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10 Steps to Improve Your Medication Safety
Leroy Kromis
Publish Date: October 10, 2007   |  Tags:   Patient Safety

In my experience as a medication safety officer, I've found that simple communication and education efforts can prevent many potential errors. Here are 10 safeguards your facility can adopt to ensure improved medication safety.

Double-check the ID. First and foremost, make sure you're medicating the right patient. Always use at least two patient identifiers, and always obtain them unambiguously by asking open-ended, not yes-or-no, questions. That is to say, ask "Can you tell me your name?" not "Are you John Smith?" Patients who are disoriented, hearing impaired or suffering from dementia may agree to any name.

Avoid verbal orders. The artificial, sometimes complex names given to pharmaceuticals and abbreviations involving letters that sound similar mean that verbal orders lend themselves to hearing, prescribing and administering the wrong drug. Avoid verbal orders whenever possible and read back those that you are given.

Write out instructions. Doctors' penmanship is notoriously indecipherable, but written orders are safer than oral ones - as long as they avoid abbreviations, which have been implicated in many, many errors. For example, the Roman numerals I and II (one and two) can easily be confused with the Arabic numbers one and 11; Q.D. (take daily) can be mistaken for Q.I.D. (take four times daily) and IM (intramuscular) can resemble IV (intravenous) in some handwritings. Instructions should simply be completely written out.

Distinguish the similar. Some drugs have names that look or sound alike: Celebrex, Cerebyx and Celexa among them. Direct your staff to include the generic and trade names when charting these. Store them in different colored bins to highlight the difference. And use "tall-man lettering" when labeling them - employ all caps for the part of their names that are different. Two examples: hydrALAzine and hydrOXYzine, or DOPAmine and DOBUTAmine.

List pills and purpose. Listing both the medication and the indication for which it's intended will remove doubt as to what the prescriber meant and prevent misinterpretation on the dispenser's part, or at least raise a red flag for verification. If the handwriting's bad, Avandia might be misread as warfarin, but of the two, only "Take Avandia for diabetes" makes sense.

"High-alert meds." For many drugs, the risks resulting from errors are comparatively small, with about 5 percent of patients erroneously medicated likely to suffer serious injuries. Errors made with "high-alert medications" such as insulin, warfarin, heparin and narcotics, however, present a drastic difference in potential harm, with the risk of severe patient injury as high as 50 percent. The use of these drugs requires extra attention to safety - double-checked doses and other safeguards - and focused education for staff.

Standardize your formulary. There's no way any individual can keep track of the entire list of the thousands of drugs approved by the Food and Drug Administration. While the average physician regularly administers only about 20 drugs, there's often more than one drug to accomplish a certain aim, and there's often more than one physician prescribing in any given healthcare facility. Each physician may be able to understand the details and effects of his own particular list, but it may be difficult for the nurses who serve all of them to keep all of these drugs straight. Standardizing your facility's formulary down to a limited number of drug options will help your staff master the burden of understanding and ensure greater safety.

Embrace technology. It's a basic truth of systems engineering that the more redundancies built into a process, the safer it will be. When you think about it, though, redundancies are where the human mind is bound to fail, falling prey to automatic routines and the belief that mistakes won't be made. The value of technology is that it adds double-checks without human error: Scanning bar-coded medications against bar-coded patient wristbands; installing automated storage and dispensing cabinets operated by touchscreens and selected staff fingerprints; and ordering prescriptions electronically all enable interaction checks and remove handwriting from the process. This can ensure patients get the right doses of the right medications at the right times.

Reconcile patient medications. Make sure your record of what medications patients are taking is accurate and complete to the best of your ability and remains accurate - and accurately reported - from the time patients arrive, through handoffs, changes and additions, to their eventual discharge. Without verification, a small mistake or omission can continue on to big effects in patient care. Provide patients with a list of their medications at the time of discharge, send it on to the next provider they'll see and continue to keep it at your facility for future reference.

Partner with patients. JCAHO, CMS and the Institutes of Medicine agree: Educated patients are a critical step toward patient safety on all fronts. Unfortunately, we in healthcare have traditionally done a poor job of educating our patients. Only educated patients are going to be able to help you prevent medication errors, however, by knowing what they're being prescribed, what previous providers have administered them and what drugs they're allergic to or otherwise intolerant of. Clearly, the best way to educate patients is through oral teaching with checks for comprehension. You can use written education as an adjunct, but don't rely on it alone. Patient education costs providers some extra time, but the benefits are high indeed.