Common Medication Errors

See also Pharmacy Newscapsule

From: Douglas Englebert, Division of Quality Assurance

There have been several serious medication errors that have resulted in Class A and B violations for health care facilities in the state. Most of these are easily avoided with proper written orders. Listed below are the most common errors that were cause for concern:

  1. Do not use U to abbreviate the word units when ordering medications. An error found was Insulin 4U that was taken as 40 units. Always write out the word units.
  2. Do not use a trailing zero when writing orders. Another error involved the dose of 5mg that was written 5.0mg and the period was not seen. In this case 50mg or ten times the dose was given.
  3. Do use zero to begin a number less than one. An order for one tenth of a drug was written .1mg and the patient received 1mg. If the order was written as 0.1mg, this should not have happened.
  4. Another source of error is the abbreviations for every day (q.d.), every other day (q.o.d.), and four times a day (q.i.d.). In several instances the period in q.d. was mistaken for an i and the drug was given four times a day and not daily.  The opposite has also occurred.
Last Revised: February 11, 2015