Eliminate Errors

The Hospitalist. 2009 May;2009(05):

May 6, 2009|The Hospitalist

Last summer, 17 infants mistakenly were given incorrect doses of the blood-thinning medication heparin during their stay at a hospital in Corpus Christi, Texas. Two of those infants died.

Thousands of medication errors, including the ordering, dispensing and monitoring of medication, occur each year in hospitals throughout the country. Several studies in recent years have shown that injuries resulting from adverse drug events (ADEs) account for up to 41 percent of all hospital admissions and more than two billion dollars annually in inpatient costs.

Whether a patient is an infant, child or adult, the potential for medication errors begins as soon as a patient reaches the hospital and continues well after discharge.

“Medication errors often start when the patient comes to the emergency room,” says Sandeep Sachdeva, MD, clinical assistant professor at University of Washington Medical Center in Seattle. “Patients usually don’t carry a detailed list of the drugs they’re taking. If they come in late at night, it may not be possible for us to get an alternative list.”

That’s why it’s important for drug reconciliation to begin at the time of arrival, Dr. Sachdeva says. “In my opinion, medication reconciliation is a dynamic process, and medication reconciliation is a daily process. When patients come into the hospital, certain medications automatically get changed to the medications that are available in hospitals, and anytime there is a change in medications, it’s an opportunity for an error.”

Opportunities for Error

Even if a patient arrives with a full medication list, once he or she transfers from one hospital unit to another or is discharged, the opportunity for errors increases exponentially, says Julia Wright, MD, director of hospital medicine at University of Wisconsin Hospital and associate professor of medicine at The University of Wisconsin School of Medicine and Public Health in Madison, Wis.

“What providers have to remember is that there are multiple stages at which mistakes can be made,” says William Basco, MD, director of general pediatrics at the Medical University of South Carolina in Charleston, S.C. The physician or nurse practitioner can make a mistake writing the order; a nurse can misread the order; a pharmacist can incorrectly prepare the order; and a floor nurse can make a mistake drawing up the medication or delivering it, Dr Basco explains.

Ensure Proper Medication Use

William Ford, MD, section chief of hospital medicine at Temple University Hospital in Philadelphia, offers these preventative suggestions:

Make sure you are writing the order for the right patient
If you have any questions, whether it’s dosing or scheduling of a medication, don’t be too proud to ask. Call the pharmacy or look it up in your pocket pharmacy guide
Don’t use abbreviations
Write legibly. “Doctors have notoriously horrible handwriting, only because we’re busy” Dr. Ford says. “I don’t think doctors have any special handicap to writing legibly. It’s just that we’re lazy, and we scribble. … Take your time.”
Reconcile medication at transitions of care. When patients are admitted or discharged, make sure you reconcile their medications. Make sure patients are going home on the medications they should be going home on.

What’s a Hospitalist To Do?

Although the opportunities for medication errors are many, Dr. Basco says hospitalists should take several steps to mitigate medication errors. First, he says, limit verbal orders for drugs. Instead, write the order out, print legibly and refrain from using abbreviations. He suggests writing out numbers and placing them inside parentheses after the corresponding numeral.