Medication errors averted

Taking the correct medicine in the correct dosage is important—obviously. But mistakes can happen at home, as well as in medical facilities and the results can mean discomfort from side-effects, an allergic reaction or even death.

Take for instance, the morning when I woke up with a splitting headache. With eyes squinted in anguish and further irritated from the sunlight shining through my bedroom window, I stumbled to the medicine cabinet. Only able to crack open a single eye just enough to read the word, “Tylenol”, I hastily grabbed the bottle and fumbled to open the lid. I dumped three pills into my hand and foolishly reasoned that my headache was so bad I could take the extra pill, against the recommended dosage of two, in order to really knock this head-splitter out fast so I could get to work.

This was an especially bad idea considering the fact which I would soon learn with much disappointment. As I brushed my teeth and looked at the bottle again, this time with both eyes fully open, I realized that the three Tylenol I took were actually Tylenol PM, the nighttime, help-you-sleep-quick kind. I had just swallowed three of them early in the morning, before work!

Needless to say my day was a battle of fighting off a strong need to sleep throughout driving, meetings, answering phone calls and tying to complete projects. There was a lot of uncontrollable drooling and head teetering.

Medication errors in hospitals across the nation can have grave consequences. Mistakes can be a result of several factors including misreading labels, misunderstanding drug abbreviations, misunderstanding allergies, lab tests or misreading hand-written notes regarding the patient’s condition or other special instructions. Environmental factors such as poor lighting, heat, noise can be causes of mistakes.

Another reason might be multi tasking and interruptions while a health care professional is administering medications. To prevent this possibility, hospitals such as Kremmling Memorial, have implemented a simple, yet effective strategy, “Non-Interruption Wear”. It is made known to all hospital staff, that when a nurse is wearing an orange satchel, the nurse is not to be interrupted. The brightly colored sash provides a visual reminder to others that the nurse is busy carrying out the critical task of administering medication to a patient.

“This is working well,” said Cindy Callihan, RN at Kremmling Memorial. She says all other employees respect the technique and simply leave the nurse alone until she has completed her drug administration and address her afterwards.

Decreasing the number of interruptions during this critical task allows the nurse to focus solely on the administration of the medication. “This is a simple but mandatory requirement we have implemented to meet one of our National Patient Safety Goals: Safe Medication Administration.” indicates Carmen Covington, RN Staff Development Coordinator for KMHD.

In 1980 there were about 600 medications that were commonly administered to patients in health care settings. Today that number exceeds 10,000 different medications, dosages, and administration routes. The nurse must have a working knowledge of the reason for taking a medication, the physiologic actions a medication has on the body, the potential side effects for the patient based on a variety of patient risk factors, and the patient’s expected reaction to a medication.

Nurses do this in addition to the many other aspects of their daily duties and responsibilities to ensure the provision of safe patient care. So actions we can take to decrease distractions for the nurse will aid them in their effort to administer the right medications to the right patient, at the right time, in the right dose, and the right route to deliver safe patient care.

Patients can also be pro-active in the safety of their medications. Start by asking questions to improve understanding of why certain medications are prescribed. It is also wise to ask for a printed out copy of your prescription along with the reason for taking it, when to take it and the dosage.

Every time a patient goes in to see a doctor, this list should be shared with the physician. Better yet, grab a paper bag, toss in all of your bottles of medications, vitamins and even herbs and show your doctor what you have been taking. These simple, yet effective measures for taking medicine at home, along with the measures taken by hospital medical staff during a hospital stay, both improve safety of taking medication.