Despite advances in technology and care protocols in the health industry, the potential for medical error remains. From administering the wrong medication to miscommunications resulting in inadequate treatment, these missteps pose liability concerns for nurses and lasting — or even fatal — consequences for patients. Despite these challenges, nurses often have opportunities to prevent errors.
What Are Medical Errors and How Common Are They?
The Agency for Healthcare Research and Quality (AHRQ), a division of the U.S. Department of Health and Human Services (HHS), defines medical errors as “an act of commission (doing something wrong) or omission (failing to do the right thing) leading to an undesirable outcome or significant potential for such an outcome.”
Medical errors may happen anywhere, including at hospitals, outpatient clinics, physician offices, nursing homes, pharmacies and laboratories. Some of the most common errors are listed below:
Medication errors. These usually involve administering the incorrect medication or dosage to a patient. Misplacing or omitting a decimal point when performing drug calculations or being distracted or interrupted during dosing can lead to adverse patient outcomes, including death. The U.S. Food and Drug Administration (FDA) receives as many as 100,000 reports for suspected medication errors each year.
Fall injuries. Patients with limited mobility due to their illness, age or residual effects of medication or surgery are at increased risk for fall injuries. The elderly are more susceptible to falls that result in fractures like broken hips and traumatic brain injuries. The Centers for Disease Control and Prevention (CDC) estimate that as many as three million older people experience falls every year, with one in five falls resulting in serious injury. Falling just one time doubles a patient’s chances of falling again.
Documentation errors. The use of electronic medical records is pre-empting some of the problems arising from illegible handwriting in paper charts. Digital record-keeping comes with its own unique challenges, however.
Data on the frequency of documentation errors is limited, but the Office of the National Coordinator for Health Information Technology (ONC) found that 5% of patients who access their medical records online found the health information “neither easy to understand nor useful for monitoring their health.”
Incomplete or missing documentation, incorrect abbreviation usage and information attached to the wrong chart are common mistakes. Dictation and transcription errors, such as the use of hyper- instead of hypo-, create an inaccurate record and can alter the course of nursing care.
How Can Nurses Prevent Medical Errors?
Medical errors happen for a variety of reasons, but there are preventive strategies nurses can use to minimize the occurrence and negative consequences. Consider the following safeguards:
- If you are unsure of a physician order, medical record note or medication, always ask for clarification.
- Utilize your facility’s appropriate channels for dispensing and administering medication, which is typically the bar code medication administration (BCMA) system. This helps to accurately and consistently verify the six medication rights — right patient, right medication, right route, right dose, right time and right documentation.
- Ask another nurse to confirm high-alert medications, which can help you avoid situations like giving an adult dosage to a pediatric patient.
- Understand the indicated uses and adverse reactions for each medication you administer and inform patients about the reasons they are receiving the medication.
- Clear obstacles from patient walkways as much as possible to allow easier access to restrooms and other areas of the room.
- Encourage patients to request assistance when they get out of bed. Use this time to assess and document their gait.
- Be mindful of medications that may impair patients’ judgment or cause drowsiness or weakness.
- Use nonslip socks and bed alarms for patients at risk of falling.
- Regularly monitor patients and document your findings, taking special care to note interventions performed.
- Report adverse events to the appropriate parties immediately, usually to the nurse manager or supervisor.
- Verify you are using the correct chart for documentation.
- Strictly adhere to physicians’ orders for patient monitoring and notification, including fever, heart rate and blood pressure guidelines.
Given the fast-paced nature of healthcare and the multiple providers involved for each patient, medical errors are an ongoing concern. Due to frequent patient contact and involvement in many aspects of care, nurses are well-positioned to implement precautions to prevent or minimize mistakes.
Learn more about EMU’s online RN to BSN program.
Agency for Healthcare Research and Quality: Adverse Events, Near Misses and Errors
Centers for Disease Control and Prevention: Important Facts About Falls
The Office of the National Coordinator for Health Information Technology: Individuals’ Use of Online Medical Records and Technology for Health Needs
U.S. Food & Drug Administration: Working to Reduce Medication Errors
Wolters Kluwer: Nursing Documentation – How to Avoid the Most Common Medical Documentation Errors