, ways to promote patient safety, and steps to take if a medication error occurs.


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What Is Defined As A Medication Error In Nursing?


The National Coordinating Council for Medication Error Reporting and Prevention defines a medication error as a “preventable event that may cause or lead to patient harm or inappropriate patient use while the medication is in the control of a patient, consumer, or healthcare professional.”


How Many Medication Errors Are Made Each Year In The U.S.?


The United States Food and Drug Administration reports receiving more than 100,000 reports of suspected medication errors each year in the United States. In fact, the leading cause of patient harm in all healthcare facilities is medication errors. According to the National Library of Medicine, 7,000 to 9,000 people die due to a medication error each year in the United States.


What Percentage Of Medication Errors Are Caused By Nurses?


According to the U.S. Food and Drug Administration, more than 100,000 reports of medication errors and approximately 400,000 drug-related injuries occur in the United States each year. Medication errors in nursing account for nearly twenty percent of these errors and medical injuries.


Top 5 Benefits Of Preventing Medication Errors In Nursing


Nursing medication errors can have far-reaching consequences, affecting patients, nurses, other members of the healthcare team, healthcare facilities, and the nursing profession. Conscientious nursing practices can help reduce the occurrence of medication errors to the benefit of everyone. Here are a few examples of the benefits of preventing medication errors in nursing.

1. Increased Patient Safety:

The ethical imperative for all patient safety efforts is, "First, do no harm." When nurses implement safe nursing practices, including measures to decrease medication errors, patient safety increases.

2. Decreased Error-Related Healthcare Costs:

Medication errors in nursing contribute substantially to the high cost of healthcare. They impact insurance premiums and per-patient expenses for all types of medical services. By preventing medication errors, nurses can help reduce healthcare costs or, at least, slow the rise in healthcare expenses.

3. Stronger Nurse-Patient Relationships:

Individuals requiring medical and nursing care often feel vulnerable. When patients feel their nurses have their best interests in mind and believe they are working to provide high-quality, error-free care, it helps establish strong, trusting nurse-patient relationships.

4. Better Work Environment:

The stress caused by errors in care, such as medication errors, can result in poor work environments. As nurses work together to implement measures to improve patient care, such as reducing medication errors in nursing, it results in a better work environment.

5. Better Patient Satisfaction Scores:

Patient satisfaction surveys are essential tools used to indicate the quality of healthcare services. These scores can impact patient retention and clinical outcomes. Patient satisfaction scores are also reviewed to determine funding resources. Patient satisfaction scores are positively impacted when there are decreased nursing medication errors.



WHAT ARE THE MOST COMMON MEDICATION ERRORS IN NURSING?


There are many causes of medication errors in nursing. Knowing which errors are most common and how to prevent them is of utmost importance for patient safety and positive patient outcomes. The following are the 25 most common examples of how medication errors in nursing may occur and ways to prevent each one of them.

MEDICATION ERROR #1: Giving the Wrong Medication

About the Error:

Medication errors in nursing occur for various reasons and in diverse settings. Giving the wrong medication occurs more frequently than you may imagine. Illegible prescriptions, faulty dispensing systems, or improperly labeled medications are a few reasons this medication error may occur.

How to Prevent this Error:

Most hospitals and healthcare facilities use electronic medical records. Physicians often enter orders in the E.M.R., and nurses follow orders. It is not uncommon for errors to occur when a physician or other practitioner spells a medication wrong or uses an incorrect abbreviation.

To prevent medication errors associated with the wrong medication, nurses should make sure hand-written orders are legible. If you cannot read the writing, verify the order with the physician. If the patient is alert and responsive, verify if they have taken this medication before or if they are aware that the medication is ordered. Additionally, compare the generic and brand names of the medication to make sure you have the right medication before administering it to the patient.


MEDICATION ERROR #2: Wrong Dosage of a Medication

About the Error:

One of the most common medication errors in nursing is when the wrong medication dose is administered. Nurses must understand their role in ensuring a safe dosage of medication is given to patients.

How to Prevent this Error:

If you are unsure about the accuracy or appropriateness of an ordered dose, do not give the medication until you have verified the order. It may be necessary to call the physician, pharmacy, or both to clarify. If you find the order is not appropriate for the patient for any reason, do not administer the medication. Report your findings to your supervisor and document the event.


MEDICATION ERROR #3: Administering IV Medication with the Wrong Infusion Rate

About the Error:

According to a 2018 report from the Patient Safety Network, intravenous medications have a median error rate between forty-eight and fifty-three percent. Intravenous medications are associated with fifty-six percent of hospital medication errors and fifty-four percent of potential adverse drug events. Mistakes with infusion rates may occur as the result of entering the wrong flow rate into an infusion pump’s rate field.

How to Prevent this Error:

A few things nursing management can do to prevent the error of administering medication with the wrong infusion rate include the following.

