Four Ways to Reduce Hospital Medication Errors Today

While it may shock those outside of the healthcare industry to hear it, at most hospitals, medication errors are an ever-present reality. Many medication errors are relatively minor (e.g., a doctor prescribes the wrong medication, but a nurse catches the error before the drug is administered to the patient), and don’t affect patient care; but systemic issues that produce minor medication errors can also produce major ones, and all it takes is one of these to destroy a health care provider or a hospital’s reputation – or worse, a patient’s life – forever.

While all hospitals should strive for zero medication errors, even small improvements can have a material impact on patient safety. Healthcare executives should consider simple tactics, such as those below, to protect staff and patients alike:   

  1. Work together: Many medication errors occur due to ineffective or insufficient communication between hospital departments. One obvious way to counteract this risk – at least between nursing and pharmacy – is to virtually house those departments together. Hospitals are beginning to decentralize their pharmacies, transferring one or two pharmacists from the “basement” to the patient floor where they may work face-to-face with nurses, doctors, and patients. Here, pharmacists may serve as a second set of ears or eyes, cover some of the duties of a short-staffed nursing department, and counsel patients on the appropriate use of a medication. While this may seem like a significant undertaking, many of these hospitals have achieved a decentralized pharmacy without hiring additional staff by analyzing pharmacy workflows for operational efficiencies. What’s more, the benefits to decentralizing the pharmacy go far beyond patient safety – hospitals that have done so have also realized increased job satisfaction among the pharmacy team who feel they’re having a more direct impact on patient outcomes. 
  2. Target low-hanging fruit: For hospitals with short staffs and budgets, enacting system changes to reduce medication errors (particularly if they’re relatively minor) may seem like an uphill battle. One tried and true method to pick up some momentum is to collect medication error data, perform root cause analyses, and target low-hanging fruit. For example, hospitals may utilize simple data analytics including segmentation to identify the top 10 most common medication errors (note: this will bring you to the common type of error, not the common cause), conduct visual observations to identify the behaviors that cause those errors, and discuss (ideally, on an interdisciplinary team) ways to eliminate them. Sometimes, hospitals may find the same behavior or misconception is causing multiple errors, and a single change (e.g., physically separating “look alike, sound alike” drugs or eliminating unnecessary steps in the medication administration process) can have a dramatic impact. With the small issues tackled, the team may feel more empowered to put together a long-term action plan to enact mid-size and large changes.
  3. Upgrade reporting systems: While federal regulations require hospitals to track all errors and adverse events that harm patients, CMS predicts only 14 percent of medical errors are ever reported (SafePatientProject.org). There are many potential reasons – despite the fact that many staff members believe it is a function of their job to catch errors –  for this trend. As mentioned previously, most errors cause minimal to no harm to patients, and as such, staff may not find these events significant enough to report. In this case, hospitals need to educate their staff on how critical each piece of data – no matter how seemingly insignificant – is to improving patient safety. In other cases, hospitals have arduous reporting processes, and staff may feel they don’t have time to complete them. To solve for this, hospitals may consider streamlining their processes – removing unnecessary questions, offering digital reporting options, or even hiring additional staff to support this task. Finally, some staff perceive a “punishment culture” at their hospital, and are hesitant to report errors lest they get themselves or colleagues into trouble. Healthcare executives can rectify this by making sure to correct behaviors rather than punish actors.
  4. Get patients on board: Many healthcare professionals feel their hospital should take 100 percent of the responsibility for ensuring patients’ safety while admitted (and, sometimes, beyond). While this is understandable, teams who don’t engage their patients in their care are missing out on a critical opportunity for safety improvement. Hospital staff should study up on the most common medication errors and identify ways to partner with patients and caregivers to prevent them. For example, 16 percent of medication errors involve using the wrong route of administration (FDA.gov), such as when a patient orally ingests a suppository. Pre-discharge counseling and thorough instruction by a pharmacist on the correct use of prescribed drugs can greatly reduce or eliminate this error. Even short-staffed hospitals can minimize medication errors by targeting particularly vulnerable populations – including older people, who are likely to be taking multiple medications, patients for whom English is a second language, and patients who are isolated within the hospital – and making special efforts to ensure medication is administered properly to them within the hospital, and they’re educated enough to continue safe practices at home. 

Medical errors are nothing new, but recently, following a BMJ study identifying them as the potentially third-leading cause of death in the U.S., there has been a brighter spotlight on them. Public and private entities have been hard at work on macro solutions to the problem, such as new technology – including computerized physician order entry, barcode medication administration, and electronic medication reconciliation.

Such fixes are expensive, however, and in some cases, can cause an initial spike in medication errors due to the learning curve associated with implementation. Thus, it’s critical healthcare executives, hospital staff, and patients themselves are invested in reducing medication errors, and make a concerted effort – including through the actions above – to do so.

Kenneth Maxik has worked with interdisciplinary hospital teams for more than 20 years on quality, patient safety and compliance. In his role as director of patient safety at CompleteRx—a hospital pharmacy management and patient care company—he develops and annually updates a proprietary 250-point patient safety checklist for clients, including medical error measures, leveraging the data he collects to recommend protocols that improve patient safety at client facilities.

 

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