Medication Error: Detection & Prevention
Miss Pankajini Panigrahi
ANS, SUM Hospital
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"A medication error is any preventable event that may cause or lead to
inappropriate medication use or patient harm while the medication is in
the control of the health care professional, patient, or consumer. Such
events may be related to:
• professional practice
• health care products
• procedures and systems
• product labeling, packaging, and nomenclature
• dispensing
• distribution
• administration
• education
• monitoring
What is Medication Error
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• Poor communication: handwriting, verbal/telephone orders
• Inadequate information flow: problems that prevent timely availability
of information including lab results
• Human problems: lack of knowledge, failure to follow policies, and
poo documentation/labeling
• Patient related problems: inadequate patient education, failure to
obtain patient consent forms, and improper patient education
• Inadequate policies and procedures: These include failure in
processes of care as well as poorly documented, non-existing, or
inadequate procedures
• Technical failure: equipment failure, poor equipment design, and
inadequate instruction in use of equipment
• Staffing pattern/work flow: inadequate staffing/supervision
• Organizational transfer of knowledge: inadequacy in training or
education for those providing care, including procedures in place for
an institution or unit.
Most Common Causes of Medication Errors
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Discussion
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Conclusions
Heading Heading Heading
Item 800 790 4001
Item 356 856 290
Item 228 134 238
Item 954 875 976
Item 324 325 301
Total 199 137 186
Results
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Category 1 Category 2 Category 3 Category 4
Chart Title
Series 1 Series 2 Series 3
Figure 3. Label in 24pt Calibri.
Medication Error Graph