Medication Errors

Avoid these life-threatening mistakes

Meds and abbreviations are easily confused

Standardize and simplify. This is the advice from Lucian L. Leape, MD, of the Harvard School of Public Health in Boston, who is chairperson of a committee studying how physicians, hospitals, and health plans can reduce mistakes. The Collabora tive on Reducing Adverse Drug Events and Medical Errors, a project of the Institute for Healthcare Improvement in Boston, is working this summer and won't announce results until September, but the committee has already established that mistakes can be significantly reduced if hospitals adopt some simple procedures, such as unit dosing - the pharmacy prepares injections in advance of urgent need. Some tips from the collaborative:

· Standardize. Make medication rooms identical throughout the hospital to reduce the opportunity for mistakes.

· Simplify. Eliminate all unnecessary steps.

· Reduce "hand-offs." Decrease the number of people involved to prevent errors in the transfer of patients, information, and medications.

· Use constraints and "forcing functions." An example of this kind of feature is when cars won't start in reverse gear. These features eliminate the need for checklists or reliance on memory.

· Adjust work schedules. Keep work loads within an acceptable range.

· Improve prescribing practices. Create guidelines and standards, such as preprinted medication order forms with the most commonly prescribed drugs with selected dosages, frequencies of administration, and times for administration.

· Adjust the environment. Increase light, reduce noise, and eliminate confusion by avoiding clutter and keeping equipment in good condition.

· Facilitate error reporting. Adopt anonymous error-reporting mechanisms, dial-in hotlines, and rewards.

· Do not confuse look-alikes. Repackage and relabel.

The USP recommends using "per" instead of "/"; using "units" instead of "u"; and using "daily," "four times daily," and "every other day" instead of "QD," "QID," or "QOD." The organization also suggests using a leading zero before a decimal - 0.5, not .5 -and avoiding trailing zeros - 1, not 1.0.