Medication Error Reduction Policy
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Ways To Prevent Medication Errors
Pin it More sharing options Linkedin Pin it Email Print When Jacquelyn Ley shattered her elbow on the soccer field, strategies to reduce medication errors her parents set out to find her the best care in Minneapolis. "We drove past five other hospitals to get to the one we wanted," says Carol Ley, M.D., an occupational health physician. Her
How To Prevent Medication Errors In Hospitals
husband, an orthopedic surgeon, made sure Jacquelyn got the right surgeon. After a successful three-hour surgery to repair the broken bones, Jacquelyn, who was 9 at the time, received the pain medicine morphine through a pump and was hooked up to a heart monitor, breathing monitor, and blood oxygen monitor. Her recovery was going so well that doctors decided to turn off the morphine pump and to forgo most common medication errors by nurses regular checks of her vital signs.Carol Ley slept in her daughter's hospital room that night. When she woke up in the middle of the night and checked on her, Jacquelyn was barely breathing. "I called her name, but she wouldn't respond," she says. "I shook her and called for help." The morphine pump hadn't been shut down, but had accidentally been turned up high. The narcotic flooded Jacquelyn's body. She survived the overdose, but it was a close call. "If three more hours had gone by, I don't think Jacquelyn would have survived," Ley says. "Fortunately, I woke up."Ley was pleased with the way the hospital handled the error. "They came right out and said the morphine pump was incorrectly programmed, they told me the steps they were going to take to make sure Jacquelyn was OK, and they also told me what they were going to do to make sure this kind of mistake won't happen again. And that's very important to me." The hospital began using pumps that are easier to use and revamped nurses' training. Ley believes there were many contributors to the error, including the fact that it was Labor Day weekend and there were staff shortages. "It goe
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Medication Errors Statistics 2015
Pharmacolv.67(6); 2009 JunPMC2723209 Br J Clin Pharmacol. 2009 Jun; 67(6): 681–686.
Medication Error Reduction Plan
doi: 10.1111/j.1365-2125.2009.03427.xPMCID: PMC2723209Medication errors: prevention using information technology systemsAbha AgrawalDepartment of Clinical Medicine and Medical Informatics, State how to reduce medication errors by nurses University of New York Downstate, Brooklyn, NY, USACorrespondence Professor Abha Agrawal, Department of Clinical Medicine and Medical Informatics, State University of New York Downstate, Brooklyn, NY 11203, USA. http://www.fda.gov/Drugs/ResourcesForYou/Consumers/ucm143553.htm Tel: +1-718-245-3980 Fax: +1-718-245-5347 E-mail: moc.liamg@ahba.lawargaAuthor information ► Article notes ► Copyright and License information ►Received 2009 Feb 9; Accepted 2009 Mar 18.Copyright Journal compilation © 2009 The British Pharmacological SocietyThis article has been cited by other articles in PMC.AbstractGiven the high frequency of medication errors with resultant patient harm and cost, their prevention is a worldwide https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2723209/ priority for health systems.Systems that use information technology (IT), such as computerized physician order entry, automated dispensing, barcode medication administration, electronic medication reconciliation, and personal health records, are vital components of strategies to prevent medication errors, and a growing body of evidence calls for their widespread implementation.However, important barriers, such as the high costs of such systems, must be addressed through economic incentives and government policies.This paper provides a review of the current state of IT systems in preventing medication errors.Keywords: CPOE, decision support, electronic health record, health information technology, medication errors, patient safetyA substantial body of evidence from international literature points to the risks posed by medication errors and the resulting preventable adverse drug effects. In the USA, medication errors are estimated to harm at least 1.5 million patients per year, with about 400 000 preventable adverse events [1]. In Australian hospitals about 1% of all patients suffer an adverse event as a result of a medication error [2]. In the UK, of 1000 consecutive clai
advocate for learning from the experiences of others—to take certain aspects of another’s experience and incorporate them https://www.ismp.org/newsletters/acutecare/articles/20100325.asp into your own work and life for the purpose of http://minoritynurse.com/10-strategies-for-preventing-medication-errors/ improvement. It is in this spirit of learning that we share with readers our support of a state-wide initiative in California (CA) to reduce medication-related errors that can be used as an example for all US hospitals to voluntarily adopt a similar medication error initiative. As a condition of licensure, every general acute care hospital in CA was required to adopt a Medication Error Reduction Plan (MERP; not to be confused with the ISMP MERP [Medication Errors Reporting Program]) to substantially reduce medication–related errors (http://law.justia.com/california/codes/hsc/1339.63.html) by January 1, 2002. The plans were required to include the to prevent medication implementation of technology proven to reduce errors. The submitted plans were approved by the California Department of Public Health (CDPH), and each hospital was required to implement its plan before January 1, 2005. Each hospital must review and approve the plan annually. MERP Components Table 1 Details regarding the required components in the hospital’s MERP are provided in Table 1. In brief, each hospital must adopt a methodology to assess, improve, and evaluate medication safety, with particular attention paid to prescribing, prescription order communication, product labeling, product packaging and nomenclature, compounding, dispensing, distribution, administration, education, monitoring, and use. This methodology must include a system or process to proactively identify actual or potential medication-related errors as well as concurrent and retrospective review of clinical care. The regulation defines a “medication-related error” as any preventable medication-related event that adversely affects a patient and is related to professional practice or healthcare products, procedures, and systems, including but no
StatisticsEventsMagazinePast IssuesBlogSubscribeFor EmployersMedia KitPost a JobRegisterFAQsPost a Job Select Page 10 Strategies for Preventing Medication Errors by Dexter Vickerie | Dec 31, 2015 | Blog | 0 comments It is important for all nurses to become familiar with various strategies to prevent or reduce the likelihood of medication errors. Here are ten strategies to help you do just that.1. Ensure the five rights of medication administration. Nurses must ensure that institutional policies related to medication transcription are followed. It isn’t adequate to transcribe the medication as prescribed, but to ensure the correct medication is prescribed for the correct patient, in the correct dosage, via the correct route, and timed correctly (also known as the five rights).2. Follow proper medication reconciliation procedures. Institutions must have mechanisms in place for medication reconciliation when transferring a patient from one institution to the next or from one unit to the next in the same institution. Review and verify each medication for the correct patient, correct medication, correct dosage, correct route, and correct time against the transfer orders, or medications listed on the transfer documents. Nurses must compare this to the medication administration record (MAR). Often not all elements of a medication record are available for easy verification, but it is of paramount importance to verify with every possible source—including the discharging or transferring institution/unit, the patient or patient’s family, and physician—to prevent potential errors related to improper reconciliation. There are several forms for medication reconciliation available from various vendors.3. Double check—or even triple check—procedures. This is a process whereby another nurse on the same shift or an incoming shift reviews all new orders to ensure each patient’s order is noted and transcribed correctly on the physician’s order and the medication administration record (MAR) or the treatment administration record. Some institutions have a chart flag process in place to highlight charts with new orders that require order verification.4. Have the physician (or another nurse) read it back. This is a process whereby a nurse reads back an order to the prescribing physician to ensure the ordered medication is transcribed correctly. This process can also be carried out