In days gone by, managing a patient’s prescription medications was far less complex than today. An adverse drug reaction or interaction is more likely today because of factors like:
- Fewer “lifetime” patients today—People move around more than in the past.
- New pharmaceuticals—The FDA approves new medications almost every day.
- Many more providers—Patients see multiple specialists for various conditions.
- More over-the-counter medicines—Dozens of former prescription meds convert to OTC availability every year.
- More alternative and nutritional remedies and supplements—Unregulated, self-administered herbs and vitamins grow in popularity every day.
Preventable adverse medication events exceed a half million every year, and most involve poor medication management or failure to reconcile medication lists. Issues usually arise from improper dosage and quantities. Many others are from omissions and general prescribing errors.
Assuming the posture of a champion of patient safety can help your public image—but PR won’t help much if your practice doesn’t get serious about reducing adverse drug events (ADEs). The Joint Commission’s Institute for Healthcare Improvement (IHI) recommends every healthcare provider pay special attention to four fundamental areas: Culture, high-hazard medications, processes, and reconciliation.
When a powerful standards organization like the Joint Commission makes a recommendation this broad and sweeping, it won’t be long until it works its way into the “acceptable standard of care” for physicians and institutions. Next thing you know, a plaintiff attorney is attacking you for providing care “not up to currently acceptable standards.” And if you don’t have a real patient-safety program in place, the jury will side with the plaintiff in a heartbeat. Use the IHI’s four areas of focus to design and implement effective drug safety procedures in your practice. Here are some useful ideas:
Culture: Looking out for your patients’ safety must become second nature to you and your staff. And that only happens when you conscientiously communicate and personally demonstrate a commitment to eliminating errors. Take a top-down approach when you train your staff. Have a physician prepare a presentation for a staff meeting at which you introduce your safety-related drug policies. In day-to-day operations, look for opportunities to remind staffers that you’re serious about safety.
High-hazard medications: Identify the medications commonly used in your specialty that pose a risk of severe ADEs. Create written policies with specific protocols for each substance. Train clinical staff regarding specific limitations or prohibitions. Make sure nurses understand any limitations or special instructions you determine as appropriate.
Core medication processes: Too many practices neglect written policies and procedures. Commonsense and word-of-mouth procedures may have sufficed once upon a time, but today’s environment demands formulating and following written protocols that describe who is responsible for ordering, dispensing, and administering medications within the practice. Thoroughly describe proper procedures for filling out prescriptions; phoning pharmacists; authorizing refills; and communicating with patients about questions, warnings and adverse effects. As tedious as it sounds, make sure you include every detail—leave nothing to chance.
Reconciliation: The IHI uses the term “reconciliation” to refer to the process of ensuring that you communicate accurate and complete medication information at each of several “transition points.” Handing off a patient’s care to another provider or to an institution creates a real moment of vulnerability. Many serious adverse events began with an incomplete information transfer as a patient moved from one provider to another. So pay special attention to your processes for communicating with providers to whom you refer patients. Create a medication form (on paper or computer screen) that lists current medications (including supplements, herbals, and nutraceuticals), known drug allergies, and any adverse reactions to medications. Use the form both for patients referring out and those being referred in. Assign the task to the physician or a trusted nurse. If an incoming medical chart doesn’t meet your standard, require your staff to find out the information from the patient, his or her family, and the referring physician.
These suggestions only provide a starting point for you and your practice. It’s up to you to create and follow the thorough protocols that will minimize the risk for medication errors in your practice.
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