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April 2007

A Few Simple Steps You Can Take to Reduce Medication Errors

Medication errors are the most common source of medical error and patient injury, but they are also the easiest error to prevent. Preventing a medication error requires adequate communication, training and keen observation of your hospital staff. The easiest and first steps to help reduce medication errors can be found in the 2007 Critical Access Hospital National Patient Safety Goals established by the Joint Commission. Here are three critical goals and requirements they have listed to help reduce medication errors.

1. Improve the accuracy of patient identification: use at least two patient identifiers when providing care, treatment or services.

By using two patient identifiers, you implement a reliable system for identifying the correct patient the medication or treatment is to be administered to. All staff administering medication should be observed on a regular basis to see if they are actually using at least two patient identifiers before giving patients their medication. After you observe them, ask how they identify their patients. Provide proper training your staff needs to ensure safe administration of medication. Always continue to observe medication administration on a regular basis to ensure the correct policies and procedures are being followed.

2. Improve the effectiveness of communication among caregivers: Verify the complete order or test result by having the person receiving the information record “read-back” the complete order or test result.

This is crucial when receiving a verbal or a telephone order for medication. You must take an addition step beyond simply taking the order and writing it down. The person taking verbal or telephone orders must write down the complete order and “read-back” the order to receive confirmation from the individual giving the order. By reading back the order after it has been written down and the correct order is confirmed, you will help eliminate medication errors by improving communication. For example, a verbal order is given for medication by reading back the name, dosage, route and frequency of the medication. The receiver of the order has just made sure  every detail of the order was understood. This is a simple and easy way to help reduce errors caused by ineffective communication. Click here to view a sample of Briggs telephone orders that promote proper communication.

3. Improve the safety of using medications:

  • Standardize and limit the number of drug concentrations used by the organization.
  • Annually identify and review a list of the look-alike/sound-alike drugs used by the organization, and take action to prevent errors involving the interchange of these drugs.
  • Label all medications, medication containers (for example, syringes, medicine cups, basins) or other solutions on and off the sterile field.

The label needs to include the drug name, strength, amount and expiration date if it is not used within 24 hours. If it expires in the 24-hour period, the time of expiration should be included in place of the expiration date. All labels must be verified verbally and visually by two qualified individuals when the person preparing the medication is not the person administering the medication. No more than one medication or solution is labeled at a time, and any medications or solutions found unlabeled are to be immediately discarded.   

Also, the list of “Do Not Use” abbreviations is a step you should have already implemented. This step is critical for preventing medication errors and improving patient safety as well. Click here to view a complete list of “Do Not Use” abbreviations from the Joint Commission.

By reducing medication errors, you are improving patient safety, raising the quality of care, increasing patient satisfaction and accomplishing everything a hospital sets out to achieve.

Source: www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals/07_hap_cah_npsgs.htm

 

Phyllis Bouley L.P.N. AS
Clinical Consultant, Briggs Corporation

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