237 million medication errors are made each year in England alone, with the majority of these (42%) occurring in care homes.
Studies in Scotland and Northern Ireland have also found similar patterns, with care homes being at particularly high risk of medication errors.
Medication errors are also among the most common incidents reported to our Florence incidents team. Here, we’ll discuss why medication errors are so common, and what we can do to avoid them.
Why are medication errors so common?
Here are some of the reasons that errors occur:
Prescription errors
These occur when a healthcare provider prescribes the wrong medication or dosage. This can be due to miscommunication, lack of knowledge, or simple human error.
Dispensing errors
These happen at the pharmacy level, where the pharmacist dispenses the wrong drug or the wrong dose. This can be due to misinterpretation of the prescription, similar drug names, or human error.
Administration errors
These occur when the medicine is administered incorrectly. This can mean the wrong dose, wrong route (e.g., oral instead of intravenous), or at the wrong time.
Compliance errors
These happen when the person receiving the medication does not follow their medication regimen correctly, either by missing doses, taking extra doses, or taking the medication at the wrong times.
Monitoring errors
These occur when the effects of the medication are not adequately monitored, leading to adverse drug reactions or interactions.
Communication errors
These can happen between healthcare providers or between providers and patients, leading to misunderstandings about the correct medication or dosage.
System errors
These are issues with the broader healthcare system, such as lack of proper protocols or training, that can lead to medication errors.
Documentation errors
This happens when the balance and medication counts are not correctly checked and documented at either the time of administration or when we receive new medicines from the pharmacy.
This can also happen when we forget to sign the MAR chart or when we sign it before the person has physically taken the medicine.
Reducing medication errors
As human error can play a huge role in medication errors, it is incredibly important that extra care is taken to ensure that checks are in place to minimise the risks.
The simplest way to do this is to always follow the 6 rights of safe medication administration.
The 6 rights of medication administration
- Right time: the time a medication is taken can greatly affect how well it works. It’s important to stick to the schedule set by the prescriber.
- Right route: medicines can be given in different ways (like swallowing a tablet, liquid, or an inhaler), and the right method needs to be used for the medicine to work properly.
- Right dose: administering the correct dosage is crucial. An incorrect dose could lead to serious health complications.
- Right medication: it’s essential to double-check that the medication being given is the one prescribed. This step is key in preventing medication errors.
- Right person: before giving any medication, we need to make sure we’ve got the right person. This step helps prevent mix-ups and guarantees that the person receiving the medication gets the medicine that is meant for them.
- Right to refuse: if a person refuses to take their medication, you should never force them to do so. Document their refusal and any reasons they give. It may be that a different medication can be given which is more suitable.
Following these 6 rights significantly reduces the risk of making mistakes when administering medications and ensures that patients/service users get the best possible care.
If you wish to refresh your knowledge of medication administration you can re-do the medication administration module on Florence Academy at any time.
If you are involved in a medication error while working for Florence or spot any potential or near miss errors, please report this to the Florence incidents team at incidents@florence.co.uk
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Stats from BMJ Quality and Safety 2020
RQIA 2023
Health Improvement Scotland Safer Use of Medicines
NICE Guidance 2017