• Implement procedures to verify the accuracy of intravenous pump programming
• Use auto-programmed infusion pumps
• Implement double-checks to verify infusion pump programming
• Configure the facility's Medication Administration Record (M.A.R.) to match the sequence that infusion parameters will be entered into the pump



MEDICATION ERROR #4: Not Adhering to the Prescribed Time for Administration

About the Error:

When physicians or other practitioners write medication orders, the order should include the frequency interval at which the medication should be given. Nurses must be conscientious of medication schedules and adhere to the times and frequency. Giving a medication too soon could lead to elevated drug levels which could cause overdose or other adverse reactions. Waiting too long between doses may cause decreased levels of the medication in the patient's system resulting in lack of effective results.

How to Prevent this Error:

At one time, the Centers for Medicare and Medicaid Services supported the 30-minute rule for medication administration, stating that prescribed medications should be given within thirty minutes before or after the scheduled time. However, in 2011, the Centers for Medicare and Medicaid Services eliminated the 30-minute rule for medication administration.

New protocol requires hospitals to have medication administration policies in place and to identify medications requiring precise administration timing. Nurses can avoid medication errors related to administration time by knowing which medications are on the time-critical list and following organizational policies to ensure medication is given at the appropriate time.


MEDICATION ERROR #5: Giving a Medication to the Wrong Patient

About the Error:

All types of medication errors in nursing can be scary. Perhaps one of the scariest, though, is giving medication to the wrong patient. Even if a patient cannot communicate with you, healthcare facilities have protocols in place to help verify patient identities and prevent this error.

How to Prevent this Error:

Of all the measures nurses can take to practice medication safety, one simple step makes it possible to prevent this medication error in nursing. The first "right" of medication administration is to verify you have the right patient. Use at least two identifiers. For example, ask the patient to state his/her name. Check the patient's name on the order and the patient's wrist band. Many hospitals have bar-code systems which offer another layer of security when verifying the right patient. In these cases, the nurse would scan the bar-code on the patient's wristband and make sure the name the scanner gives matches the other identifiers.


MEDICATION ERROR #6: Incorrect Route of Administration

About the Error:

Nurse medication errors may occur due to using an incorrect route of administration. The most common route of administration errors are associated with injectables. For example, nurses should administer the antibiotic injections Rocephin and Penicillin intramuscularly. If the nurse uses a needle that is too short, resulting in a subcutaneous injection, this is a medication error.

How to Prevent this Error:

Verifying medication orders and following administration protocol can help prevent this medication error in nursing. If the doctor writes an order and you believe the route of administration order is not appropriate, verify the order before giving the medication.


MEDICATION ERROR #7: Not Following Directions

About the Error:

Of all the medication errors in nursing, this one should never occur. Failure to follow directions for administration could result in serious consequences for patients and nurses. Therefore, nurses should verify orders and follow directions for proper administration.

How to Prevent this Error:

If you feel the instructions are not appropriate for the ordered medication and patient problem, it is okay to double-check with the physician, pharmacy, or both before giving the medication. However, if the directions are correct and the medication is not contraindicated, you should never alter the directions or course of administration without an updated physician's order.


MEDICATION ERROR #8: Failure to Check If the Patient Has Medication Allergies

About the Error:

Failure to check for patient allergies can lead to major health risks very quickly! If a patient receives a medication they are allergic to, it can result in severe, possibly life-threatening adverse reactions or events.

How to Prevent this Error:

To prevent this medication error in nursing, nurses should verify whether the patient has any medication allergies before administering medications. Verifying medication allergies should not be a one-time event. Check the patient's chart to see if any allergies are listed. Then, each time you prepare to administer medications, ask the patient to verify if they have any allergies. If your patient does have drug allergies, make sure their ordered medications are not contraindicated because of the allergy.


MEDICATION ERROR #9: Improper Medication Preparation

About the Error:

Some nurse medication errors occur as the result of preparing the medication improperly. For example, injectable medications such as Rocephin or Penicillin must be reconstituted with a diluent to change the medicine from powder to a liquid, injectable form. Some intravenous medications may be mixed with others, while others cannot.

How to Prevent this Error:

If a patient's medication order includes medications that must be mixed or prepared prior to administration, it is the nurse's responsibility to read and follow directions. Improper medication preparation can be easily avoided by following the manufacturer's instructions and questioning any unclear directions or suspected contraindications.


MEDICATION ERROR #10: Not Checking for Medication Compatibility

About the Error:

While some medications are safe to take with other pharmacotherapies, others are contraindicated. One reason for this contraindication could be that the medicines are incompatible. Drug incompatibilities can lead to toxicity of one or more of the medications, organoleptic changes, and reduced drug activity or drug inactivity.

How to Prevent this Error:

Nurses can help prevent these types of medication errors in nursing by reviewing the medications ordered for patients and verifying any suspected incompatibility.


