MEDICATION SELECTION AND ORDERING
Key Areas for Errors:
- Appropriate indications for medication
- Avoiding drug-drug interactions
- Allergies
- Concomitant medical conditions
- Common dosing errors: look alike-sound alikes, unusual regimens, mathematical errors
- Black box warnings
- Delegating prescriptive authority to less-trained staff
Strategies to Reduce Errors:
- Document thought processes with high-risk or narrow therapeutic index medications
- Don’t be “first to try a new medication, or the last to abandon an old”
- Formalized medication reconciliation—enlist the patient, use one pharmacy when possible, and update at all transitions in care
- Single allergy registries
- Recognize the common look alikes/sound alikes
- Avoid math errors—mg/kg/day, factor of 10 issues, etc.
- Know the black box warnings; look up common medications periodically
- Set your EHR alert properly: too high=alarm fatigue; too low=complacency
- If you delegate any prescriptive authority, train, educate and clarify protocols
DELIVERY: DISPENSING AND ADMINISTRATION
Key Areas for Errors:
- Communication failures
- Entrusting electronic system and never questioning items that don't seem appropriate
- Alarm fatigue
- Failures in The 5Rs—right drug, right dose, right patient, right route, and right time
- Look alike, sound alike medications and labels
Strategies to Reduce Errors:
- Training in standardized communication techniques: SBAR, readbacks, TeamSTEPPS
- Reconcile medications at every transition
- Avoid distractions during dispensing/administration
- Just Culture—all are open to question an order, and disciplinary action only when willful disregard
MONITORING AND MANAGEMENT
Key Areas for Errors:
- Failure to consider or perform follow up or monitoring of medications
- Systems failures of necessary monitoring labs
- Failure to reconcile long-term medications
- Incomplete medical histories
- Failure to consider adverse drug reactions as diagnosis changes in the patient's condition
Strategies to Reduce Errors:
- Know the riskiest medications: anticoagulants, opioids, and narrow therapeutic index medications
- Have a system that works for follow up/monitoring
- Shared decision making with patients
- Always consider medications as the cause of a change or a new medical condition
- Use and document formal patient education
Information in this article is for general educational purposes and is not intended to establish practice guidelines or provide legal advice.
Article originally published in 3Q24 Copiscope.
