Medication error: Wrong dose

Medication error: Wrong dose

Vivarian Moulton, Student Nurse
University of South Florida

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Introduction- Purpose/ objective of paper

The article Effect of Barcode-assisted Medication Administration (BCMA) on Emergency
Department Medication Errors defines a medication administration error as, administration of
a medication that does not match the physician order (Bonkowski, 2013). Administration errors
include omission of prescribed medication, wrong medication given when not prescribed, dose
preparation, wrong formulation, wrong route, wrong administration technique, wrong dose and
wrong time, duplication and wrong patient. With the switch from paper to electronic medical
records and the assistance of Barcode assisted medication administration, medication errors
happen less frequently. Among those mistakes that still take place is wrong dose.

Discuss one common type of med error

A wrong dose error can vary from too much, too little or wrong form of a medication.
Among the causes of wrong doses are miscalculation, interruptions, and not giving the dose in its
entirety. With the integration of the electronic medical record, the medication administration
process has become more passive, hence the process has become more susceptible to errors. In a
study done by the Pennsylvania Patient Safety Authority, it was shown that default values
accounted for 71 out of 324 more than 20 %- of wrong dose errors (Goedert, 2013). Default
values are automatic, preset values that should assist in hospital efficiency and if used
presumptuously it can help to cause a variation of inappropriate dosage calculations such as
accepting a higher than intended dose and giving an extra dose because of accepting a default
administration but not realizing that it is too soon after the previous dose. Another common

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example of a medication error occurs with insulin where personal preference, that differ from
hospital policy, of how a nurse rounds influences the amount of units a patient receives and if the
amount differs from the hospital policy answer it is wrong dose. With some simple enough steps
wrong dose errors can be drastically reduced and even eliminated.

Nursing interventions for avoiding such errors

Introducing the electronic medical record and the barcode assistive medication administration
has contributed in reducing medication errors. Of the 996 medication administration errors
observed in the Academic Emergency Medicine study, 42 were dose errors pre- BCMA; after
BCMA only 4 wrong dose errors occurred, a reduction of rate of 90.3 (Bonkowski, 2013)! Dose
errors are best caught with direct observation through trained eyes therefore having witnessing
on all medications might help to catch errors that a computer would not recognize. Insufficient
math skills; inadequate medication knowledge; limited experience as in the cases of new nurses
and failure to follow policies such as properly checking drugs contribute to dose errors. If
quarterly math remediation were given to nurses who did commit an error wrong dose rates
would decrease as they would get more math practice without injury to any patient.
Mandating completion of pharmacology modules each month would help to increase the
medication knowledge of nurses - both seasoned and new graduates. Swift and progressive
counselling for those nurses who continually have medication dose errors would make the nurse
aware and more proactive about medication administration and possibly getting double
verification in the hopes of preventing the administration of a wrong dose that can potentially
cause serious injury, result in the loss of licensure and a career in the medical field. Prevention is
the key to addressing dosing errors and once each nurse becomes more proactive in preventing

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errors by double checking themselves, getting a second opinion or even double checking orders
with the provider then there shall be a welcoming decrease in dose errors.
Which medical error I am afraid I will commit and ways to prevent
I am afraid I will commit a wrong route medical error in the sense that I might give an
intramuscular injection in a subcutaneous area or vice versa. It is because of this fear that I
carefully review the MAR and try to get the route and volume from the order so that I can make
a conscious and educated decision of where to administer an IV medication. With continuous
practice, revision of laboratory information and making the administration of medication a
proactive process are ways I plan to avoid and prevent this wrong route medication error that was
8/996 pre BCMA and 5/ 982 post BCMA.
Conclusion
Wrong patient, wrong med, wrong route, wrong dose, wrong time and wrong documentation are
forms of medication errors that happen in the medical field. Although not occurring as
frequently, wrong dose medication errors have been reduced with the introduction of the
electronic medical record and the BCMA. With further responsibility being placed on the nurse
to be more active during the process of medication administration; to build math skills and
progressive counselling for those who continually do not follow hospital specific policy dosing
errors can be reduced even further. By recognizing my area of weakness in medication
administration and strengthening it via education and making it an active medication
administration process I hope to also contribute to reducing medication errors.

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References
Goedert, J., & Goth, G. (2013, November 3). ERRORS: Study Links Medical Errors to EHR
Default Values; Wrong Time, Wrong Dose Errors Common When EHR Order Entry
Values Set at Default. Health Data Management. Retrieved November 19, 2014, from
http://www.lexisnexis.com.ezproxy.lib.usf.edu/hottopics/lnacademic/?
verb=sr&csi=305434
Bonkowski, J., Carnes, C., Melucci, J., Mirtallo, J., Prier, B., Reichert, E., ... Mello, M. (2013).
Effect of Barcode-assisted Medication Administration on Emergency Department
Medication Errors. Academic Emergency Medicine, 20(8), 801-806. Retrieved November
19, 2014, from http://ejournals.ebsco.com.ezproxy.lib.usf.edu/Direct.asp?
AccessToken=3XXMMX181P2Z2MNPENPNZP1S2-ZE8MPDXL&Show=Object