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Medication Errors

Medication errors have been a common problem in nursing facilities for decades. Though it also happens in hospitals, the rate of medication error is much higher in nursing facilities, where as many as one in five patients suffer from preventable mistakes such as medication errors. Though most states aim to keep the medication error rate of their nursing facilities under 5%, in reality it can often be much higher.

If you are an elderly patient or a family member, you will not be able to prevent every error made by physicians and caregivers, but you will be able to help with monitoring, so that mistakes can quickly be recognized and addressed.

Consequences and Costs of Medication Error

Medication error has the potential to cause adverse drug effects in the patient. Though most medication errors are minor, more than half of adverse drug effects are caused by such errors. Adverse drug effects such as overdosing and harmful drug interactions can lead to very serious health problems, sometimes causing long lasting consequences. Serious health consequences of medication error include: malnutrition, dehydration, delirium, incontinence, changes in behavior, and falls and fractures.

These additional health problems are very costly, both for patients, their families, and the facilities. Patients may suffer lasting damage to their organs, requiring expensive treatment and new medications. Similarly, these adverse drug effects cost nursing homes an estimated $7.6 billion dollars. It is in the interest of everyone to reduce the incidence and severity of medication errors by paying greater attention to the prescribing and monitoring.

What Are the Causes of Medication Errors and Adverse Drug Effects?

Medication errors can typically occur in three different stages: prescribing, monitoring, and administration.

Errors in Prescriptions

Though physicians do their best to properly prescribe medication to patients, sometimes they make mistakes. Physicians may prescribe the wrong dose, may misdiagnose and choose the wrong prescription, and they may fail to account for interactions with existing prescriptions.

Because elderly patients are often taking several different kinds of drugs simultaneously, it can be very difficult to properly prescribe and consider every drug interaction. Prescribing the wrong dose accounts for 63% of prescribing errors, while unforeseen drug interactions account for 22%.

Errors During Monitoring

As a caregiver, patient, or family member, one of the areas that you have the greatest responsibility to reduce adverse drug effects is during monitoring. No physician can correctly predict 100% of the time how a new prescription will interact with existing prescriptions and the patient’s diet. It is imperative that caregivers look for signs of adverse drug effects. One of the leading causes of errors is the failure to respond or to respond too late to signs and symptoms of drug toxicity.

Types of Medication Errors During Administration

  • Inappropriate crushing and slicing of medication
  • Inadequate use of fluids
  • Improper food and antacid ingestion with medication
  • Incorrect administration of enteral nutritional fluids
  • Under dosing or overdosing of medication
  • Expired or incorrect medication
  • Misdiagnosis and incorrect prescription
  • Incorrect duration or frequency of medication

Many of these errors can be prevented by paying attention and strictly adhering to the instructions of the physician. Once an error has been identified, the individual or caregiver should immediately contact the physician and stop administering the medication incorrectly.

Negligence & Medication Errors

Although some adverse drug effects are not preventable, a majority of them are caused by mistakes that could have been avoided. Because nursing facilities are understaffed, and sometimes lack experienced and certified staff members, simple mistakes happen far too often. If you notice that nursing staff are not strictly following medication orders or are not monitoring effectively, you should bring this to the attention of the physician and the facility staff immediately.


Crespin, D., A. Modi, D. Wei, C. Williams, S. Greene, S. Pierson, and R. Hansen. United States. National Library of Medicine. Repeat medication errors in nursing homes: Contributing factors and their association with patient harm. Bethesda: PubMed Health, 2010. Print. http://www.ncbi.nlm.nih.gov/pubmed/20624615

Hamilton, Thomas. United States. Department of Health and Human Services. Nursing Homes – Clarification of Guidance related to Medication Errors and Pharmacy Services. Centers for Medicare & Medicaid Services, 2012. Print. http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-13-02.pdf

Hansen, R., P. Cornell, P. Ryan, C. Williams, S. Pierson, and S. Greene. United States. National Library of Medicine.Patterns in nursing home medication errors: disproportionality analysis as a novel method to identify quality improvement opportunities. Bethesda: PubMed Health, 2010. Print. http://www.ncbi.nlm.nih.gov/pubmed/20684035

“Medication Errors in the Nursing Home.” Nursing Home Families. N.p., n.d. Web. 20 May 2013. http://www.nursinghomefamilies.com/NH_web/Medication_Errors.html


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