In a highly unusual case, a nurse charged with reckless homicide after a medication error killed a patient pleaded not guilty in a state courtroom packed with other nurses who came in scrubs to show their support for the accused nurse defendant. The medication error occurred when the nurse injected the patient with a paralytic medication instead of the sedative Versed. This case is unusual because most of the cases involving medication errors are resolved in the civil action through a Plaintiff bringing a civil lawsuit for damages caused by the error. Some errors are negligence, some are gross negligence, and in this particular case, the allegation is that it is criminal. Obviously, that begs the question: what is a medication error. Many publications have focused on this and there are some accepted definitions.
Medication errors can occur at many stages of the medical care, including writing the wrong prescription or giving the wrong medication when the prescription is correct. They can also occur in many different settings, such as at a doctor’s office, urgent care facility, ER, hospital, or pharmacy. Still other prescription errors occur in the patient’s home when the home health aids give the wrong medication. A prescription is a written order, which includes detailed instructions of what medicine should be given to whom, in what formulation and dosage, by what route, when, how frequently, and for how long. A prescription error can be thought of as a failure in the prescription writing process that results in a wrong instruction about one or more of the normal features of a prescription. The prescription should include, at a minimum, the identity of the patient, the drug being prescribed, the dose, and the route, timing, frequency and duration of administration.
Adapting the definition of a medication error, a prescribing fault can be defined as a failure in the prescribing process that leads to, or has the potential to lead to, harm to the patient. A previous definition, stated that ‘a clinically meaningful prescribing error occurs when, as a result of a prescribing decision or prescription writing process, there is an unintentional significant (i) reduction in the probability of treatment being timely and effective; or (ii) increase in the risk of harm when compared with generally accepted practice’. However, this rules out prescribing faults that do not result in harm, and ignores the fact that it is desirable to detect and examine all errors, whether ‘clinically meaningful’ or significant, since an error indicates a weakness in the system, which might on a future occasion lead to an error of clinical relevance.