Medication Error in the Emergency Room Essay

The emergency department (ED), sometimes termed the emergency room (ER), emergency ward (EW), accident & emergency (A&E) department or casualty department is a hospital or primary care department that provides initial treatment to patients with a broadspectrum of illnesses and injuries, some of which may be life threatening and requiring immediate attention. Emergency departments developed during the 20th century in response to an increased need for rapid assessment and management of critical illnesses. In some countries, emergency departments have become important entry points for those without other means of access to medical care.

Upon arrival in the ED, people typically undergo a brief triage, or sorting, interview to help determine the nature and severity of their illness. Individuals with serious illnesses are then seen by a physician more rapidly than those with less severe symptoms or injuries. After initial assessment and treatment, patients are either admitted to the hospital, stabilized and transferred to another hospital for various reasons, or discharged.

The staff in emergency departments not only includes doctors, but physician assistants (PAs) and nurses with specialized training in emergency medicine and in house emergency medical technicians, respiratory therapists, radiology technicians, Healthcare Assistants (HCAs), volunteers, and other support staff who all work as a team to treat emergency patients and provide support to anxious family members. The emergency departments of most hospitals operate around the clock, although staffing levels are usually much lower at night. Since a diagnosis must be made by an attending physician, the patient is initially assigned a chief complaint rather than a diagnosis. This is usually a symptom: headache, nausea, loss of consciousness. The chief complaint remains a primary fact until the attending physician makes a diagnosis.

Patients arrive at emergency departments in two main ways: by ambulance or independently. The ambulance crew notifies the hospital beforehand if they are transporting a severely ill patient, and if the patients condition warrants, a physician may direct the ambulance crew to begin treatment while still en route. These patients are rushed to the emergency department’s resuscitation area, where they are met by a team with the expertise to deal with the patients’ conditions. For example, patients with major trauma are seen by a trauma team consisting of emergency physicians and nurses, a surgeon, and an anestheologist.

Patients arriving independently or by ambulance are typically triaged by a nurse with training in emergency medicine. Patients are seen in order of medical urgency, not in order of arrival. Patients are triaged to the resuscitation area, majors area, or minors area. Emergency/Accident and Emergency departments usually have one entrance with a lobby and a waiting room for patients with lessurgent conditions, and another entrance reserved for ambulances.

Medication errors can and do occur in all clinical settings. However, the complexity and fast-paced nature of care provided in the emergency department (ED) enhance the probability of errors occurring. Studies reporting medication errors in the ED setting have typically been limited to only one ED.

Data collected through USP’s two national voluntary medication error-reporting programs -MEDMARX and the Medication Errors Reporting (MER) Program—represent one of the largest reviews of ED errors reported from multiple facilities. (MER is presented in cooperation with the Institute for Safe Medication Practices.) An analysis of medication error records from both MER (1991-June 2003) and MEDMARX (calendar year 2002) uncovered 3,516 records of errors in the ED.

EDs were ranked as the fifth leading location of medication error in calendar year 2002. More than 300 unique facilities collectively reported more than 3,440 medication errors. The majority (94.8%) of errors did not result in patient harm. However, 5.2% did result in various levels of harm, with two fatalities reported.

Improper dose/quantity and prescribing errors (27%/22%) were the most common types of error committed (see Table 1). Performance deficit was cited as the leading cause of error (see Table 2). There were nearly 400 unique products reported, with heparin at 7.6% the most common drug reported in a medication error. Heparin was followed by ceftriaxone (3.0%), insulin (2.9%), meperidine (2.4%), and levofloxacin (2.4%). Patients appeared to receive medications for which they had previously reported allergies.

Medication errors and emergency room statistics reveal that emergency room departments have a greater rate of medication errors than any other facet of health care services. Patients in need of emergency room care are often those with the greatest need for urgent and proper care. The United States Pharmacopeia (USP) released the results of a major study regarding medication errors and emergency room cases in 2003. Since 1998, over 360,000 medication errors occurring in emergency rooms have been reported to the USP database. In 2001 alone, more than 2,000 cases of medication errors and emergency room cases were reported to the agency.

Timing is of the essence in emergency room situations and medications often need to be administered quickly and correctly. This haste, paradoxically, is one of the major causes of medication errors and emergency room departments need to have an efficient protocol in order to avoid these mistakes. The USP found that 23 percent of medication errors in emergency rooms were intercepted before they reached the patient, compared to 39 percent in other areas of hospital service. The combination of great pressures, a high speed and stressful environment, interruptions, and other complications makes medication errors in emergency rooms all the more likely. This fact, however, does not mitigate a patient’s right to receive prompt and appropriate medical care.

In terms of medication errors and emergency room situations, there are many different times at which an error can take place. There are three major types of errors that the USP have identified in the emergency room setting. Prescribing errors involve a physician’s failure to prescribe the correct medication. Omission errors involve a health care professional’s failure to administer a prescribed medication. Improper dosage errors occur when a patient receives the incorrect dose of a medication.

Medication errors can also occur when the wrong medication is administered altogether. Another consideration regarding medication errors and emergency rooms is a patient’s medical history, including current medications and known allergies. If overlooked, these can cause or contribute to medication errors and subsequent injuries. Communication breakdown among medical staff can also result in missed doses or duplicate doses of a medication.

There are steps that consumers can take to reduce the likelihood of medication errors in emergency room situations. Keeping a list of allergies and current medications can help avoid medication errors. Ultimately, it is the responsibility of medical professionals to administer the proper dose of a medication at the appropriate time. When medication errors occur in emergency rooms, they increase a patient’s risk for suffering injury and even death as a result of this medical negligence.

If you or a loved one has been injured as a result of medication errors in a health care setting, you may be eligible to seek compensation for your losses through a medical malpractice lawsuit. For more information on medication errors and emergency room cases, you may wish to contact a well qualified and knowledgeable attorney.

Based on these findings, the following conclusions can be drawn:

1. Nearly 6% of the errors resulted in some form of harm.
2. Distractions were the leading contributing factor to errors.
3. Omission errors were associated with patient deaths.
4. Errors involving improper dose/quantity (wrong dose) were associated more often with harmful outcomes than any other type of error.

References

1. Emily S. Patterson, Richard I. Cook, David D. Woods, Marta L. Render, “Examining the Complexity Behind a Medication Error: Generic Patterns in Communication”. Web.
2. David G. Schulke, “IOM Medication Error Identification and Prevention Study”. Web.
3. John P. Santell, “USP Patient Safety CAPSLink”. Web.
4. Michael R. Cohen, “ISMP Medication Error Report Analysis”. Web.
5. David P. Phillips., Jason R. Jarvinen, and Rosalie R. Phillips, “A Spike in Fatal Medication Errors at the Beginning of Each Month”. Web.