MEDICATION ERROR #11: Administering Medication Without Patient Consent

About the Error:

Unless it has been clearly demonstrated otherwise, there is a presumption that all patients have the capacity to consent to treatment. If the patient is capable, he has the right to decline any treatment, including medications, even if the decision may negatively impact his health. Nurses must honor a patient's decision about treatment. It is crucial for nurses to understand that administering medication without patient consent can result in legal ramifications, as well.

How to Prevent this Error:

Before administering any medication, patients must be informed what medicine the nurse is giving, the reason it is necessary, and ask permission to administer the medication. If the patient states he does not want the medication, the nurse should document the patient's refusal. Patients should never be pressured or coerced to agree to take medication for any reason.


MEDICATION ERROR #12: Failure to Assess Blood Pressure Before Administering an Antidysrhythmic/Antiarrhythmic Medication

About the Error:

Antidysrhythmic medications work by blocking impulses that lead to irregular cardiac rhythm and interfere with hormonal influences, such as that of adrenaline, on cardiac cells. The action of these drugs results in decreased blood pressure and heart rate. Before administering these medications, the nurse should assess the patient's blood pressure and pulse to ensure they are within safe ranges to receive the medications.

How to Prevent this Error:

Before administering any cardiac-influencing medication, take the patient's blood pressure and pulse. If the systolic blood pressure measures <100 mm Hg or the pulse is <60, hold the medication. Assess the patient to see if they are stable, noting any complaints of dizziness, dyspnea, or chest pain. If the patient is unstable, notify the doctor immediately. If the patient is stable, document findings, hold the medication, and reassess them in 15 minutes.


MEDICATION ERROR #13: Improper Use of a Medication

About the Error:

Drug misuse occurs when a prescription medication is used for a purpose other than its intended use, as established by the manufacturer. For example, if a patient complains of nausea and a headache and the nurse administers Xanax to calm the patient, this is improper use of the medication.

How to Prevent this Error:

It is crucial for nurses to follow manufacturer guidelines for proper medication use. If a patient reports symptoms for which there is no appropriate medication ordered, the nurse should contact the physician, report the symptoms, and ask the doctor if they feel a new medication is necessary.


MEDICATION ERROR #14: Failing to Monitor for Possible Side Effects or Adverse Reaction

About the Error:

All medications have the potential for side effects or adverse reactions. The nurse’s job is not complete when a medication is given to a patient. Medication errors in nursing could be the result of improper or lack of follow-up after the medicine is administered.

How to Prevent this Error:

While it is important to monitor for changes in a patient's status routinely, it is especially necessary when a new medication is introduced to their regimen or if a dosage change is indicated. Nurses who follow up medication administration by monitoring patient responses to medications and indications of any adverse reactions can help reduce serious adverse effects and promote better patient outcomes.


MEDICATION ERROR #15: Not Following Manufacturer Guidelines

About the Error:

Sometimes, medication errors in nursing occur because the nurse does not follow guidelines for administration established by the manufacturer. Whether this error is related to an oversight, or an intentional adjustment based on the nurse's judgment, it is imperative that nurses make every effort to prevent this medication error in nursing.

How to Prevent this Error:

Before administering any medication, be sure you read the directions carefully. If you have concerns about a medication order, clarify the order against the manufacturer’s guidelines for use. You may need to call the pharmacy and/or the doctor. In cases where your concerns are valid, you do not have to administer a drug. You do, however, need to report your concerns to your supervisor and document why you held the medication.

Remember to choose your words carefully when documenting. For example, in this scenario, you may document like this: “Medication held pending validation of order from physician and pharmacy. Patient and supervisor notified.”


MEDICATION ERROR #16: Failure to Recognize Inappropriate Therapeutic Duplication

About the Error:

Therapeutic duplication occurs when physicians or other practitioners order more than one medication for the same patient problem. In some cases, therapeutic duplication is indicated and does not result in negative outcomes. However, at other times, duplicate therapy is contraindicated.

How to Prevent this Error:

Although nurses do not create medication orders, it is our responsibility to ensure safe practices regarding medication administration. If you have a patient whose medication orders include possible duplications, verify the order. It is okay to ask about the rationale for using multiple medications for the same problem.

While the physician may be correct and have a justifiable reason for therapeutic duplication, you need to know and verify the order was not the result of an oversight. By asking questions, it is possible to reduce or prevent nurse medication errors.


MEDICATION ERROR #17: Not Checking Patient Lab Results Before Administering Diuretics

About the Error:

Diuretics are often used to treat hypertension or excess fluid volume related to cardiac issues. These medications help reduce blood pressure by helping the body eliminate water and sodium through urine. However, some diuretics can also cause elimination of potassium, which can lead to unsafe, low levels of potassium, also known as hypokalemia. Hypokalemia requires urgent medical attention as extremely low levels can be life-threatening.

