August 2006, Volume 36 Number 8 , p 24 - 25
CAESAR, BERNITA R. RN, CRRN, BSN; HUTCHINSON, BETTY RN, AACBIS, CRRN
“I'M SO MAD at myself! I almost mixed up Mrs. Johnson's medications with her roommate's. I checked her armband and…well, her medications looked so similar that I was sure I had the right ones. What can I do better?” asked a staff nurse. As education coordinator and nurse-manager, respectively, we'd heard similar stories before.
Approximately 1 of every 131 outpatient deaths and 1 of 853 inpatient deaths result from medication errors. Baxter International reported that 39% of errors originate with prescribers, 23% occur during transcribing or compounding by pharmacists, and 38% occur during administration by nurses.
In 2002, our facility implemented patient-safety initiatives that focused on reducing medication errors. We hoped that technology would provide some innovative solutions.
In 1997, our facility had adopted ...