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Follow or subscribe, rate, and review this show in your favorite podcast app. Find the show on YouTube by searching for ‘TRC Healthcare’ or clicking here.
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If you’re not yet a Pharmacist’s Letter or Prescriber Insights subscriber, find out more about our product offerings at trchealthcare.com.
Follow or subscribe, rate, and review this show in your favorite podcast app. Find the show on YouTube by searching for ‘TRC Healthcare’ or clicking here.
You can also reach out to provide feedback or make suggestions by emailing us at ContactUs@trchealthcare.com.
This transcript was automatically generated.
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Welcome to Medication Talk, the official podcast of TRC Healthcare, home of Pharmacist’s Letter, Prescriber Insights, RxAdvanced, and the most trusted clinical resources.
On today’s episode, we’ll discusses practical strategies to promote medication safety across healthcare teams.
You’ll hear from members of our team at TRC Healthcare…Pam Piotrowski, Product Manager for Pharmacist’s Letter & Prescriber Insights and Mary Franks, Lead Nurse Planner for NetCE
This podcast is an excerpt from one of TRC’s monthly live CE webinars. Each month, experts and frontline providers discuss and debate evidence-based practice recommendations.
The full webinar originally aired on March 21st, 2024.
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And now, the CE Information.
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This podcast offers Continuing Education credit for pharmacists, physicians, and nurses. Please log in to your Pharmacist’s Letter or Prescriber Insights account and look for the title of this podcast in the list of available CE courses.
None of the speakers have anything to disclose.
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Now, let’s start our discussion!
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PAM PIOTROWSKI:
Let's start by exploring the concept of medication errors, examining the significant effects that they can have on patients and the health care systems alike, and discussing the various types of medication errors along with the contributing factors…The statistics surrounding medication errors are alarming. The WHO estimates that medication errors cost at least one death every day and injure approximately one point three million people annually in the United States of America alone. Globally the cost associated with medication errors has been estimated at forty two billion dollars annually or almost one percent of the total global health expenditure. These figures show that medication errors represent not only a profound human cost in terms of patient health and safety, but also impose a significant financial burden on the health care system…
Medication errors can happen during any phase of patient treatment including prescribing, dispensing, administering the medication, and monitoring the patient's reaction to the treatment. Now let's take a look at common examples of these types of medication errors and the reasons why these errors occur…
Prescribing errors can include choosing the wrong medication for a patient, getting the dose wrong, not accounting for how drugs might interact or a patient's medical history, and leaving out important details about how to take the medication… The factors that lead to these errors include lack of information…in the fast paced environment we all work in it's all too easy to miss a crucial piece of patient history. Whether it's allergies, past reactions to drugs, or the full extent of their current medications. These details are the linchpins of safe prescribing…The challenge amplifies with complex medical regimens. Training patients with multiple chronic conditions require an intricate balancing act of various medications…Time and pressure workload can also lead us astray. The demanding nature of health care with high patient volumes and back to back appointments means we're often working against the clock. This environment can lead to rushed consultations and consequently mistakes…Lastly, we must confront knowledge gaps. Medicine is an ever evolving field with new drugs and guidelines emerging continuously…
Dispensing errors can include giving out the wrong medication, the wrong form of medication such as tablets instead of liquid, incorrect dosages that could lead to an overdose or under dose…and mistakes on labels that cause confusion about how and when to take those medications…Dispensing errors in pharmacies can occur due to confusion between drugs that look alike or sound similar and are compounded by high workloads leading to bless scrutiny. Misunderstandings caused by unclear handwriting verbal communication…or digital prescription errors alongside a lack of thorough double checking…significantly contributes to these mistakes…
Administration errors can happen in various healthcare settings including hospitals, clinics, long term care facilities, and even at home if the patient or caregiver administers the medication. These errors can range from given a medication at the wrong time, through the wrong route, using the wrong technique, or even missing doses entirely. Administration errors can occur due to distractions in busy healthcare settings, misunderstandings from poor communication…lack of training on how to properly give medications. And not adhering to the essential five rates of medication administration, which includes verifying the correct patient drug dose route and timing…
Monitoring…errors happen when healthcare providers fail to properly observe in a assess the patient's response to their medication treatment. Monetary errors in medication management can occur when side effects are overlooked, Follow-up appointments to check-in on the effects of the medications are missed…or dosage adjustments that aren't made in response to changes in the patient's condition or lab results. Monitoring errors in health care can arise from not educating patients properly on potential side effects. Insufficient staffing leading to inadequate monitoring, poor communication among health care team members, and networking to update or review patient records, all of which can compromise the effectiveness of ongoing treatment monitoring…