How to Prevent this Error:

If diuretics are ordered for your patient, it is crucial that you closely monitor their lab work and report any changes. It is important for nurses to monitor fluid and electrolyte levels, especially potassium, intake, and output. If any lab results indicate concerning changes, or if the patient's intake and output measurements are not close to equal, hold the medication and notify the physician.


MEDICATION ERROR #18: Missing a Medication Dose

About the Error:

Nurses are busy people. It is not uncommon for nurses to have several patients to care for during any given shift. One of the most common medication errors in nursing occurs when a medication is missed. This error may occur when the number of patients is overwhelming, or an emergency occurs that causes the nurse to be distracted. Additionally, if the patient is scheduled for a test or therapy, they may not be in their room when the nurse makes rounds to give medications.

How to Prevent this Error:

Although there are several reasons medication doses may be missed, no reason is truly acceptable. The nurse can help reduce the risk of this type of medication error by prioritizing care. At the beginning of your shift, verify which patients may be out of their rooms for tests, therapy, or other reasons, and make sure to prioritize administering their medications within the appropriate time frames.


MEDICATION ERROR #19: Ignoring or Overlooking Patient Medical Histories

About the Error:

It is common knowledge that nurses spend more time with patients than physicians or other specialty members of the healthcare team. Because of the extra time and often closer relationships they have with nurses, patients may disclose information about their previous medical histories to nurses before doctors.

Some patients may not realize the importance of sharing all past medical history, including details about all medications they are taking or have taken. If your patient took a medication previously that was not effective or caused an adverse medication event, it is crucial to know which medication and the type of reaction.

How to Prevent this Error:

Not disclosing information or the nurse overlooking or ignoring a patient's previous medical history are common but preventable causes of medication errors in nursing.

Nurses can help reduce the risk of this type of medication error by obtaining a complete health history during assessment and asking follow-up questions as needed. Carefully review medication orders and compare them to past medication regimens. If any new medication order is similar to a previous medication that was ineffective or to which the patient had an adverse response, address this concern with the doctor before giving the medication.


MEDICATION ERROR #20: Substituting Generic for Name Brand Without Physician Approval

About the Error:

Many healthcare facilities and providers allow substitution of brand name drugs with generic drugs. However, in some cases, physicians may write "do not substitute" or "brand name only" on some medication orders. Some cases when doctors prefer to use brand name only maybe when using medications classified as having a narrow therapeutic index, such as some seizure medications. Nurses should never assume substitution is appropriate.

How to Prevent this Error:

The easiest way to prevent this medication error is to read the orders carefully and verify whether stipulations for generic medications are noted. If the pharmacy sends a generic medication but the order says, "do not substitute," do not give the medication. Notify the pharmacy of the physician's order and ask for a replacement. Sometimes the physician will approve the generic medication after the original order is written. If this occurs, the order must be updated and proper documentation included. Never assume it is okay to substitute medications.


MEDICATION ERROR #21: Administering a Medication Without an Order

About the Error:

Another medication error in nursing that may occur results when a nurse administers any pharmacologic intervention without an order.

How to Prevent this Error:

Unless a nurse has prescriptive authority, such as a family nurse practitioner or other advanced practice registered nurse, there must be some type of order in place. In some situations, nurses may administer medication without a physician's order by adhering to their facility’s standing orders. Standing orders are written protocols that authorize nurses and other healthcare team members to complete tasks without first obtaining a doctor’s order. For example, a healthcare facility may have standing orders that authorize nurses to give Tylenol for a temperature greater than 101. In this case, if a patient has an elevated temperature, the nurse may administer the Tylenol without a verbal or written physician’s order.


MEDICATION ERROR #22: Giving Medications Which Were Subjected to Storage Compromise

About the Error:

Pharmaceutical manufacturers typically recommend their products be stored at controlled temperatures no less than 68 and not greater than 77 degrees Fahrenheit. When medication storage is compromised, it can result in alterations in the drug, making it ineffective. If nurses administer medications that were stored inappropriately, it can negatively impact patient outcomes.

How to Prevent this Error:

Healthcare facilities usually have medication storage rooms or on-site pharmacies where drugs are kept prior to patient administration. Nurses should monitor the temperature in storage rooms and medication coolers or refrigerators and document temperature readings. If the temperature in the room or storage container is outside the acceptable range, the charge nurse and pharmacy should be notified so proper disposal, and replacement can be initiated. Never administer medications suspected of compromised storage.


MEDICATION ERROR #23: Creating or Applying Incorrect Medication Labels

About the Error:

Medication labels may become smudged or smeared over time, requiring the application of a new label. Although it may be a natural response to want to create a new label or write over the smeared label information, this can lead to serious medication errors in nursing.

