Prescription Error
Mistakes in dispensing medication are a well-known problem in nursing homes. Dispensing medication goes through a number of steps. They begin in the pharmacy where the pharmacist fills your prescription, inserting into a vial the right dosage, number and type of medications that the doctor has prescribed.
After the medication arrives at the nursing home from the pharmacy, there are numerous opportunities for mistakes to be made. Medication boxes for each patient are usually filled by a nurse or senior caregiver. Each box has a section for day of week and time of day to give the medication. Then, the nurse or caregiver makes rounds, delivering the medication to the patients at various times during the day.
Types of Medication Mistakes
Mistakes can be made at each of the various steps beginning in the pharmacy and ending in delivery to the patient. These mistakes may include:
- Giving the wrong medication to the patient
- Giving contraindicated medication
- Mixing up medications among patients
- Giving the wrong dosage
- Giving the medication at the wrong time of day
- Using the delivery system incorrectly (for example, an inhaler must be set up properly and inhaled at the right time in the process for the medication to enter the lungs and work)
- Making medication errors when transporting patients between their homes and the nursing home facility or between facilities
- Making repeated errors (in one North Carolina study of repeat medication errors in North Carolina nursing homes, the authors reported that medication errors are highly prevalent in long-term care facilities and are responsible for preventable injury)
- Omitting a dose
- Overdosing or giving multiple doses
- Wrong product strength
- Medication has expired
- Wrong route of administration
Possible Causes of Medication Errors:
- Simple human error
- Transcription error and inability to read handwriting
- Frequent distractions and care changes by caregivers
- Poor communication
- Inaccurate pharmacy dispensing
- Unavailable medication
- Medication name confusion
- Failure to follow policies and procedures
- Overloaded staff
- Shift changes
- Mistakes in product labels
- Problems in packaging design
- Inadequate information
- Lack of training
Another more disconcerting cause of medication error is deliberate overmedicating by nursing home staff to sedate a patient and make him or her easier to control. This practice can have deadly consequences, depending upon the medication, the dose and the patient’s general health. It can also lead to serious falls, trauma, injury and possible death among patients who try to get out of bed to walk but are unable to because the medicine has made them too unsteady.