Now that we have a base understanding of the types of medication errors, let's delve into the more common contributing factors and examine strategies to prevent them…As we discussed already several factors contribute to medication errors. We saw factors like complex medical regimens, similar medication names, and poor communication among healthcare providers. System issues such as staffing shortages and inadequate electronic health record systems also play a significant role. While all of these factors can cause medication errors, communication failures, and human factors are often cited as the most significant contributors…
As nurses physicians and pharmacists we have all been taught the five rights of medication safety during training. The right patient, drug, route, time and dose. Let's all take a minute to reflect on how these apply to our practice areas…There are many checkpoints to ensure the five rates are utilized potentially to avoid errors such as utilizing barcode scanning, clear handwriting of written prescriptions, avoiding unapproved abbreviations…providing clear instructions to the patient and the caregiver and avoiding decimal points if possible…
One of the leading factors contributing to medication errors is communication failures. This can occur at any point in the health care process from prescribing to dispensing…and administering medication…Miss communication between healthcare providers or between providers and patients can lead to serious health events…Now let's explore strategies for improving communication across the health care teams.
Using technology like electronic health records and e prescription…software is key to reducing medication errors by making the prescriber clearer and preventing mistakes with dosages and tug interactions…These tools streamline the prescribing and dispensing process…enhance the clarity of the medication orders and significantly reduces the risk of errors related to handwriting, dosage calculations, and drug interactions…Despite our best efforts communication errors with e prescribing can and do occur. Common issues include the selection of incorrect drug formulations or strengths, including vague or incomplete dosing instructions, and critical details being overlooked when buried in notes or nonstandard fields. Recognizing these potential pitfalls is the first step towards preventing them. Pharmacist play a critical role in this ecosystem. It's important to carefully review each e prescription for clarity and completeness. Pay special attention to non standard fields where critical information might be noted. Enhanced the overall efficacy of electronic prescribing practices by identifying, reoccurring e prescribing issues and communicating these two prescribers. This can initiate collaborative efforts to find solutions…Moreover, some EHRs are equipped with real time updates and alerts about formulary changes. Generic alternatives, and insurance coverages, ensuring that prescribers make informed decisions and prevent therapy delays due to medications that may be unavailable or not covered for the patient. EHR systems also provide a valuable resource in the form of comprehensive logs of all entries and changes. This audit trail serves as a critical tool for tracking the source of any errors and promoting accountability within our health care practices…
Integrated clinical decision support tools in both e prescribing and EHR systems can play a significant role in mitigating medication errors, but only if the patient's information is up to date. Establish clear processes for updating health records promptly, assign responsibility to specific team members, set deadlines for updates, and implement regular checks to ensure compliance with record keeping standards…Accurate and up to date information provides comprehensive view of a patient's medical history, allowing doctors to tailor treatments and interventions based on individual needs and circumstances…Conducting regular training sessions for all staff involved in the prescribing process can ensure that these tools are utilized accurately and to their full potential…Finally, using standardized communication tools such as checklists, order sets and standardized forms is another effective strategy. These tools ensure that information is communicated clearly, completely, and consistently, thereby enhancing patient safety and streamlining how care processes…
A standardized communication tool like Sbar can ensure accuracy and completeness and communication. Sbar is a communication method used to provide concise and structured information exchanges between health care teams. Here's what each component represents. S stands for situation. This is where you briefly describe what's going on providing the immediate reason for the communication. For example, I am calling about mister Smith in room five who is experiencing severe chest pain. Next is b for background. Here you give the context needed to understand the situation. This might include relevant medical history or the lead up to the current problem. It's the backstory that shapes the picture like, mister Smith has a history of heart disease and had bypass surgery two years ago. Now moving to a for assessment. This is your analysis of the situation. It's not always a definitive diagnosis but your professional judgment on what you think might be happening. You could say, I believe mister Smith may be having a heart attack…Finally, our stands for recommendation. What do you want to happen next? This is where you suggest a plan of action or seek guidance. An example of this could be, I recommend that we administer nitroglycerin and prepare for a possible transfer to the ICU…Using Sbar ensures communication is clear structured, and efficient. It minimizes confusion and it maximizes the effectiveness in patient care…