How to Prevent this Error:

Prescription medications should have labels printed and applied by the pharmacy. If a label becomes damaged, contact the pharmacy and notify them. The pharmacist may feel it is appropriate to prepare a new label or issue a refill on the prescription. It is never appropriate to mark through the original label or write over the label on the medication bottle.


MEDICATION ERROR #24: Changing the Rate of Oxygen Administration Without an Order

About the Error:

Oxygen is naturally available in the atmosphere, but it is considered a medication when given in higher concentrations than room air. Like other medications, oxygen administration requires a medical prescription and is subject to laws covering its use. Orders for oxygen must be clear and followed appropriately to prevent medication errors in nursing.

How to Prevent this Error:

The most effective way to prevent this error is to verify the rate and method of administration, such as per nasal cannula or mask. If your patient requires oxygen, but the current rate of administration does not appear to be helping, check to see if the physician has made provisions in the order to increase the rate based on the patient's oxygen saturation or other symptoms. When provisions for adjusting the oxygen administration rate are in place, you may make changes accordingly. Be sure to document the patient's symptoms before and after changing the rate. On the other hand, if the order does not include provisions for changing the O2 rate, you must first contact the physician and inform them about the patient's status and discuss what changes to implement.


MEDICATION ERROR #25: Not Providing Patient Education About Medication Administration

About the Error:

One responsibility of nurses is patient education. Depending on where the patient is receiving care and their level of participation in self-care, nurses may need to educate patients about the preparation, storage, and administration of medications. If patients do not receive proper instruction about their medications, it can result in dire consequences.

How to Prevent this Error:

Teaching patients about medications includes explaining why the medication is necessary, the possible side effects or adverse reactions, the expected outcomes from use, proper storage, and ways to administer the medication(s). The first step to reduce or prevent this medication error in nursing is for the nurse to read and understand the physician's orders. While the nurse may not be responsible for the patient's actions once they are discharged from care, pre-discharge instructions must be complete and well-documented.



6 Nursing Actions That Cause The Most Medication Errors


There are numerous causes of medication errors in nursing. Nurses must learn to identify actions that could lead to errors and implement measures to avoid those actions. The following are six nursing actions that cause the most medication errors.

1. Using Abbreviations Instead of Complete Names of Drugs:

There are many common abbreviations for medications. For example, acetaminophen (Tylenol) is abbreviated as APAP. Aspirin's abbreviation is A.S.A. While it is acceptable to use abbreviations, it is not always the best option. When medication abbreviations are used instead of writing the complete medication name, the occurrence of medication errors is higher.

2. Failure to Verify Patient Information:

It’s no secret that a day in the life of a nurse can be hectic. One action associated with medication errors in nursing is inaction. Inaction or failure to verify important information, such as making sure you have the right patient, verifying medication allergies, and checking for any duplicate therapy can lead to medication errors and negatively impact patient outcomes.

3. Not Acting on Concerns About Medication Orders:

Some medication errors in nursing occur because, despite concerns that an order is inappropriate or medication is contraindicated, nurses are afraid to question orders for fear of retaliation. It is crucial for nurses to remember that patient safety and well-being is a priority and to speak up about concerns.

4. Overlooking Look-Alike and Sound-Alike Drugs:

Some medications look like other drugs, although they may be a different class or have other uses. Also, the names of some medications sound alike. If nurses are not careful to check medication labels against the orders or do not ask for clarification if medications look or sound alike, it can lead to medication errors.

5. Failure to Reconcile the Medication Administration Record:

Medication reconciliation should be performed any time there is a transition in care and when changes in medication orders occur. Transitions in care include being transferred from one area of the hospital to another, when healthcare providers or levels of care change. Because nurses often work understaffed, it is not uncommon for medication reconciliation to be overlooked. It is vital for nurses to understand the importance of this step in patient care and to put forth every effort to make sure it is done.

6. Being Distracted:

Depending on what is going on in the nurse's immediate environment, it can be easy to get distracted when performing medication passes. Being distracted may be inevitable at times. Nurses must learn to recognize potential distractions and eliminate them as soon as possible to prevent the risk of medication errors.


6 Types of Drugs Commonly Associated With Errors Every Nurse Must Be Aware Of


Any medication or drug class can be associated with medication errors in nursing. However, some types of drugs are more commonly associated with errors. The following is a list of six drug types often related to errors in medication administration.

1. Anti-Diabetics:

Medication errors associated with anti-diabetic medications are one of the most common nursing medication errors. For instance, insulin medication errors are a common, preventable mistake that may occur at every step of the medication use process, including prescribing errors, data entry errors, preparation, dispensing, and administration errors.

2. Intravenous Antibiotics:

It is estimated that forty-eight to fifty-three percent of intravenous antibiotics are associated with medication errors in nursing, making them one of the most commonly occurring medication errors.

