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Medication administration safety for elders and caregivers

by Isabel Fawcett

Many caregivers are responsible for a rather daunting task of medication administration to elders who are under medical supervision. Burying our caregivers' heads in the sand when it comes to the potential for medication errors is not an option. Wherever humans are involved, errors will happen. Medication errors happen to the brightest and best in the medical profession. Best for caregivers to face this issue head-on, objectively and with common sense.

Historically, doctors have been sworn to abide by the Hippocratic Oath. The Hippocratic Oath has its origins in Old World Greece. The Oath is taken by doctors who must swear to comply with ethical practices in medicine. Even without further elaboration, the message is on-point and clear.

My favorite *line in the Oath is: "…I will prescribe regimens for the good of [my] patients according to my ability and my judgment and never do harm to anyone…."

I'm glad that licensed physicians are sworn to such high standards of care. In spite of such high medical standards, individual abilities and ethical judgment will vary.

I am not a doctor. I provide round-the-clock assistive care to my mother. Her life depends on a medically prescribed regimen. I am a hawk on high alert when it comes to safe medication administration practices. There are lives depending on caregivers' and healthcare workers' strict adherence to medically prescribed regimens. No guesswork allowed when the stakes are so high. I would be devastated if any medication error compromised the life and health of any human being, certainly my mother's safety and well-being.

Medication Errors by Commission or Omission

Many medication errors in healthcare occur by omission, rather than commission.

Sane and ethical allied health personnel, including pharmacists, physicians' assistants, nurses and licensed doctors do not set out to harm patients. However, there have been high profile cases in the news featuring medication errors made by a healthcare worker's negligence, often by commission, meaning intentional. There are former registered nurses in the news who have been tried, and in some instances convicted, of administering lethal doses of controlled substances to patients.

Mercifully, negligent nurses are in the minority. The vast majority of nurses are a godsend to medical practice, elders and family members. Ethical, skilled nurses achieve sustained focus on high standards of care. Former nurses convicted of unethical nursing practices are right where they need to be, at arm's length from chronically ill patients and others.

Regardless, the overarching truth is that human beings make mistakes. As in the airline industry and regulated workplaces all across America, strict protocols, controls and best practices help prevent and mitigate human errors. Having worked for years in healthcare, I have every confidence in the healthcare industry's strong internal and multiple layers of external regulatory controls which help minimize medication errors. Industry controls also help to identify such errors. In addition to high public scrutiny, healthcare controls are as they should be.

Medication Administration Tips for Caregivers

If you administer presecribed medical regimens to an elder, keep the following in mind.

  • If you have any concerns about an elder's memory, get thee to thy elder's doctor. Be clear on prescribed regimens needing to be followed. Even prescription labels or pick-ups may have errors. Many mistakes are avoidable with frequent cross checks and balances.
  • Some medications are prescribed to be taken at regular intervals or specific times. Others may be weekly or monthly. Timely administration is the therapeutic goal. Calendar reminders in your cell phone, or other handy place, just may save your elder's life.
  • Avoid keeping multiple prescriptions in a drawer where you have to wade through to find the prescription your loved one needs at a certain time. Separate elders' prescriptions from other family members' prescriptions to avoid mistakes.
  • I administer multiple insulin injections daily to my octogenarian mother. If there is more than one type of insulin prescribed, avoid different insulin bottles in proximity to each other unless they need to be simultaneously administered. Mom's night insulin is far right in the refrigerator; daytime insulin, far left. Never the twain shall meet. The right insulin type - one bottle - per injection administration time is all that is needed for the task. The time of day determines which insulin bottle is out.
  • If anyone speaks to me while I focus on filling Mom's syringe with the prescribed insulin dose, I firmly and gently say that I do not wish to make a mistake, never taking my eye off the syringe's measurement gauges. Talking instead of focusing on reading cc's on syringes is bad medicine and bad news. Not only does Mom understand, but she expresses her gratitude.
  • Contact your elder's doctor promptly if you have made, or suspect you have made, any medication error. In certain instances emergency medical intervention may be needed. Don't delay emergency medical treatment in such situations.

Stay Tuned. More to Come.

It is not realistic to share as many tips as come to mind right now. Neither would any of my fellow caregivers have the time to read such a lengthy list in one sitting. I've walked a mile in your shoes, remember? Until the next round of medication administration tips, all we need is focus, focus, and focus.

Medication safety is a forever goal.

*Denotes original translation to English. Also available on the National Institute of Health website: