The likelihood of medication errors in the nursing home is well recognized in America.

In response to the certainty of errors, certain state inspectors must determine the number of medication errors prevalent in a nursing home as part of an annual survey.

There are acceptable percentages and severity of errors in the daily dispensing of medications to residents under Medicare and Medicaid regulations, but an excessive number of such errors lead to the facility being cited and required to develop and fulfill a plan of correction.

The very fact that there is an acceptable level of errors would suggest a high probability that drug errors will not be eliminated in the current system of dispensing medications, making all nursing home residents at risk for minor errors, and periodically to significant, possibly life threatening situations.

Thus, individual nurses that are responsible for safe administration of medicines, and their employers face considerable penalties if breaking regulation §483.25(m) Medication errors, which requires the facility to ensure that 1. It is free of medication error rates of 5 percent or greater. (2.) Residents are free of any significant medication errors.

A nurse may report their facility for non-compliance with regulation §483.25(m),although, how likely is this?, with employers holding a noose around nurses’ necks. This is still rather ironic, though, when compared to the situation in the UK, where a nurse can be reported to the NMC for minor, and historic misdemeanors at the blinking of a vindictive employer’s eyelid, yet care facilities only face being savaged by a dead sheep called CQC.

I have often noted that the UK has adopted American (free market) approaches to health care (private nursing homes, etc.) without any meaningful penalties on corporate failure. The axe in the UK falls mainly on the nurse.

A study of 36 Ameerican healthcare organizations showed that medication errors occur in almost 20% of administrations (Arch. Intern. Med. 2002; 162: 1897-1903).

Procedural failures included occurrences such as failure to read a medication label, failure to check patient identification, and nonseptic technique.

Clinical errors involved mistakes that included wrong drug, wrong dose, and wrong strength of medication.

Failures and errors were classified according to severity on a scale of 1-5, to which I add a description of effect:

1. Unlikely to effect patient
2. Small effect
3. Considerable effect
4. Major effect
5. Fatal effect

The relative significance of medication errors is a matter of professional judgment.

If the resident’s condition requires rigid control, a single missed or wrong dose can be highly significant.

If the drug is from a category that requires strict control a single missed or wrong dose can be highly significant.

If an error is occurring with any frequency, there is more reason to classify the error as significant.

Possible Causes
• Basic Human Error – to err is human.
• Frequent Distractions/Care Changes – dearhearts, have you ever worked in the coal face of a busy, understaffed, nursing home or hospital? Have you ever been besieged by wandersome and confused elderly residents, or hounded by concerned ones? In the middle of a drug round have you been interrupted by a doctor on the phone, a moaning manager, and uncle Tom Cobley and all?
• Too Much Workload/Overtime – the entire evolutionary history of humankind encourages the body to shut down at night, but have you ever worked 12 hour night after night shifts with the expectation of unblinking awakeness and clarity of mind? If a prisoner of war was subjected to this treatment, the Geneva Convention would be cited! Good enough for nurses, though. Another stick for nurses to be beaten with by the Perfect Ones that control nursing.
• Improper Training – three years of being Jack and Jill of all nursing trades does not make a nurse an expert in any one, that comes some way after training, and, to be frank, the quality and compatability of some overseas nurse training is zilch. Ask the Perfect Ones of the NMC how many striking off orders in the last year applied to staff trained overseas. 10%? 15%?, oh no, dearhearts, the true figure is as shocking as it is inevitable.

Overall, 2,266 (53.1%) of administrations were interrupted one or more times.

The results showed that 74.4% of administrations had procedural failures, and 25% were associated with clinical errors.

The procedural failure checklist included 10 items. The most common mistake was failure to check a patient’s identification (2,500 of 4,271 administrations).

Four items related to a requirement that two nurses be involved in the drug administration. Two nurses failed to check an intravenous administration device where a control device was in use in 55 of 70 cases (78.6%), and compliance with the requirement for two nurses to witness administration of dangerous drugs was only 51.4% (164 of 319 cases). On the other hand, two nurses checked the preparation of a dangerous drug in 99% of cases, and two nurses signed the dangerous drug register in 94%.

The most common clinical error was incorrect timing of administration (688 of 4,271).

Errors that were most likely to be level 3-4 in severity were uncommon: wrong drug (13 cases), extra dose (seven), and administration of unordered drug (six).

Overall, 1,067 of 4,271 (25%) administrations were associated with one or more clinical errors, which were level 3-4 severity in 10.8% of cases.

