Medication errors


I was just reading a report from the National Patient Safety Agency entitled ‘Safety in Doses’ (See link below). This report gives a review of medication errors reported to them during 2007.  The majority of these involve general medical settings although 9% of them (6551) happened within mental health services. Luckily, 96% of all incidents are not serious, in that nobody got hurt – however there were 100 cases of death and severe harm.

In mental health and learning disabilities settings the most common problems are caused by omission of anti-convulsant medications, generally, omission of medications is a serious problem. Incidents involving methadone and clozapine were also frequently seen. A big problem is found in the interface between primary and secondary care settings. Given the complexity of modern mental health care provision the number of such interfaces and the potential for confusion is greatly increased.

I can remember a couple of incidents from practice in which medication was administered incorrectly. Fortunately neither case caused any harm to anyone but I will never forget the feeling of absolute horror when I realised what had happened.

General Views Of The UK's Major HospitalsLess fortunate were the patients being cared for by these Nurses practising at Heartlands Hospital in Birmingham – I can remember reading about this truly dreadful incident.  It is very easy to understand the anger felt by the widow of of one of the patients killed.

How many of us can say that we have never made a mistake when working with drugs?

Those of you who are a little older will remember the ‘drugs assessment’ that every student nurse had to pass. This involved studying the contents of a drug trolley, learning the nature and purpose of every drug as well as it’s usual dosage and most common side effects. It was a tough test to pass!

I just wonder if we need something like this now?

I guess a lot of people will say that nurses are often working in stressful situations, there isn’t always the level of staffing & resources needed to do things as well as we would like. I certainly don’t think that all errors are down to nurses lacking knowledge.

What others think? Do you as qualified staff feel that students are as well prepared as they ought to be? – what about students, are you ready to take responsibility for administering medication? Also, if there are errors being made then why do you think this happens?

I would really love to hear from people.

Link to National Patient Safety Agency report

Photo at top of blog from Flickr creative commons by Charles Williams (click on picture)

PS On an unrelated note I had an email from the RCN asking that I draw your attention to the RCN election website – there are two links below for your attention

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I actually just did a post on this:

We get no formal training in medication at my uni, it’s all left to individual practice mentors thus everyone ends up with different skill levels. Some people who have repeatedly been passed as ‘competent’ in medication administration scored as little as 10% in a recent formative pharmacology exam. Yes, some (much?) of it is due to being busy whilst administering drugs, mistakes happen. But often students don’t realise the potential dangers of the drugs they are giving out and don’t understand the problem with ommiting some doses.

I think it is important for students to be thoroughly educated both in university and in practice about the different types of medication being prescribed, routes of administration, BNF maximum doses, side effects, as well as education in how to support service users to assess whether a treatment is effective or not.

In addition to this students need to be aware that medication errors do happen. Mentors and lecturers need to stress the need to be vigilant and accurate in medication adminstration, however student nurses also need to know what to do if they do make an error with medication once they are qualified and no longer supervised. Students need to have considered this in advance of an incident taking place, so that rather than becoming terrified and keeping quiet, they make sure the recipient of the medication receives a speedy medical assessment, and that the incident is investigated to see what wider failings in the system led to the problem.

Whilst I hope that nurses take the responsibility of drug administration very seriously, it is also important to avoid creating a culture where mistakes are brushed under the carpet for fear of being disciplined. We need to create a culture of honesty as well as responsibility, for the safety of service users.

I wish there was more education around medication particularly how to work with clients to assess its effectiveness. It has been my experience that most nurses while they administer medications any decisions regarding it are left to the psychiatrist that prescribed it (I have now worked with 2 nurse prescribers but neither actually prescribe).

I’m a second year mh student nurse and it is my experience that you only ever need to take meds out of a clients tray, and I’ve never worked with a member of staff who has been able to spare any time to explain anything to me.

Therefore I’ve sat with clients medication cards in my break and written down the medications and dosages then looked them up on when I’ve got home.

At uni we have lectures on how to administer medications and what the types of medication are, but it is down to the individual to go off and research side effects and what medications are of what type and anything else they may like to know…

We talk of ‘medication errors’ and rightfully point out that this is a bad thing. But what about the errors that occur daily and have major impact on people? I am of course, talking about nurse-patient interactions or to be precise, the lack of these interactions. Other respondents have pointed out the lack of training students get in medication management – what about the training to speak with a person? I am not talking about how to Sit squarely, Open posture etc etc but how to connect with someone on a fundamental level to help a person recover, to help them regain their lives?

I am always amazed/dismayed at how students seem to be obsessed with medication – I am far more impressed when a student can talk to people rather than hand out tablets to patients.

Yes medication management is important. But not as important as talking.

Just remembered…if you look at my blog on ‘Nurse Plumber‘ you will understand my point a bit better.

First year students in particular seem overconcerned with the contents of the medication trolley. As I see it, in training prospective mental health nurses we have a duty to stress that medication is just a tool that can be used to encourage client’s to access other forms of help. When I mentor new students my aim is to convey to them that the objective of their placement is to begin to develop the confidence to be able to ‘be with’ the people who are experiencing difficulties in their mental health. Let’s face it, a vending machine could dispense medication at an appropriate time, but without spending time with the client, how can you assess the efficacy of any interventions (including medication) being used?

I agree with Julie’s comments that it is more important to provide a range of therapeutic interventions rather than just dish tablets. I do however think we could have a module at uni on MH medication and medication administration. On placements I have seen a large proportion of nursing time spent checking drugs cards and side effects, if we were better prepared in the first place we could more confidently get on with the dispensing and have more time to do the rest. It is a combination of skills that make an effective nurse, e.g if you know what you are doing with meds you are more likely to be able to talk to clients about any issues they have with them and this promotes the therapeutic relationship.

Uni these days are like factories – its a production line where the end result – a nurse – needs to be done in as quick a time as possible and as many are generated as possible. The classrooms are too big, Unis need to pass people to get the funding, and I dare say the lectueres are too tired to care.
The result? Ill educated nursing graduates.
They start work on a ward already up to its ears with patients and severely overworked nurses who now need to bare the burden of another inexpeirneced staff member.
Its no wonder that so many medication errors occur.

I agree with many of the comments that medication is not the most important component of the skills and interactions that are used on a daily basis with service users, but as Andy states the consequences of getting it wrong can have serious immediate detrimanetal affects upon people.It is also really important that nurses have the knowledge and information regarding medication so they can inform the service users about the medication including side effects. I think nurses need to feel confident in their abilities and sometimes having competency assessments is a way of ensuring confidence and competence. This is something we are developing within Birmingham and Solihull mental Health Foundation Trust for newly qualified staff and staff that have a an identified training need or requirement around medication administration. I agree medication does not have to be the focus and sometimes student nurses focus on mdeication as it is a task they feel can be measured. Communication needs to have the same focus as I agree communicating in the wrong way can have detrimental affects upon people aslo and is a tool you use in medication administration.

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