Medication Errors: Definitions and Classification - Case Study Example

Critical Analysis of a Scenario: Medication Errors Student’s Name Institutional Affiliation Critical Analysis of a Scenario: Medication Errors Paramedics are commonly the first health personnel that handle patients requiring emergency pre-hospital care such as those that develop heart failure while at home. Paramedics such as the extended care paramedics are allowed to see and treat certain patients before they are transported or taken to a hospital set-up (Finn et al., 2013). Paramedics are, therefore, required to have sufficient knowledge and skill to facilitate an initial management of most condition presenting at the ED whose initial management begins at the pre-hospital level. Heart failure requires prompt management to sustain the heart’s basic function of pumping blood and save the patient’s life (Weintraub et al., 2010). This requires appropriate selection of the right medication to use. Delaying treatment or using the wrong medication or simply making a medication error can worsen the prognosis of the condition. In the following discussion, a scenario where a paramedic made a medication error resulting in a patient’s death shall be examined including identification of the error made and how to prevent such errors. Errors Made The patient had presented with heart failure at the pre-hospital level. Among the drugs that the paramedic had were two drugs that look similar, norepinephrine and bumetanide. Norepinephrine is a non-selective adrenergic agonist that has activity on both beta and alpha adrenergic receptors present in the heart and blood vessels resulting in an increase in heart rate, cardiac output, peripheral vascular resistance and a decrease in blood circulation in the kidney (Katzung & Trevor, 2014). On the contrary, bumetanide is a loop diuretic that causes a decrease in body fluid volume through loss in the renal tubules. The two drugs are both available in 4ml vials but at different drug concentration. The physical appearance of the two vials is almost the same. In picking and using noradrenaline instead of bumetanide, the paramedic made a number of mistakes. The five basic rights of medication administration are supposed to observed by paramedics when managing patients using any form of medication (Elliot & Liu, 2010). The “right patient, right drug, right route, right time and right dose” are fundamentals. Identifying the right patient requires the paramedic to have taken sufficient and relevant history, physical and clinical examination to ascertain heart failure as a diagnosis. After diagnosing heart failure, the paramedic is expected to try and identify the symptomatic presentation of the condition that would warrant immediate management based on the ABC pneumonic (Thim, Krarup, Grove, Rohde & Lofgren, 2012). It is not clear whether the paramedic managed to take any history, physical and clinical examination to ascertain the type of heart failure. Moreover, not all types of heart failure require treatment using a diuretic except for those that exhibit symptoms of congestion such as oedema (Simon, 2013; Summers & Sterling, 2012). It is only mentioned that the paramedic was trying to manage a patient with heart failure in the pre-hospital set up although it was not confirmed whether it’s indeed heart failure, and if so, the type of heart failure and some of the clinical presentations that would guide emergency care treatment. Therefore, it is possible that the paramedic made a clinical judgement error of assuming that all heart failure patients require immediate treatment using diuretics. Therefore, the patient may not have been the right one for diuretic treatment as intended by the paramedic. After identifying the right patient, the paramedic is supposed to identify the right drug which did not happen in this scenario. A possible error that the paramedic made was picking the wrong medication. The paramedic intended to pick a vial of bumetanide and not norepinephrine. Even though the two vials have a great percentage of similarity, the paramedic was supposed to read the content of the vial using the generic name labelled on the vial and not identify the drug based on the physical appearance of the vial (Elliot & Liu, 2010). Another error that was made by the paramedic was failing to verify the medication picked. The paramedic was supposed to verify that the medication chosen was indeed bumetanide before proceeding to administer to the patient. It is also possible that the paramedic had both vials of bumetanide and norepinephrine placed next to each other. Placing two medications that have some similarities in physical appearance next to each other in such a setup increases the likelihood of confusing the two and using one instead of the other. Therefore, the mistake made was storing or placing vials of bumetanide and norepinephrine next to each other. Contributing factors to Human and System Errors Among the factors precipitating errors such as the selection of the wrong medication include knowledge inadequacy (Cheragi, Manoocheri, Mohammadnejad & Ehsani, 2013). Knowledge of the formulation of drugs available for use by the paramedic is salient to appropriate selection. It is likely that the paramedic was not very familiar with the minute differences in the physical appearances of the two formulations. In addition, professionally, it is a requirement that health care providers, should prescribe and select their medication based on the generic names of the drugs and