‘Nurse experience provided no protection against making a clinical error and was associated with higher procedural failure rates’, the authors concluded.

Too true!

Florence Nightingale wouldn’t have much time to walk around with a lamp on a busy night shift today. I wonder what she would make of one of her nurses being sent to face a NMC firing squad for having made an error which 1. was unlikely to effect the patient, 2. had only a small effect. Yet, this is what happens today.

No nurse should be reported to the NMC for scale 1. and 2. misdemeanours, unless they happened repeatedly.

No nurse should have a catalogue of petty offences compiled on them by vindictive employers retrospectively. All issues to be dealt with promptly, then forgotten.

No nurse should be expected to be Superman or Superwoman at all times, only the totally absurd would expect this.

No nurse should pay the NMC subscription fee, it’s like paying for the rope that will hang you.

Set up an alternative Medical Council, comprising of doctors and nursing staff.

Down with the stooges of big business!

1. Physical/psychological/sexual abuse, not reporting same.
2. Fabricating/shredding records.
3. Medicine errors – scale 3-5 only, or 1-2 if constantly repeated.
4. Not communicating important information about a patient’s medical condition.
5. Incompetence in procedures which result in scale 3-5 effect, or 1-2 effect if constantly repeated.
6. Fake CV/qualifications/health history.

Petty and historic offences to be dealt with at source.

The guiding principle should be would you have been able to do better.

Hospital and nursing home environments that promote undue stress through short staffing should result in heavy fines on those that run them.

Stop allowing employers to ask the NMC to whip nurses without very good cause!
lenin nightingale 2015


  1. If only the NMC would read this and take notice. The majority of nurses have made drug errors, if fact I would say anyone who says they haven’t is a liar! Its how that drug error is dealt with is the answer to this ongoing problem.
    With the UKCC there was a ‘No Blame’ approach. If a nurse made a mistake, they reported it themselves. They had no fear of reporting it. It was used as a learning tool for teaching & supervisory meetings. The nurses never repeated the error. The offender was disciplined but not dispatched to the NMC(UKCC) SS It wasn’t immediately reported to safeguarding and have police visits, suspension, dismissal & NMC vultures picking out the meaty bits until they have half a case. The NMC then makes up the rest altering the law and any legal drawbacks to suit their needs,

    The nurse then goes through up to 2 years in no mans land, will they wont they? After this time they must trail up to London from all corners of the country at their own expense for a 1,2 or 3 day hearing, thereby incurring hotel costs as well as travel. This is why the majority do not attend or be represented. Unions back off due to costs. The NMC rely on this! At this stage they know they will have unmanageable conditions of practice applied (not much good to an unemployed nurse) be suspended and have interim suspensions added to that and then after 3,4,5 or even 7 or 8 years have a ‘PERMANENT SUSPENSION’ (another name for being struck off the register) How can this aggression by the NMC be justified? An appeal has to go through the High Court costing the nurse from £2500 to £7000 in solicitors costs and court costs. The majority of the cases are overturned on appeal.

    How can this change;
    Better medicine administration training for all newly qualified UK trained nurses.

    For all overseas staff, an interim entry to the register with a 3 month training programme to cover Missuse of Drugs Act & drug classification, medicine administration due to drugs having different names abroad.
    Overcoming language barriers especially colloquial terms & use of words in different areas, It happens’ having seen a nurse tell a patient they can go shopping when they go home, all the patient wanted to do was ‘spend a penny’, words like canny which has different meanings in different areas.
    Cultural differences, overseas nurses often dictate to patients or act without consent because of their own counties approach.The UK approach is different from their country of origin

    The NMC refuses to accept any ‘Duty of Care’ towards the ‘offending’ nurses in their claws, they do not give any support whatsoever to the nurses, who by this time is totally isolated from colleagues, demoralised, may be in financial ruin, be having family breakdowns because of the referral, be seriously mentally ill or suicidal. The NMC refuse to say how many cases of PTSD, serious mental health issues or even suicides have been as a direct result of their procedures because of their dealings with a simple medication error.

    Nurses become the Secondary Victim

  2. Thanks for comments.
    To note further- If an employer does NOT provide a safe environment in which the nurse distributes medication for instance wandering patients or few staff , that employer has NO right to report the nurse for an error. It is time the NMC considered such mitigating factors- as is done in the USA.

  3. Pingback: Silly bureaucracy and nursing errors - Wikihospitals

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