… Omission of dose is the most common error occurring among nurses

Lhakpa Quendren  

Medication errors occurring among nurses in health facilities have remained a serious public health concern that poses a substantial threat to patient safety.

According to a recent study by a group of nurses, Tshering Dema and her team from the national referral hospital (JDWNRH), the nurses reported having experienced quite a high rate of medication error.

A medication error is unintentional and occurs during the medication process of prescription, transcription, dispensing, and administration including monitoring and documentation, among others.

This study on “medication errors and associated factors” involves 225 nurses out of 508 nurses of the JDWNRH of which about 63 percent reported having experienced medication error in the past six months at the time of the study.

Omission of prescribed dose error (43.1 percent) is the most common cause of medical errors followed by having administered medicine at the wrong time (25.3 percent), administering medicine without physicians’ orders (19.1 percent), and administration of wrong dose (18.7 percent). 

Errors such as medicine administered through the wrong route with 3.6 percent, and noticing allergy after administration of drugs with 4 percent were the less commonly experienced.   

The study showed that nurses in intensive care units and those caring for paediatric patients experienced more errors compared to their counterparts in general wards and those caring for adult patients.

“Mistakes in medication administration are considered a significant issue that threatens a patient’s safety and may increase their hospital stay, treatment costs, and mortality rate,” the researchers stated.

The study further adds that nurses are at the frontline to intercept and report medication errors, but the errors are severely under-detected and under-reported in practice.

Some perceived factors leading to the occurrence of medication errors include look-alike medicines (84.4 percent) and patients receiving a similar kind of medicine (82.2 percent).

Other common factors are more number of medicines prescribed to one patient, oral instruction in place of written medicine order, and the use of acronyms instead of writing full medicine order.

Challenges and recommendations

The study seeks to improve patient safety by strengthening the culture of the medication error reporting system and investigating reports to give better insight and understanding into the prevalence and magnitude of the problem.

“Although nurses understood the importance of reporting medication errors to improve patient safety, their perceptions of why errors happened and how it may be implicated to them discouraged them from reviewing medication error events as a corrective action than the punitive one,” the study stated.

The study also calls for action to prevent and reduce medication errors, especially on how one perceived the events of errors including why it happened and how it can be corrected.

A senior nurse with JDWNRH said that one activity could be conducting a monthly nursing audit on medication errors in the in-patient department to address the issues.

“Both the nursing administration and nursing workforce at JDWNRH have an individual work plan to reduce medication error and deliver quality nursing service which is also reflected in the annual performance indicator (APA) of the nursing department,” she said.

She added audit will assess and evaluate the category of medication error and the rate of medication errors made by nurses to guide corrective actions and preventive action.

The study also suggests that preventive and corrective actions toward reducing medication errors need to be strengthened to reduce harmful medication errors and save health expenditures associated with medication errors. 

However, challenges remain due to shortages of general nursing staff to provide effective healthcare services.

Nurses say that there are shortages of qualified and experienced nurses to mentor and coach junior nurses for the on-job training process which is essential in nursing service progression to deliver quality services to the patients.

According to the WHO report in 2017, one in every 10 patients is injured because of adverse events during their hospital process and the rate is even higher in developing countries where children are more at risk.