3. Antihypertensives:

Medications used to treat hypertension are associated with twice as many duplicate therapy medication errors than any other medication. Nurses must familiarize themselves with the medications ordered for patients and verify any concerns related to duplicate drug therapy. Another nursing intervention to help reduce the risk of nursing medication errors associated with antihypertensive medications is to check the patient’s blood pressure before administering the medication.

4. Anticoagulants:

Anticoagulants, often referred to as blood-thinners, account for more than eight percent of all medication errors of patients in inpatient settings. The most common cause of this type of medication error is therapeutic duplication. If your patient has been prescribed more than one anticoagulant, it is always appropriate to verify the order.

5. Diuretics:

Even in patients for whom diuretics are indicated, close monitoring is required. Diuretic-related medication errors in nursing are common in patients with electrolyte imbalances, unstable cardiac issues, and with compromised renal function.

6. Opioids:

Opioid medications are associated with significant risks of harm to patients, including potential abuse and accidental death by overdose. One reason opioid medications are commonly associated with medication errors in nursing is nurses may offer the medication to patients when a less potent drug may be as effective for the patient's current symptoms or situation. Nurses must learn to recognize the signs of opioid dependency and symptoms of possible overdose.


8 Possible Consequences Of Medication Errors In Nursing


There are several possible consequences of medication errors in nursing. Some errors may lead to minor complications, while others can be quite profound. The following are some examples of possible consequences that could occur due to various types of medication errors in nursing.

1. Unsafe Changes in Vital Signs:

Medication errors may lead to rapid, sometimes dangerous, changes in the patient's vital signs. For example, if a patient is prescribed digoxin, one of the nurse's responsibilities is to check the patient's pulse before giving the drug. If the apical pulse rate is <90 bpm in an infant, <70 bpm in a child, or <60 bpm in an adult, the medication should be held. If the medication is given without verifying safe heart rate, it could result in dangerously low heart rate or other complications.

2. Hospitalization or Prolonged Hospitalization:

Depending on the nature of the error and the after-effects, one consequence of medication errors in nursing is the need for patients to be hospitalized or prolonged hospitalization of those already hospitalized. Studies suggest medication errors in nursing prolong hospital stays by an average of two days.

3. Sentinel Event:

The Joint Commission defines a Sentinel Event as an “unexpected occurrence involving death or serious injury, psychological injury, or the risk thereof.” Sentinel events have significant morbidity and mortality rates and are often preventable.

4. Mental Anguish:

Nurses who commit medication errors often report serious emotional responses. Many report feeling guilty, nervous, afraid, or anxious. Some nurses experience a loss of confidence in their ability to perform their jobs effectively. It is urgent for nurses to discuss these issues with leaders, as anxiety and fear are often associated with future mistakes.

5. Disciplinary Action:

Even unintentional medication errors can result in disciplinary action against the nurse. Depending on the effect the error has on the patient and the cause of the error, disciplinary action may include disciplinary counseling, suspension, or loss of job.

6. Increased Healthcare Costs:

Increased length of hospital stay and legal cases related to nursing medication errors have a substantial impact on the cost of healthcare. Financial costs associated with medication errors cost approximately $77 million dollars yearly, an average of $2,500 per patient.

7. Lawsuits:

Medication errors in nursing not only result in overall increases in healthcare costs but there is the potential for serious financial ramifications for nurses committing the errors. If patients decide to pursue legal action because of a medication error, the nurse can be named solely or together with the facility where the error occurred. Fines, penalties, and restitution for pain and suffering are potential consequences. If gross negligence or intentional harm is proven, nurses could also face jail time.

8. Loss of Licensure:

Although not all nursing medication errors lead to the loss of nursing license, it is possible. The nature of the error and any harm the patient experiences are carefully considered before a decision to revoke a license is made. License revocation is handled by the State Board of Nursing where the nurse holds primary residence.


7 Steps A Nurse Should Take When A Medication Error Is Made


When a medication error occurs, its essential for nurses to know how to respond. The following are seven steps nurses should follow when reporting medication errors in nursing.

STEP #1 : Assess the Patient!

The first, and most critical step a nurse should take if a medication error is made is to assess the patient for adverse reactions.

STEP #2 : Inform your nursing supervisor immediately.

Never attempt to hide medication errors. Instead, as soon as you assess your patient and confirm he/she is stable, inform your nursing supervisor.

STEP #3 : Notify the Physician.

Even if the patient does not experience any adverse effects, it is necessary to notify the physician of any nursing medication error. Errors that involve giving the wrong medication or wrong dose can impact the effectiveness of other medications or future doses. If the physician is aware of the event, he can make informed decisions about the patient’s care moving forward.

STEP #4 : Complete an Incident Report.

Anytime nursing medication errors occur, an incident or occurrence report must be completed. Most healthcare facilities have a designated supervisor or compliance officer who can assist in making sure the report is prepared correctly. The incident report should include the date and time of the event, patient information, and a clear description of the event. Document each person notified about the error and any corrective action taken, and then forward the report to the appropriate department.

