Safety in Medication Administration
LEARNING OBJECTIVES
On completion of the materials provided in this chapter, you will be able to:
1 Explain the fundamental need for patient safety programs
2 Describe the impact of medical errors on patient outcomes
3 Relate patient safety to the calculation and delivery of medications
4 Determine individual responsibility in maintaining a safe patient environment
5 Define the types of injuries associated with medications for health care workers
The concept of safety in health care is applicable to both patient populations and health care workers. Both groups are susceptible to injury unless measures are taken that maximize prevention while minimizing the likelihood that a medical error or injury will occur. The following sections relate to both patient and personal safety.
PATIENT SAFETY
Patient safety has never been more important. It is linked directly to a health care organization’s ability to attract patients, to fund services that are market competitive, and to meet the requirements for accreditation by regulatory agencies. Additionally, it is also important in the delivery of high-quality patient care outcomes of interest to third-party payers for reimbursement and external agencies monitoring quality. These parties include the federal government through the Centers for Medicare & Medicaid Services (CMS), the Joint Commission, the Leapfrog Group, and some state governments. All these agencies require reporting of significant or sentinel events that result in patient harm.
The risk associated with delivery of health services to patients creates a sense of urgency in monitoring safety. Health care, as an industry, is considered at high risk in regards to its ability to deliver safe patient care. In this people-to-people business, the likelihood of errors related to medications and procedures is greater than the likelihood of a product error in the manufacturing industry. This is believed to be due to many factors that are present in the health care culture today, such as
• The fast-paced environment in which patient care activities occur
• Advanced technologies that require more attention and skills
• Possible decreased staffing in critical positions, such as nursing and pharmacy
• A sicker and older patient population
These factors create a more complex environment for both patients and health care workers. The potential for negative patient outcomes increases as workers become more stressed in terms of management of time, patient needs for medication and treatments, and equipment. Negative outcomes can result in
• Complications that affect patients’ ability to get well and go home
• Serious physical or psychological harm
• Death
Safety Precautions for Patients
Health care workers who are administering medications to patients have a legal responsibility to ensure that the right medications are delivered to the right patient in the right dose and route at the right time and that the administration is appropriately documented in the patient’s medical record. A thorough knowledge of the patient’s medical history, including drug allergies and medications that the patient has previously taken, is necessary to safeguard against medication interactions and anaphylactic reactions. It is extremely important that health care workers understand the intended action of the drug that has been ordered, how it is to be safely delivered, and the potential effects (both therapeutic and side effects) it can have on the patient. Additionally, health care workers involved in medication administration need to be aware of “do not use” abbreviations and look-alike/sound-alike medication names that can increase the potential for medication errors. Examples include q.d., q.o.d., cc, o.s., o.d., and o.u. See the Joint Commission’s “Do Not Use” List (Table 9-1).
TABLE 9-1
| Official “Do Not Use” List* | ||
| Do Not Use | Potential Problem | Use Instead |
| U (unit) | Mistaken for “0” (zero), the number “4” (four) or “cc” | Write “unit” |
| IU (International Unit) | Mistaken for IV (intravenous) or the number 10 (ten) | Write “International Unit” |
| Q.D., QD, q.d., qd (daily) | Mistaken for each other | Write “daily” |
| Q.O.D., QOD, q.o.d., qod (every other day) | Period after the Q mistaken for “I” and the “0” mistaken for “I” | Write “every other day” |
| Trailing zero (X.O mg)† | Decimal point is missed | Write X mg |
| Lack of leading zero (.X mg) | Write 0.X mg | |
| MS | Can mean morphine sulfate or magnesium sulfate | Write “morphine sulfate” |
| Write “magnesium sulfate” | ||
| MSO4 and MgSO4 | Confused for one another | |
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