Why are mental health nurses still continuing to make drug errors?

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Why are mental health nurses still continuing to make drug errors?


Administration of medicines is a key element of nursing care. Every day some 7000 doses of medication are administered in a typical NHS hospital (Audit commission 2002a).

Drug administration forms a major part of the clinical nurse’s role. Medicines are prescribed by the psychiatrists and dispensed by the pharmacist but responsibility for correct administration rests with the registered mental health nurse (O'Shea 1999). Each registered nurse is accountable for his/her practice. This practice includes preparing, checking and administering medications, updating knowledge of medications, monitoring the effectiveness of treatment, reporting adverse drug reactions and teaching patients about the drugs that they receive (O'Shea 1999). The patient is expected to receive the correct medication at each drug round but several studies have shown that this is not always the case (Ferner 1995). Medication errors do occur and are a persistent problem associated with nursing practice (O'Shea 1999).

The aim of this paper is to answer the question: Why are mental health nurses still continuing to make drug errors? In order to answer this question this paper shall examine the guidelines that nurses must adhere to when administering drugs, shall provide a definition for ‘drug errors’, to evaluate why drug errors occur and to consider the effectives of strategies that are aimed at reducing drug errors on the ward.


There are a number of pieces of legislation that relate to prescribing, supply, storage and administration. It is essential that nurses comply with them (NMC 2003).

The 1968 Medicines Act was the first comprehensive legislation on medicines in the United Kingdom. The act provides the legal framework for the manufacture, licensing, prescription, supply and administration of medicines. The act classifies medicines into the following categories: prescription only medicines, which are medicines that may only be supplied or administered to a patient on the instruction of an appropriate practitioner (a doctor, dentist or psychiatrist) and from an approved list for a nurse prescriber. The pharmacist is the expert on all aspects of medicine legislation and should be consulted. Pharmacy only medications are only available to buy from a registered primary care pharmacy provided that the pharmacist supervises the sale. General sale list medicines do require neither a prescription nor the supervision of a pharmacist and can be obtained from retail outlets (NMC 2002).

In 1992 the UKCC published Standards for administration of medicines and was replaced in 2002 by the NMC's Guidelines for administration of medicines. The guidelines state principles for the administration of medicines. They state that in exercising your professional accountability in the best interests of your patients the registered nurse must know the therapeutic uses of the medicine to be administered, its normal dosage, side effects, precautions and contra-indications, be certain of the identity of the patient to whom the medicine is to be administered, be aware of the patients care plan, check that the prescription, or the label on the medicine dispensed by the pharmacist is clearly written, has considered the dosage, method of administration, route and timing of the administration in the context of the condition of the patient and co-existing

therapies, check the expiry date of the medicine to be administered, check that the patient is not allergic to the medicine before administering it, contact the prescriber or other authorized prescriber without delay where contraindications to the prescribed medication are discovered, or where assessment of the patient indicates that the medicine is no longer suitable, make a clear, accurate and immediate record of all medicine administered, intentionally withheld or refused by the patient, ensuring that any written entries and the signature are clear and legible, it is also the  responsibility of the nurse to document if the administration of medicines is delegated to another member of the nursing team.

The guidelines also state that when complex calculations are being carried out it may be necessary for a second practitioner to check the calculation in order to minimize the risk of error and that the use of calculators to determine the volume or quantity of medication should not act as a substitute for arithmetical knowledge and skill.

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The American Society of Hospital Pharmacists (1982) defined a medication error as a dose of medication that deviates from the physicians order as written in the chart or from standard hospital policy and protocol. From this definition the society have identified 9 categories of medication error namely; Omission error, unauthorized drug error, wrong rate error, wrong dose error, wrong route error, wrong dosage from error, wrong preparation of a dose and incorrect administration technique. Wolfe (1989) defines a medication error as mistakes associated with drugs and Intravenous solutions ...

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