STEP #5 : Contact Your Nursing Union or Local Nursing Association.

Not all nursing medication errors result in dismissal from work or loss of licensure. However, if you are a member of a nursing union or nursing association, it may be helpful to contact a representative for support and guidance.

STEP #6 : Be Honest, Yet Discreet.

It can be scary knowing you made a medication error. The natural first response may be to avoid discussing it with anyone and hope that the problem goes away. This is not the correct way to handle the situation. Explain the situation as clearly and concisely as possible. Avoid making excuses or downplaying the situation. On the other hand, you do not have to elaborate excessively, either. Stick with the facts. Do not discuss the situation with anyone not directly involved. For instance, your supervisor, the physician, the patient, and/or the patient's caregiver(s), and your union or association representative should be the extent of your conversation about the issue.

STEP #7 : Be Kind to Yourself.

Sometimes we are our own worst enemy. Of course, if you are responsible for a nursing medication error, you will be worried. It is normal to be anxious or concerned about your patient, your job, and the potential for any disciplinary action. Unless you intentionally administered a medication in an erroneous manner, give yourself some credit. Take a deep breath, discuss your options, and move forward day by day until the situation is resolved.


Useful Resources For Learning More About Medication Errors In Nursing


All nurses should strive to provide high-quality, safe patient care and reduce the occurrence of nursing medication errors. There are many useful resources to learn about medication error prevention. The following are a few examples of journals, websites, YouTube videos, and podcasts with information about medication safety and error prevention.

Journals

Health Science Journal

publishes articles on multi-dimensional aspects of health sciences. One example is the article, “An Inside Look Into the Factors Contributing to Medication Errors in the Clinical Nursing Practice.”

• Nursing Management

offers quality articles on many issues related to nursing, including medication administration and safe nursing practices. “A Safe Standard of Care for Medication Administration,” by Sally Austin, A.D.N., B.G.S., J.D. is one example of the content offered by Nursing Management.

Blogs/Websites

U.S. Food and Drug Administration

provides information for consumers, patients, and healthcare professionals. “Working to Reduce Medication Errors” is one article offered by the F.D.A.

YouTube Videos

Preventing Medication Errors:

In this ten-minute video, learn about the rights of medication administration and how to avoid medication errors in nursing.

Medication Errors:

This YouTube video is a one-hour lecture covering several possible medication errors in nursing. The speaker offers strategies to detect errors, manage, and minimize harm.

Podcasts

Speak Up for Safer Care:

This podcast offers insight from subject matter experts, healthcare providers, nurses, and caregivers focused on identifying errors and preventing future harm.

The Nursing Post Podcast

is another excellent nursing podcast. One featured interview the site offers is “To Err is Human, but First Do No Harm... Medication Errors.”


BONUS! 5 Things Nurse Leaders Can Do To Help Reduce Medication Errors In Nursing Practice


Preventing medication errors in nursing is the responsibility of every nurse. Nurse leaders can be instrumental in preventing errors. Here are some ideas of ways nurse leaders can help reduce
nursing medication errors.

1. Create an atmosphere of safety where nurses feel it is okay to discuss concerns:

When workplaces do not support psychological safety, the likelihood of employees speaking up about concerns lessens. Nurse leaders can be proactive about preventing medication errors in nursing by encouraging nurses to alert them about any orders that concern them.

2. Advocate for nurses when they report issues with orders:

If staff nurses express concern about the appropriateness of orders, nurse leaders should listen, and when appropriate, speak up on their behalf, especially if the concern needs to be directed to a prescribing doctor or escalated to management.

3. Promote Followership:

Followership is a term used to describe the “upward influence” of individuals on their teams and leadership. Nurse leaders who promote followership encourage team members to trust their judgment, initiate change, and disagree if it is in the patient and organization’s best interest.

4. Offer Opportunities for Continued Learning:

New medications are created, tested, and approved daily. To be effective care providers, nurses must commit to lifelong learning. Nurse leaders can encourage the concept of learning by offering opportunities to learn about new medications and drug safety, which can help reduce the number of medication errors in nursing practice.

5. Storytelling:

Storytelling is a method of opening a narrative between healthcare professionals. In medication safety programs, storytelling is an excellent way to open dialogue for improvements in patient care and better patient outcomes. Nurse leaders can implement storytelling by meeting with staff nurses and opening dialogue by asking about their workday. As staff nurses open up to leaders, the leaders can identify potential risks for medication errors and involve the team in measures to help reduce the risks.


My Final Thoughts


Patient safety should be a concern of all nurses and healthcare team members. One of the most effective ways to promote patient safety is to practice safe medication administration and reduce errors. In this article, we have discussed answers to the question, “What are the most common examples of medication errors in nursing?” and provided examples of the 25 most common medication errors in nursing + how to prevent them. While it may not be possible to avoid every medication error, each nurse can be accountable for their actions and help reduce the risk of errors, improving patient outcomes and promoting the profession.


