Enhanced Medication Safety
By Jeannell M. Mansur
Improving communication and instituting double-checking protocols can catch a host of medication errors.
Cerebyx versus Celebrex versus Celexa. The first drug is used to treat seizures, the second to relieve pain and inflammation, and the final one to treat depression. Vastly different applications, shockingly similar names. With a slip-up on a written prescription or a misinterpretation at the pharmacy, a patient may be taking something that is not needed and potentially harmful.
Health care practitioners are all too familiar with this scenario. According to the Institute of Medicine’s July 2006 report Preventing Medication Errors, medication errors harm an estimated 1.5 million people in the United States each year, resulting in upward of $3.5 billion in extra medical costs. Put into even more personal terms, every hospital patient may be subjected to as much as one medication error each day. These are shocking statistics for a largely preventable problem.
Common Medication Safety Issues
With more than 33,000 trademarked and 8,000 nonproprietary medication names in the United States as of 2004, it’s no surprise that many drug names sound and look alike. (See FDA Consumer Magazine, July/August 2005.) Nurses, pharmacists and others on the front lines may easily confuse unclear prescriptions because of the similarity in name or appearance.
This sort of miscommunication extends beyond similarly named drugs. Using abbreviations and zeroes after decimal points creates additional unnecessary uncertainties. Handwriting (the penmanship of many physicians is notoriously atrocious) often leaves things up for interpretation.
Given that noncommunication or miscommunication is to blame in many common errors, the central person with whom health providers need to communicate—the patient—should be the first priority. Many times, historical information on the patient is incomplete and does not include detailed information on a patient’s allergies, previous diagnoses and lab results, or other medicines that are being taken, including vitamins, herbs and over-the-counter medication. Collecting this information and consistently reviewing it prior to making treatment decisions will allow clinicians to carefully consider potential contraindications and medical concerns.
In this same vein, points of transition for patients yield yet another set of challenges for safe medication use. According to the Institute for Healthcare Improvement, up to 46 percent of medication errors occur when new orders are written at patient admission or discharge. Changing a patient’s clinical status or transferring a patient introduces new caregivers and creates the opportunity for misinterpretations or missed instructions.
Finally, lack of information on a particular drug or outdated warnings can also impede safe medication use. With so many drugs on the market, up-to-date and clinically relevant drug information must be available to all involved in the medication use process.
Solutions for Improving Medication Safety
Though there are a wide range of concerns in relation to medication safety, there exist a number of practical solutions that can realistically be implemented in any setting.
Better communication. First and foremost, increased communication with patients can drastically reduce medication errors. The key factor here is that the conversations need to be two-way. Patients should not just listen to health professionals; they should be actively engaged in their own health care, question prescription recommendations and take responsibility for making sure that caregivers know their health history. Providers should spend a few extra minutes with the patients to teach them about medications and to listen to patients’ questions about proper use or side effects. See the figure below for suggested topics in patient education.
Keeping records. It’s also vital to maintain a record of a patient’s medications and to make sure to discuss all pills or supplements he or she takes—from vitamins and herbal remedies to over-the-counter drugs and regular prescriptions. Statistics from the Institute of Medicine show that, inany given week, morethan four of five U.S. adults take at least one medication (e.g., prescription or over-the-counter drugs, vitamins, minerals or herbalsupplements), and almost a third take at least five different medications. To avoid those circumstances when a medication may need additional monitoring or its use may be contraindicated, it is critical to know in detail what the patient takes at home.
As previously mentioned, medication errors occur most commonly at transitions. Creating a complete and accurate list of all medications the patient is currently taking; comparing it against the admission, transfer and/or discharge orders when writing medication orders; and communicating thoroughly about current medications with the next provider of care as well as the patient are essential to reducing medical errors in prescriptions and dosing.
Involving the pharmacist. Another way to decrease medication errors is to involve the pharmacist more actively in the patient’s care. A recent study from U.S. Pharmacopeiafound that surgical patients face an increased risk of harmful medication errors due to a lack of comprehensive oversight of medications. The conclusion of that report? Dedicate pharmacists to the perioperative units. Even in a non-perioperative setting, the pharmacist can provide critical support in providing essential drug information, monitoring patients’ response to medication, providing education to patients on the medications they take or making recommendations on medication changes to optimize drug therapy.
Double-checking. Medication systems should be designed to detect the error before it reaches the patient. High-risk medications—those medications that have the potential to cause serious patient harm if they are given in error—may benefit from an additional, independent double-check. An independent double-check means a second person goes through the whole process independently, including drawing up the medication and administering it to the patient. Studies at the Institute for Safe Medication Practices have shown that independent double-checks detect approximately 95 percent of errors.
The take-away message for all health leaders is this: Enhanced communication between providers, patients and pharmacists is critical to reducing the likelihood of medication errors. Communication among those health care professionals responsible for prescribing, administering, preparing and dispensing, or monitoring medication is critical to optimizing treatment. Leaders must inspire teamwork and open communication. Understanding the value of communication pertaining to the use of medications and fostering an environment that supports excellent communication can decrease the incidence of medication errors and resulting harm to the patient.