Patient safety is an essential part of nursing care; the ultimate aim is to avert avoidable errors and harm to patients. The Nursing and Midwifery Council's (NMC) (2018)Code requires nurses to put the interests of people using or needing nursing services first.
Elliot et al (2021) estimated that each year in England there are 237 million errors at some point in the medication process; nearly three-quarters of these have little or no potential for harm but 66 million are theoretically clinically significant. Avoidable drug errors are estimated to cost the NHS in the region of £98.5 million a year, taking up 181 626 bed days, as well as contributing to 1708 deaths.
Where there are hospital admissions because of medication errors, these are most likely to involve non-steroidal anti-inflammatory drugs (NSAIDs), anti-platelet drugs, epilepsy treatments, drugs used in the treatment of hypoglycaemia, diuretics, inhaled corticosteroids, cardiac glycosides and beta blockers. Most of the resulting deaths (80%) are caused by gastrointestinal bleeds from NSAIDs, aspirin, or the anticoagulant warfarin. Errors occur at every stage of the medicines management process, but over half (54%) are made at the point of administration. Error rates are lowest in primary care, but because of the sector's size, these account for around 4 in 10. Around 1 in 5 medication errors are made in the hospital setting.
The Department of Health and Social Care (DHSC) commissioned a new system to monitor and prevent medication errors. However, all Medicines Safety Improvement Programme activities are currently being reviewed so as to offer support to the national COVID-19 response.
The appropriate allocation of healthcare resources to reduce medication errors requires an understanding of where it is these errors exist and where they are causing the most problem. It is essential to use the data to make links between errors and patient outcomes to progress understanding and reduce harm. In order to create an environment that best promotes shared learning, professional regulators and leaders in the health and care organisations should encourage the reporting of medication errors.
Attempting to prevent errors from occurring in the first instance, and the creation of a culture that actively encourages continuous learning and reflection is advocated. Employer organisations should provide their staff with support so that they are able to uphold the standards in the NMC Code as an important part of providing the quality and safety expected by those who use services.
The medication process will never be error free, but steps need to be taken to reduce harm and support mechanisms must be in place to assist those making errors (Scobie and Thompson, 2005). People make mistakes all the time, not generally because they are incompetent or callous or negligent, but because of the complex systems in which they work. As there are so many possibilities for things to go wrong it is inappropriate for nurses to be punished when they make mistakes. Developing a culture of safety in an organisation and fostering a proactive approach to patient safety can enable meaningful learning to take place when errors have occurred. Increased incident reporting is a strong positive indicator of a good safety culture. Where there are negative attitudes and behaviours these will discourage staff from learning from preventable incidents. In an environment such as this, it is more likely that such incidents will occur again.