FREQUENTLY ASKED QUESTIONS ANSWERED BY OUR EXPERT


1. Do Nurses Report All Medication Errors?

Unfortunately, although nurses can identify medication errors, many are reluctant to report them.


2. What Population Is Most Affected By Medication Errors In Nursing?

The two patient populations at the highest risk of being affected by medication errors in nursing are children less than five years old and the elderly.


3. Can A Nurse Get Fired For A Med Error?

While all medication errors may not result in termination from a job, it is a possibility. The reason for the error and the effect the error has on the patient are the main things management considers when determining disciplinary action against a nurse for a medication error.


4. Can A Nurse Get Sued For A Medication Error?

Nurses can be sued for a medication error. The nature of the error and any harm caused by the error are factors attorneys consider when deciding whether to pursue legal action for nursing medication errors.


5. Why Nursing Medication Errors Are High In Nursing Homes?

Nursing homes are often understaffed and tend to have higher patient-to-nurse ratios. As nurses are overworked, tired, or become distracted, it increases the likelihood of medication errors.


6. How Often Do Nursing Medication Errors Occur In Hospitals?

Nursing medication errors occur often in hospitals. In fact, there are approximately 400,000 drug-related injuries in hospitals each year in the United States that occur because of medication errors.


7. What Are The Most Common Nursing Medication Errors Of Nurses In The Emergency Department?

Some of the most common nursing medication errors in emergency departments are administering the wrong dose of a medication and using the wrong intravenous fluids.


8. Why Nurse Burnout Is One Of The Major Causes Of Medication Errors In Nursing?

Nurse burnout can lead to difficulty making decisions, an inability to focus, and confusion, making nurse burnout one of the major causes of different types of medication errors in nursing.


9. What Are The Most Common Medication Errors In Pediatric Nursing?

The most common nursing medication errors in pediatric care are administering an incorrect dose, failure to follow the order for frequency, and incorrect route of administration.


10. What Are The Most Common Medication Errors In Psychiatric Nursing?

Medication errors in psychiatric nursing are typically associated with prescribing errors or administration errors. Improper medication administration is believed to be the most commonly reported nursing medication error in mental health facilities.


11. What Are Some Complications Of Nursing Medication Errors In the I.C.U.?

Although there are several possible complications associated with nursing medication errors, the most common complications in intensive care units are respiratory suppression, overdose, and death.


12. What Nursing Medication Errors Can Result In Death Of The Patient?

Administration of the wrong dose of medication accounts for approximately forty-one percent of fatal nursing medication errors. Also, giving a medication that is contraindicated because of drug incompatibility or patient allergies can have dire, sometimes fatal consequences.


13. What Nursing Medication Errors Are Considered Harmless?

Medication errors that do not cause harm, either because the potential error was intercepted before it reached the patient or because no significant harm occurred are often referred to as potential ADEs (Adverse Drug Events). All nurse medication errors have the potential to cause harm or some adverse patient response. Medication errors in nursing that may be considered harmless (or at least less harmful) include giving a medication later than scheduled, substituting a generic medication for name brand without physician approval, and failure to educate the patient.


14. What Action Should A Nurse Take First When A Medication Error Is Made?

The first action a nurse should take when a medication error occurs is to assess the patient for any adverse reactions or complications. Patient safety should always be the nurse’s priority.


15. What Are The 5 Most Common Types Of Medication Errors In Nursing?

The most common types of medication errors in nursing are administering medication to the wrong patient, giving the wrong dose of a drug, wrong route of administration, missing an ordered dose, and failing to administer the medication altogether.


16. What Are The 5 Most Common Causes Of Medication Errors In Nursing?

Five common causes of nursing medication errors include dosage miscalculations, prescribing errors, incorrect administration of the drug, poor communication between nurses and doctors, and illegible orders.


17. Do All States Require Nurses To Report Medication Errors?

Currently, twenty-six states and Washington DC require nurses to report medication errors.


18. What Should I Do If I Make A Medication Error That No One Else Knows About But It Appears Harmless To My Patient?

Even if a medication error appears to have no ill effects to your patient, it is still necessary to report the event to your supervisor. Although the immediate effects of a medication error may seem harmless, it can affect decisions for future treatment or medication changes. Also, patients should be monitored closely for any delayed adverse reactions.


Darby Faubion BSN, RN
Darby Faubion is a nurse and Allied Health educator with over twenty years of experience. She has assisted in developing curriculum for nursing programs and has instructed students at both community college and university levels. Because of her love of nursing education, Darby became a test-taking strategist and NCLEX prep coach and assists nursing graduates across the United States who are preparing to take the National Council Licensure Examination (NCLEX).