Medication Errors

Question 1

Which of the following nursing measures should be included to reduce the risk of medication errors?

a) If questioning the drug order, always assume the prescriber is correct.
b) Be careful about questioning the drug order a surgeon has written for a patient.
c) Always double check drugs with sound alike names and look alike names, they are high risk for errors.
d) Always go with your gut reaction and if you think a drug route has been incorrectly prescribed, use the oral route.

Answer 1

c) Always double check drugs with sound alike names and look alike names, they are high risk for errors.

Question 2

Which of the following is an important medication administration process to remember?

a) When in doubt an order, ask a colleague about the drug
b) Stop, listen, and investigate any concerns expressed by the patient
c) Contact the patient and ask what the patient knows about the medication and whether it was taken prior to this hospitalization
d) If you are too busy as the charge nurse about the drug, the research the drug once you have given it to the patient at the right time.

Answer 2

b) Stop, listen, and investigate any concerns expressed by the patient

Question 3

If a student nurse realizes that a drug error has been committed, which of the following should be emphasized to the student?

a) The student bears no legal responsibility when giving medications
b) The major legal responsibility for drug errors lies with the faculty members
c) The major legal responsibility lies with the health care institution at which a student is placed
d) Once the student has committed a medication error, the responsibility is to the patient and to being honest and accountable

Answer 3

d) Once the student has committed a medication error, the responsibility is to the patient and to being honest and accountable

Question 4

The nurse is giving a medication to a newly admitted patient who is to receive nothing by mouth (NPO) and find an order written as follows: Digoxin, 250mcg, stat. Which action is appropriate?

a) Ask the charge nurse what route the physician meant to use
b) Clarify the prescribed order with the physician before giving the drug
c) Give medication immediately by mouth because the patient has no IV access at this time
d) Start and IV line, give medication IV so it works faster and because the patient is NPO

Answer 4

b) Clarify the prescribed order with the physician before giving the drug

Question 5

Which of the following is an acceptable authoritative resource for information about medication?

a) Drug information pulled from internet sites for lay persons
b) An experienced professional nurse colleague
c) The faculty person supervising the student during clinical rotations
d) Drug information sites such as rxlist.com or hc-sc.gc.ca/dhp

Answer 5

d) Drug information sites such as rxlist.com or hc-sc.gc.ca/dhp

Question 6

Medication errors have been occurring with increasing frequency on the unit which you work on. A committee has been appointed to investigate why medication errors occur and how to solve the problem. Considering this situation and the drug administration process, is it safe to only follow the guideline of checking the 10 rights of drug administration? Why or why not?

Answer 6

1. The Ten Rights of drug administration are protection against the commission of drug errors. Errors most often occur because of the wrong drug, dose, route, time, patient, reason, documentation, assessment, or patient education. In addition, drug errors can occur because of system-type errors, such as inadequate knowledge on the part of the health care professional, inadequate education regarding new drugs, lack of knowledge about outdated medications, or poor stocking systems for medications. Therefore, a system and process analysis of medication errors may serve as a valuable resource when trying to identify why medication errors occur.

Question 7

You are a charge nurse at a small community hospital. The physician ordered a stat IV vancomycin infusion, but when the bag comes up from the pharmacy you notice that the dose is incorrect. It takes 2 hours for the pharmacy to send up an IV bag with the correct dose. As you check the medication, you note that it is the right drug, right dose, etc… Yet it’s been 2 hrs since it was ordered stat. What if anything should you do before you give this medication?

Answer 7

2. This delay would be considered an error because for a stat order, the nurse has a 30-minute time frame in which to order the drug. Therefore, in this scenario, there would be claim for medication error. The protocol for handling the situation before giving the drug is as follows:
   • Monitor the patient.
   • Perform and document vital signs and perform a head-to-toe physical assessment.
   • Contact the physician and explain the situation.
   • Complete any new orders and make sure that the drug is given on time if that is what the doctor orders (that is, if the doctor says to go ahead and give the late drug, then do so and have the doctor approve any change in the timing of the drug).
   • Complete an incident report, including an explanation of why the drug was late.
   • Make sure the name of the pharmacist who filled the order is given to the physician and noted in the incident report.
   • If the remaining Rights are met, then after the order has been clarified, the situation handled, the patient made safe, and the drug appropriately received, complete the documentation and report to the charge nurse.

Many more general and more-specific suggestions are outlined in Chapter 5; review, read, and prepare.

Because such situations will continue to occur and could (depending on the patient situation and the drugs involved) be life threatening, have a backup solution for obtaining drugs, chemotherapy, and so forth when a pharmacist is not on duty. Be true to the legalities of nursing practice and to standards of care. A multidisciplinary task force should be formed to address this issue.

Question 8

List several internet sources for information medication safety and briefly discuss how this information could be shared with your patients in a community outpatient setting where the patients are primarily indigent (poor).

Answer 8

3. Some Internet sources are as follows:http: //www.ismp-canada.org/
   http: //www.rxfiles.ca/
   http: //www.shoppersdrugmart.ca/At these sites, the nurse can learn about and develop some safety cards for drugs that are commonly administered on the unit and (in this case) in the community. Standardize drug information so that it can be shared among colleagues. Identify ways to use pictures that are related to the drug and its use and other relevant and pertinent information that would be easy for the patient to understand. Patients may be indigent, but this does not mean that they cannot read, decipher, analyze, and so forth. They may be financially lacking, not cognitively lacking, so use creativity and resourcefulness to assist the patient or group.