Close up on doctor writing on clipboard while holding a prescription bottle of pills
HealthSeptember 04, 2020

Review IDs best interventions to ensure medication safety

By: Sarah Handzel, BSN, RN
All nurses learn the “five rights of medication administration” as a basis of their practice: (1) right patient, (2) right drug, (3) right dose, (4) right route, and (5) right time.

Why, then, do more than 100,000 medication errors occur each year as reported by the U.S. Food and Drug Administration? The answer, obviously, is multifactorial, and it isn’t just the result of errors nurses make. Everyone in the medication administration process, from physicians to pharmacists to registered nurses, are responsible for preventing errors that could lead to patient harm.

Medication errors occur at every point in the administration process, including prescribing, dispensing, and administering prescriptions. These errors occur in all healthcare settings and with all types of patients, and they make up the highest proportion of avoidable medical harm to patients. And medication errors may be more likely to occur in particular departments, such as surgery, emergency, and intensive care.

What, then, can healthcare practitioners do to make the medication administration process safer? A recent umbrella review published in the International Journal of Evidence-Based Healthcare examined data from systematic reviews published between 2007 and early 2020. Ultimately, four interventions were identified as having the highest effectiveness in reducing medication errors.

Strategies to reduce medication errors show varying effects

In healthcare settings around the country, clinicians have already implemented a variety of strategies to cut down on medication errors and patient harm. These strategies are usually aimed at specific sources of errors, such as the dispensing of incorrect drugs or healthcare provider distraction. Additionally, information technology-based systems, including systems like computerized physician order entry systems, have been created to mitigate risk associated with medication errors.

While these efforts are certainly commendable, medication errors still persist. This may be due to factors such as electronic system outages and practices like documenting medications as given prior to actual administration. Some nurses also report developing ‘work-arounds’ to help shortcut perceived problems with medication administration, including disabling alarms or attaching extra copies of a patient’s wristband to convenient objects or furniture. It’s true that this may help save time during a busy workday, but these practices also make medication errors more likely.

Four interventions are particularly effective

The umbrella review published in the International Journal of Evidence-Based Healthcare identified 13 interventions commonly used by healthcare providers in efforts to avoid medication errors. Of these 13 interventions, only four were shown to be particularly effective; the outcomes of these interventions were easier to measure, and there were larger sample sizes indicating the interventions’ benefits.

Medication reconciliation or review

All healthcare providers are familiar with the process of medication reconciliation, which compares a patient’s medication orders to their actual medications. Of all the studies reviewed, this intervention showed consistent evidence of a positive effect in preventing medication errors, particularly in acute care settings where prescriptions may be changed between admission and discharge or inaccurately recorded during acute medical crises.

Medication reconciliation is essential, especially since there are high rates of omission of at least one regular medication upon admission to a hospital. And while this activity may take some time—reconciliation activities for older patients may take half an hour or more—it truly is a good way to reduce medication safety risks.

Specialist health professional roles

While all healthcare providers have a role in preventing medication errors, pharmacists are especially important to preventing possible harm because of these mistakes. The review found that specialist pharmacists perceived themselves to be important educators to other clinical staff, particularly regarding prescribing behaviors. Additionally, these specialists almost certainly performed medication reconciliation or review before dispensing drugs to other clinicians.

Barcode administration systems

Nurses who dispense medications to patients report that barcode administration systems help them feel more confident and organized during the process. In general, this intervention helps reduce dosing, incorrect medication, and wrong route errors, making the patient care experience safer. Also, barcode systems seem to help reduce transcription errors which could lead to adverse events.

Preprinted order sheets

Preprinted order sheets are commonly used to control the use of high-risk drugs with specific dosing regimens, such as insulin or chemotherapeutic drugs. In many cases, these order sheets are also used during medical emergencies such as anaphylaxis. They are inexpensive compared to other interventions like barcode systems. Preprinted medication order sheets may help reduce the risk of medication errors by as much as two-fold, especially in settings like the emergency department.

Medication safety is the responsibility of all healthcare providers, and some interventions are more effective than others in reducing medication error risk. Healthcare practitioners are encouraged to adopt the use of these practices as part of the larger effort to reduce risk and avoid patient harm.

Sarah Handzel, BSN, RN
Freelance Health and Medical Content Writer, Wolters Kluwer Health
Sarah has over nine years’ experience in various clinical areas, including surgery, endocrinology, family practice, and pharmaceuticals. She began writing professionally in 2016 as a way to use her medical knowledge beyond the bedside to help educate and inform healthcare consumers and providers.
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