All healthcare professionals need to maintain consistent records of their activities to ensure proper tracking of activity related to the patient. Medical transcription outsourcing is a reliable strategy to ensure accurate records that promote proper care delivery by all providers caring for the patient and protect healthcare organizations in the event of litigation. Accurate records can play a key role in preventing errors in administration of medicines.
In a busy, fast-paced healthcare setup, medication errors can occur due to many reasons and at any stage of the medication process. The different types of medication errors are:
- Prescribing errors
- Administration errors
- Failure to prescribe, administer, or dispense a medication
- Not following a medication’s dispensing/prescribing rules
- Administration of a medication too late or too early
- A patient being given a medicine not prescribed for them
- Improper use of a medication
- Wrong dose prescription/preparation
- Not paying attention to the patient’s medical conditions or potential drug interactions
Medication errors can have serious consequences such as prolonged hospitalization, need for additional medication interventions, and severe patient injury or death.
The main reasons for medication errors are insufficient pharmacologic knowledge, miscalculations, distractions, increased workloads, and fatigue, according to an article published in Nursing. Medication errors are highly preventable. Here are 10 effective strategies to prevent or reduce the risk of medication errors.
- Follow the 5 rights: In 2018, Patient Safety Network estimated that there is about an 8%-25% median medication error rate during medication administration. Nurses can prevent medication errors by following certain rights of medication administration: right drug, right patient, right dose, right time, right route of medication administration. Other rights include: right reason, education, documentation, right to refusal and expiration date.
- Proper drug calculation: Proper medication calculation is an important skill for nurses. Mathematical skills are required to make accurate drug calculations and administer medications safely and minimize errors.
- Medication reconciliation during patient transfer: When a patient is moved from one facility to another or to another unit in the same facility, all medication should be reviewed against transfer instructions. Each medication should be verified to ensure correct patient, dosage, route, and time of administration.
- Continuing education: Nurses should stay updated about new drugs and their safe use, including patient monitoring, patient teaching, and documentation. Maintaining ongoing medication competency is prevent errors when administering new medicines.
- Double checking: Double checking is defined as a procedure that requires two qualified health professionals checking the medication before administering it to the patient. A medical transcription service provider documents all physician orders on each patient’s treatment administration record. Nurses should independently verify each medication on the patient’s order to ensure it is noted and transcribed correctly. Chart flags can also help, especially for high alert medications.
- Verbal orders – know the rules: Electronic prescriber order entry and prescribing have significantly reduced errors resulting from unclear handwritten and verbal orders. However, reports say that verbal orders still persist. Verbal orders have the potential to be misinterpreted, misheard, or transcribed incorrectly. These issues make them error prone when the prescriber and the person receiving the order have different accents, dialects, and drug name pronunciations.
However, the American Medical Association (AMA) has clarified that there are no federal regulatory prohibitions on the use of verbal orders. According to CMS, “verbal orders must be dated, timed, and authenticated promptly by the ordering practitioner or by another practitioner who is responsible for the care of the patient. That practitioner must be acting in accordance with State law, including scope-of-practice laws, hospital policies, and medical staff bylaws, rules, and regulations”. The AMA recommends the use of repeat-back of the order by the documentation assistant, especially for new medication orders.
- Indication alerts: High-alert medications are those that carry a higher risk of causing significant patient harm when they are used in error. The most serious errors reported due to similar names are associated with high alert medications. The Institute for Safe Medication Practices (ISMP) recommends the following strategies to reduce risk of errors linked to high alert drugs:
- Standardizing medication ordering, storage, preparation, and administration
- Improved access to information about these drugs
- Limiting access to high-alert medications
- Using auxiliary labels and automated alerts
- Employing redundancies
- Minimize distractions: Eliminating distractions during medication preparation can reduce risk of medication errors. This means implementing the ‘sterile cockpitrule’ in the medical setting. Even when conversations occur and are necessary between nurses and patients, nonessential activities or conversations can be prevented with a ‘quiet zone’ sign in the medication preparation area (journals.lww.com).
- Safe storage of medications: As heat, air, light, and moisture can damage medicines, there should be proper measures in place to ensure their safe storage. Certain medications need to be kept refrigerated to maintain efficacy, while others may need to be stored at room temperature. When multidose vials are used they should be labeled to prevent usage after their expiration date.
- Patient education: Empowering patients, families, and caregivers can prevent medical errors. They should be educated about medications’ therapeutic effects, potential adverse reactions, and desired outcomes. Nurses should review medications and their possible reactions with patients and educate them on how to stay safe. This is especially important when patients manage their medication regimens at home.
When used correctly, technology can help to decrease medication-dosing errors. For instance, bar code-assisted medication administration (BCMA) requires the nurse administering the medication at the bedside to scan the patient’s identification bracelet and the unit dose of the medication. It there is a mismatch of patient identity or of the name, dose, or route of administration of the medication, the system will alert the nurse about it. Electronic health records (EHRs) can also reduce medication errors by sending alerts about food/drug and drug interactions and identifying potential drug side effects and/or adverse reactions.
Providers must keep accurate records of medication administration to prevent errors in dosing. Nurses should document the dose only after the medication is given. A medical transcription company can ensure accurate EHR documentation of patients’ medication administration as well as allergies.
This can go a long way in helping to prevent medication administration errors. However, transcribed records of medication administration in the patient chart should be used in accordance with the instructions of the prescriber ((www.sps.nhs.uk/articles). The transcribed information should not be used in place of prescriptions, to add new medicines, to supply or dispense drugs or to change original prescriptions unless it is counter-signed and validated by the prescriber.