Closed-loop communication helps to ensure that information is transferred effectively and can be crucial in preventing errors. It is essentially a three step process. One person sends a clear and concise message. The receiver repeats the message to confirm the message was received and understood correctly. And then the original sender verifies the confirmation. This method acts as a real time check catching and correcting communication errors immediately…
And finally patient centered communication emphasizes the importance of actively involving patients and discussions about their medications. Engaging patients in their own care is not a new concept, but its application and medication safety is vitally important. Studies show that patients who are informed and involved in their medication management are less likely to experience errors and adverse events. This engagement fosters the partnership between healthcare professionals and patients, encouraging open communication and empowering patients to be advocates for their own health…Visual aids, simplified written materials, and teach back methods can help ensure patients understand their treatment plans…Using plain language when discussing medications and their management is key…Engage an open non judgmental…with patients about their beliefs and concerns regarding their medications. Educating patients about the benefits and the risks of their medications can help align their treatment with their values and their preferences…Provide language interpretation services and culturally sensitive materials to bridge communication gaps. Understanding and respecting cultural beliefs and practices around medication can improve engagement and adherence…
Utilize technology to enhance patient engagement while being mindful of the digital divide. Simple tools like SMS reminders for medication doses or appointments can be effective and widely accessible. Provide tools and resources that enable them to track their medications, understand potential side effects, and know when and how to seek help. Additionally, develop and implement standardized processes…for engaging patients and medication safety. This can include routine medication reconciliations…regular reviews of medication plans, and consistent education efforts…And finally, regularly solicit feedback from patients about their experiences and challenges with medication management. Use this feedback to adapt and approve engagement strategies…
Human factors also play a significant role in medication errors. Healthcare professionals often work in high pressure environments which can lead to mistakes in prescribing, dispensing or administering medications. These can range from simple slips and lapses to more complex errors in judgment…Factors such as cognitive overload, stress and fatigue, and the lack of knowledge or training can significantly impact decision making processes and attention to detail. In today's world these are sometimes the most difficult to overcome, but we all need to ensure that we are doing what we can to maintain our focus and keeping our patients safe…
So how do you handle these particularly stressful workdays? What do you do when you're feeling ill or have something going on personally that may be interfering with your concentration and focus? I know we've all had these days. Techniques such as deep breathing exercises, short walks or even talking to a colleague can help manage stress levels and improve decision making. Sometimes even just a step back from the desk or from the office can help…Additionally work schedules can be organized to minimize fatigue such as modifying shift lengths and allowing for adequate breaks. These strategies prioritize mental health and can significantly reduce stress induced errors.
Breaking down complex tasks into smaller more manageable steps can also reduce cognitive overload. Distractions are a major source of errors during critical medication management tasks. Another way to reduce distractions is wearing vast fasches or badges signaling to others that a critical task is in progress and interruption should be avoided unless absolutely necessary…Implementing a double check system where another health care professional…independently reviews and confirms medications and dosages is a resource intensive, but effective strategy to minimize errors at crucial stages of patient care. This approach adds an extra layer of verification that can catch and correct potential mistakes. We often see these types of double checks in things such as sterile compounding, and then also with medications involving narrow therapeutic index drugs…
Finally many errors caused by human factors can be mitigated and managed by promoting a culture of safety. An example of this is just culture. Just culture encourages creating an environment where health care professionals feel empowered to report errors and near misses without fear of retribution…This includes for example, assertiveness training so staff feels empowered to speak up if they notice potential safety concerns…Rather than assigning blame adjust culture focuses on understanding the underlying system factors that contribute to errors. By analyzing errors in a non punitive manner, healthcare organizations can identify root causes and implement corrective actions to prevent similar errors from occurring in the future. While just culture emphasizes learning from errors it also holds individuals accountable for their actions when they demonstrate reckless or intentional disregard for safety particles…This helps maintain accountability within the health care system while still promoting a fair and supportive environment for reporting errors…By fostering a culture of continuous improvement, just culture encourages healthcare organizations to reevaluate and enhance their systems and processes to minimize the risk of errors. This may involve implementing new safety protocols, providing additional training and resources, or redesigning workflows to reduce the likelihood of errors occurring…