not their brand names, something that if it had been adhered to by the paramedic such an error would not have occurred (Aronson, 2009). System causes such as poor staffing may result in fatigue and overburdening a single staff tasked to attend to various patients (Cheragai et al., 2013). With fatigue, human beings can lose their capacity to work optimally. It is possible that the paramedic was attending to the patient alone with no other fellow paramedic to verify the drug selected and support in the administration and ended up administering the wrong drug because of an overwhelming situation. The pre-hospital set-up, unlike the hospital set-up, is predisposed to more external destructions such as bystanders and chaos (Crossman, 2009). This could have impaired the paramedic’s concentration resulting in the medication error. A multitude of drugs are handled by paramedics with drugs arranged next to each other with some paramedic kits having only the tips of drugs exposed predisposes the paramedic to wrong selection especially since vials of different drugs may share the same colour (Crossman, 2009). Non-uniformity in the arrangement of kits and drugs in kits is also a system based contributing factor (Crossman, 2009). The paramedic might have picked the norepinephrine vial thinking that it was a bumetanide vial because he was familiar with the prior arrangement of vials in the kit, an arrangement that might have been altered by another paramedic. Recommended Medication Error Preventive Measures Various measures can be implemented to prevent the occurrence of medication errors similar to the one experienced in this scenario. These include refresher course for paramedics emphasizing the need to read carefully the labels on any syringe, ampoule or vial before injecting or drawing up (Crossman, 2009). This will fortify the idea of ‘stopping and reading' for careful identification of a given medication before administration of the same despite the prevailing pressure in the emergency environment in a pre-hospital setup. In addition, the refresher course should emphasize the identification of drugs with their generic names to avoid consuming drugs that have almost similar brand names (Cheragai et al., 2013). Another possible measure is through improved drug labelling where manufacturers would be expected to label their drugs comprehensively including the tips of vials with small abbreviations (Crossman, 2009). The printings should be clearly readable, should not wear off and should be under a background that enhances legibility in poorly lit areas. This would enhance legibility and durability of labels so that drugs stocked for long can still be easily identified. Pre-filled syringes should be legibly labelled. Paramedics should be provided with sufficient labels for writing the identity and strength of the medication (Cheragai et al., 2013). This is salient because drugs especially injectables may have similar appearance in terms of the colour of the content. If such drugs are drawn up and kept in syringes, selection can be very confusing if the syringes are not labelled appropriately. This will also be useful in differentiating similar drugs with different strengths. Paramedics’ workspace and drawers should be formally organised with emphasis on ampoule, vial and syringe positions, tidiness, and separation of drugs that have similarities or are dangerous (Crossman, 2009). For instance, bumetanide and norepinephrine vials should be clearly separated and never to be placed next to each other. Maintenance of constant uniformity in kit layout and placement of drugs in a given ambulance service will enhance familiarity among paramedics and reduce medication errors (Crossman, 2009). Lastly, crosschecking of drug labels by a second person before extraction of the drug or administration will also limit medication errors such as it was experienced in this scenario (Cheragai et al., 2013; Crossman, 2009). Conclusion Medication errors have the potential to threaten the safety of patients receiving care in a pre-hospital setup. Minimization of the errors will aid in reducing morbidities and mortalities arising from such errors. System and human predisposing factors to medication errors should be examined, and strategies such as the ones highlighted implemented to minimize the risks associated with medication errors. References Aronson, J.K. (2009). Medication errors: definitions and classification. British Journal of Clinical Pharmacology, 67(6), 599-604. Charagi, M.A., Manoocheri, H., Mohammadnejad, E. & Ehsani, S.R. (2013). Types and causes of medication errors from nurse's viewpoint. Iran Journal of Nursing and Midwifery Research, 18(3), 228-231. Crossman, M. (2009). Technical and environmental impact pn medication error in paramedic practice: A review of causes, consequences and strategies for prevention. Journal of Emergency Primary Health Care, 7(3), 1-10. Elliot, M. & Liu, Y. (2010). The nine rights of medication administration: An overview. British Journal of Nursing, 19(5), 300-305. Finn, J.C., Fatovich, D.M., Arendts, G., Tohira, H., Williams, T.A., ... & Jacobs, I.G. (2013). Evidence-based paramedic models of care to reduce unnecessary emergency department attendance - feasibility and safety. BMC Emergency Medicine, 13(13), 1-6. Katzung, B. & Trevor, A. (2014). Basic and clinical pharmacology (13th ed.). New York, NY: McGraw-Hill Publishers. Simon, W.A. (2013). Assessment and treatment of right ventricular failure. 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