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A provisional report for the 10 month period April 1st 2017 to 31st Jan 2018 acknowledged 393 never events within NHS England, including 172 wrong site surgeries, 97 retained foreign body post procedures, 60 wrong implants/prostheses and 31 medication administration errors.
A study of 2,600 patients at two hospitals determined that between 26% and 60% of patients could not understand medication directions, a standard informed consent, or basic health care materials. [133] This mismatch between a clinician's level of communication and a patient's ability to understand can lead to medication errors and adverse outcomes.
Variations in healthcare provider training & experience [45] [52] and failure to acknowledge the prevalence and seriousness of medical errors also increase the risk. [53] [54] The so-called July effect occurs when new residents arrive at teaching hospitals, causing an increase in medication errors according to a study of data from 1979 to 2006.
State regulators faulted two hospitals in Southern California for medication errors that put patients at risk, including one who suffered a brain bleed after receiving repeated doses of blood thinner.
Barcode medication verification at bedside allows for nurses to automatically document the administration of drugs by means of barcode scanning. A study conducted in 2010, found that barcode usage prevented about 90 000 serious medical errors each year and reduced mortality rate by 20%. [ 8 ]
Bar code medication administration was designed as an additional check to aid the nurse in administering medications; however, it cannot replace the expertise and professional judgment of the nurse. The implementation of BCMA has shown a decrease in medication administration errors in the healthcare setting. [6]
The Institute for Safe Medication Practices (ISMP) is an American 501(c)(3) organization focusing on the prevention of medication errors and promoting safe medication practices. [1] It is affiliated with ECRI .
This could occur when a patient is given medication that is too strong and is causing detrimental effects or is simply not necessary. [7] Adverse drug reaction. This could occur when a patient has an allergic response to a medication. [7] Inappropriate adherence. This could occur when a patient chooses not to or forgets to take a medication. [7]