ICU Medication Errors Literature Review Chapter

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Medication Errors in an ICU Unit

Medication Errors -- Including Look-Alike and Sound-Alike Drugs -- in an ICU Unit

Medication errors can and do occur in the ICU unit, and they often come from look-alike and sound-alike medications that can easily get mixed up. When a nurse or other health care professional gives a medication to a patient, that professional should be absolutely certain the medication is the right one, and in the right dosage (Helmons, Dalton, & Daniels, 2012). Unfortunately, that due diligence does not always take place, and people who want and need the proper medications do not always get them (Helmons, Dalton, & Daniels, 2012). Especially in an ICU, when patients are dealing with critical injuries or sicknesses, an incorrect, missing, or wrongly added medication could result in the worsening of a patient's condition or even the death of that patient (Athanasakis, 2012). In addition to medications that look and sound very much like other medications, transcription errors, pharmacy mix-ups, and a simple lack of attention can all lead to medication mistakes that can cause serious harm to patients who are already in the ICU.

There are measures that are taken to avoid these things, but they are not always effective. One of the reasons behind the lack of effectiveness is not having enough -- or the right -- measures available to nurses in the ICU (Pape, 2013). Another reason that effectiveness is lacking when it comes to preventing medication errors is that people make mistakes (Crigger & Godfrey, 2014). It is a human problem, and that part of it is very hard to overcome. Because there is no real way to take the human element out of the equation, and because people are fallible and can make accidental errors, ICUs need to consider other ways of avoiding the medication error problem (Kiekkas, et al., 2011). The best way for most ICUs to do this is to utilize technology that helps reduce errors and protect patients (Frith, et al., 2012). Often, this comes in the form of things like self-dispensing medication drawers and other advanced products. These dispense only the right medications, making errors less likely to happen -- provided the information on what medications are needed by that patient has been properly input into the machine previously (Elliott, Page, & Worrall-Carter, 2012; Helmons, Dalton, & Daniels, 2012).

Trends can be seen when looking at the literature over a period of time. While medications have changed, become more plentiful, and are now used for a wider variety of maladies, the number of medication errors that are being seen in hospitals has also continued to rise (Athanasakis, 2012). The numbers of medication-related deaths in hospitals have been reported to be as high as 400,000 per year, although other estimates show these deaths as low as 98,000 (Helmons, Dalton, & Daniels, 2012). Either way, that is an alarming number of people who die every year because medical personnel make mistakes with medication. More and more hospitals, and their patients, are finding these kinds of numbers unacceptable and insisting that changes are made and something is done in order to improve the quality of care patients in the ICU are receiving (Pak & Park, 2012). While medication errors are not the only issue faced, they are the only error that has been consistently on the rise, and over which it seems hospitals have very little control.

If the figures are to be believed, hospital medication errors would be the third leading cause of death, behind heart disease and cancer (Pape, 2013). That is a trend that can and should be reversed, as mistakes made by people who are focused on caring for others should never rank as a leading cause of disease. These numbers reflect more than just the ICU numbers, of course, but the ICU is often where the patients are in their most vulnerable state (Kiekkas, et al., 2011). Because of that, more of them succumb to medication errors and experience different levels of harm that could have potentially been avoided (Pak & Park, 2012). With the current trends showing that medication errors are growing, further studies can and should be done to address that issue and focus on why a serious problem that has been in the news for a number of years is still being ignored -- and actually getting worse in many respects (Elliott, Page, & Worrall-Carter, 2012). There are gaps in the literature that also must be addressed, including why these medication errors have been overlooked as a serious issue for so long, and how they seem to continue slipping through the cracks and being overlooked (Pape, 2013).

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The fact that they appear to be growing in scope is something that can and should have been addressed years ago, but most of the literature glosses over the issue and ignores the real crux of the matter (Frith, et al., 2012). While there is a great deal of literature that focuses on the fact that medication errors do exist, there is surprisingly little literature that goes beyond the acknowledgement of those errors. In other words, it is one thing to say that there are studies that address medication errors, but there are few studies that go beyond these errors to the true reason the errors are being made, how to correct them, and why they appear to be increasing. Literature has skirted these issues, but that is something that should not be allowed to continue (Athanasakis, 2012). The gaps that are seen in medication error literature can be filled, with further study of the issue (Pak & Park, 2012).

Instead of focusing only on the errors themselves, future studies should consider the ways in which the errors are increasing. Whether it is due to a lack of staff and a need to hire more nurses, whether pharmacies are making too many mistakes that trickle down to patients, or whether there are other reasons that have not been carefully considered, future study of the issue can help researchers find the problems and address them, so that the number of medication errors starts to decrease (Elliott, Page, & Worrall-Carter, 2012). It may not be possible to stop any and all medication errors in the ICU, because there will always be the human element that can put people at risk for mistakes (Athanasakis, 2012). However, the lower the amount of sway humans have over how the medications are dispensed, the lower the number of errors that will likely be seen when it comes to the ICU and other areas of the hospital (Pape, 2013). The issue with making those kinds of changes is mostly financial, as it is not inexpensive to employ new technology (Pape, 2013).

Several theories have been presented as to why medication errors in the ICU appear to be so common. The one that nearly always appears first and foremost is that human mistakes are very often seen. People are in a hurry, and they have many patients to care for. Nurses get tired, and they may be distracted by other issues they are facing in their personal or professional life. While that is certainly not an excuse for medication errors that can result in serious injury or even death, it is one of the most commonly cited reasons for the problem to occur (Frith, et al., 2012). With that in mind, theories have been advanced addressing the idea that nurses and others who work in the ICU should not have as much control over medications as they do at this point in time (Kiekkas, et al., 2011). Automated options are expensive, but they can save lives. Hospitals, however, have a hard time balancing this issue, because they already struggle to have enough money (Pape, 2013). The costs of healthcare continue to rise, and adding automated technology that costs hundreds of thousands of dollars will not help those costs become lower, or even remain stable. Despite that, it is difficult -- and many would argue, unfair -- to put a price on human life.

If the avoidance of newer technology due to cost is causing patients to become injured or even die because of medication errors, it would seem quite logical from a human life standpoint that the newer technology would be warranted (Elliott, Page, & Worrall-Carter, 2012). Theories abound regarding the value of this technology, and the percentages by which medication errors can be reduced (Athanasakis, 2012). Hospitals that have better medication dispensing technology for their ICU units and other areas do have lower numbers of medication errors, but the percentages are extremely variable (Crigger & Godfrey, 2014). Some hospitals seem to have enough of a difference to see real value in the upgrade, and others do not have that level of benefit. Because there are significant discrepancies, it becomes difficult to say that a particular level of technology can or would be more effective for a specific hospital when it comes to reducing medication errors (Pape, 2013).

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