**8. Prevention of medication errors**

regarding adverse reactions of medications, poor access to Manuals of Pharmacology). Apart from these five categories of errors, it is worth referring to the causes that have been mentioned by other authors including incorrect mathematical calculations; poor dosage adjustment, in order to prevent liver and kidney damages; inability to obtain a proper medical history that may also include possible allergies to medication preparations; and inability to prevent synergistic effects between two or more drugs and to further convey this information to health professionals [40, 41]. Part of medication errors is largely attributable to lack of relevant information regarding the new technologies, such as the function of medical drug

Other causes of medication errors are associated with working conditions at the sites where medical products are produced, i.e., lighting conditions, noise, packaging, and nomenclature for medical products, i.e., medications with similar names, distribution and storage processes,

The NCC MERP documented 10 basic factors that influence medication use process and are frequently associated with the causes of medication errors. These 10 factors involve information related to the medical history of the patient; medications; communication between healthcare professionals, in order to convey information regarding medications; nomenclature and packaging of medication preparations; storage, safekeeping, and standardization of medication; acquisition, use, and monitoring of medication devices; environmental factors; competence and education of the staff and the patient; and quality and risk management

The consequences of medication errors vary; the instance, however, that the error becomes apparent and the immediate action for the prevention or reversal of adverse events are of critical importance. The impact of medication errors on patients who are admitted in intensive care units (ICU) is more serious, since most of the times these patients receive a considerable amount of medications and they are often characterized by impaired capacity to adapt to the consequences of such errors (due to organ failure, possible immunosuppressant, poor communication, etc.). The consequences of medication errors may be associated with extended hospitalization and application of additional interventions, or they may be life-threatening

In a study of Bates et al., every error related to drugs was responsible for an average of 2.2 more days of stay in the ICU [47]. In another study, despite the fact that no lethal errors were observed, 26 of them were potentially threatening to patients' lives, whereas 55 of them were considered important [48]. Moreover, a study of Calabrese et al. did not observe any lethal errors, but five of them contributed to the need for increased monitoring of the patient and two of them led to the implementation of an appropriate intervention [49]. On the contrary, Flaatten and Hevroy found that one error led to the death of a patient; five (5.7%) were evaluated as important, whereas twenty two (25%) contributed to the implementation of an appropriate intervention [50]. Finally, in a study of Rothschild et al. (2005), 120 AE were reported,

and processes and protocols specified in every agency [42–45].

**7. Consequences of medication errors**

for the life of the patient and may even lead to death [11].

delivery pumps [39].

84 Vignettes in Patient Safety - Volume 4

processes [46].

The use of technology contributes to the improvement of the quality of the services provided and maximizes the protection and safety of patients against eventual errors and events throughout healthcare provision. Intranet installation as well as the use of personal computers in healthcare provision units contributes to the implementation of automated (computerized) systems for the writing of medical instructions, therefore eliminating errors attributable to illegible handwritings [52].

It also minimizes errors that occur while copying instructions on medication cards and prevents questions and misinterpretations, since every prescription includes mandatory fields that must be completed, such as route and time of administration as well as the precise dosage. Using special software for pharmacology, nurses can also be informed about possible allergies or side effects from incompatible medications every time they check on a patient's medical record. The placement of barcodes on every medication as well as the placement of identification wristbands for every patient upon admission to the hospital may decrease errors associated with inappropriate administration of medications with similar packaging and the administration of the wrong medication to the wrong patient. Using a wireless device at the time of hospitalization, nurses are able to monitor the administration of the appropriate medication preparation to the correct patient in the appropriate dosage using the appropriate route [53].

The use of "smart" infusion pumps for intravenous medication administration and more specifically for the administration of unsafe preparations, such as heparin or insulin, predetermines the infusion rate and provides security alarms. Such pumps have been used for several years in specialized departments, such as ICU. The rapid technological development contributed to further improvement of the existing pumps by customizing them and giving the healthcare professional the ability to enter information, such as possible allergic reactions, for every patient or install a software with pharmacology data [54].

Additionally, nurses should ensure the correctness of their actions not only during the preparation but also during the execution of hospitalization, thereby eliminating any external interference. Preparation of hospitalization is also advised as well as dissolution of intravenous preparations, at a separate, individual space and not in the room, where patients may pose various questions to the nurse. Moreover, patients' escorts should not be in the wards during hospitalization, so that it is quite and the nurses can concentrate on the administration of medications without anything distracting their attention [54].

Last but not least, the medication errors may also be prevented by simplifying nursing actions, by developing and establishing guidelines and protocols that will be followed systematically during the preparation and the administration of medications. Yet it is imperative to ensure the proper staffing of every health institution with nursing staff, in order to increase the ratio of nurses to patients.
