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More dosage errors are made in the ED than other hospital departments, and fewer potential dosage errors are caught before they occur, according to a new report from the Rockville, MD-based United States Pharmacopeia (USP), which analyzed medication error reports submitted to its national database in 2001.
According to the report, the most common errors in the ED involved improper dosing, with more than 75% of errors occurring during prescribing or administering. ED staff intercepted only 23% of errors, whereas 39% of errors were intercepted in other areas. To dramatically reduce errors in your ED, use these strategies:
• Assess automated medication dispensing machines units.
Collaborate with pharmacists to survey the contents on a regular basis, advises Lt. Cmdr. Christopher Schmidt, RN-CS, MSN, CEN, emergency/trauma nursing specialty leader for Jacksonville, FL-based Nurse Corps, United States Navy, and division officer for the ED at Naval Hospital Jacksonville.
Check for similar appearance, name
Make sure that drugs similar in appearance or name are not stored in the same drawer, check that all medications are stored in the correct spot, and remove items that may not be necessary, such as multiple-dose formulations, Schmidt recommends. For example, instead of storing both 1 g and 2 g vials of cefazolin, stockpile more of the 1 g, so nurses can take two vials if needed, which eliminates the potential for an overdose, he suggests.
• Eliminate the need for nurses to prepare dosages.
Consider using pre-filled or prepackaged medications for vasoactive drugs requiring mathematical computation, says Schmidt. At Naval Hospital Jacksonville, a "stat pharmacy request" system was implemented, with nurses calling the pharmacy to ask for rush orders of certain medications, such as intravenous drugs that require calculations to ensure proper dosing, says Schmidt. This practice is effective in reducing errors and anxiety of nursing staff, but it must be continuously evaluated, he cautions. "As good as it sounds, if it’s not consistently done, the nurses may go right back to the old way of doing things," he says.
• Perform verbal check backs.
Have a system in which verbal orders are communicated back to the physician, says Schmidt. "If the order is called back incorrectly, it can quickly be clarified and corrected on the spot," he says. "That will help reduce errors related to prescribing." The key is to encourage ED staff to report potential errors, he says. "People are fearful of financial and professional retribution if they report their own actual errors or near misses," Schmidt adds. "We are all human and make mistakes. A quiet health care provider may not always be the safest one," he contends.
(Editor’s note: The views expressed by Schmidt in this article are his and do not reflect the official policy of the Department of the Navy, the Department of Defense, or the U.S. government.)
For more information on medication errors in the ED, contact:
• Lt. Cmdr. Christopher Schmidt, RN-CS, MSN, CEN, Division Officer, Emergency Department, Naval Hospital Jacksonville, 2080 Child St., Jacksonville, FL 32214. Telephone: (904) 542-7350. E-mail: firstname.lastname@example.org.
• A free copy of the United States Pharmacopeia recommendations can be accessed on the organization’s web site: www.usp.org. Click on "Practitioner Reporting," "Summary of Information Submitted to MEDMARX in the Year 2001: A Human Factors Approach to Medication Errors." Under the "Medmarx 2001 Data Details," section, click on "A look at Emergency Departments."