Environmental factors including poor lighting noise in cluttered workspaces and non clinical interruptions can lead to medication errors, emphasizing the need for well designed health care settings to ensure patient safety…Improvement the physical work environment can significantly impact medication safety. Some great ways to make a difference can be designating quiet zones for medication preparation and administration that minimize distractions…At the same time enhancing lighting and reducing noise in these areas can also improve concentration and accuracy and medication handling. We can also reduce fatigue and strain by analyzing the ergonomics of the workstations…assessing the current layout can also identify areas where inefficiencies or potential for errors can exist…strategically planning a layout that supports logical workflow can drastically improve medication safety and operational efficiency…Finally, designating specific clearly marked zones for receiving storage, preparation, verification, and dispensing operations can enhance safety…
System related issues such as inadequate electronic health record or EHR systems problematic workflows, and lack of integration across healthcare systems can lead to gaps and errors in medication management. Insufficient staffing and excessive workloads further exacerbate the risk of errors…Health care organizations can promote continuity of care, enhance patient safety, and improve medication management outcomes…Healthcare organizations can also develop clear communication channels and protocols for sharing medication related information without patient care facilities including pharmacies. This ensures that accurate and up to date medication lists discharge instructions, and any other necessary prior authorizations or medication assistance programs are communicated promptly and efficiently…
Increased in staffing can be challenging due to the factors such as budget constraints, workforce shortages, and competing priorities for resources. However organizations can evaluate and optimize workflow processes to eliminate inefficiencies and bottlenecks that contribute to medication errors. By identifying workflow barriers like redundant tasks, unnecessary documentation requirements and delays in medication delivery or administration…that can enhance efficiency and minimize the risk of errors. By integrating Adjust culture into the organization, these types of efficiencies can be brought to light from the bottom up…
It goes without saying that you should follow your organization's protocols and procedures. It's a good practice to routinely review standard operating procedures to ensure your actions consistently match them. But you can actively participate in your organization's feedback systems to report any safety concerns or inefficiencies from the established procedures and protocols. Your voice can highlight areas or improvement that might otherwise go unnoticed…You can also help foster just culture by encouraging colleagues to speak up about potential issues or hazards and actively listen to their feedback and suggestions for improvement…You can familiarize yourself with and actively use of the technology, tools and resources…available in your health care setting such as electronic health records, bar code medication administration technology, and clinical decision support tools. Look for any trading initiatives offered to enhance your proficiency in utilizing these resources effectively…And finally, get involved with safety committees or policy review boards within your organization. Use your experience of insights to advocate for changes that improve patient safety. Your initiative can lead to meaningful improvements that benefit everyone…
Now I'm gonna hand it over to Mary so she can discuss handling medication errors…
MARY FRANKS:
Thank you Pam So far we have learned the components of medication errors and understanding of the shortfalls that contribute to the errors. Let's now discuss how to handle those medication errors…You or someone on your teams have been involved in an error Now what? What emotions or thoughts may be going through your mind as you learn on the medication error? Is the patient okay? How did the error happen And how can we correct it?
Everyone remembers their first error I know I still do and it's been over ten years. Mine occurred while working in the emergency department as registered nurse And administering the vancomycin via the IV pump. The key to medication errors is to learn from the error and make changes to help mitigate the reoccurrence.
First and foremost, take care of the patient. As a provider, nurse or pharmacist, we all have the due diligence to take care of the patient first. Report the error. Know what your organization's process and policy is for error recording. Document as many details as possible. And as soon as possible. Because as time passes, these details become more difficult to remember, but are just as important. Then reflect on that event what possibly led to the error, identifying the root cause or causes…may allow you to take action to ensure that it doesn't reoccur. It can be as simple as adjusting your practice routine, or maybe some SOP or system errors that needed to be brought to your attention or your supervisor's attention. The last step is the key. How can we all learn from our mistakes…There are several checklists or forms that can help the health care team gather details of the error and help to retrace steps and ask questions to identify the root cause or causes. These types of checklists can help you to have all the information needed to report the error per your organization's policy.
Intuitive, easy to use programs will allow the user to focus more time on the actual error and collecting the details rather than finding out where and how to provide those findings. Having an open discussion about the process and explaining the why around why it's important to report this information can build trust within the team. A debriefing may be of service to providers and pharmacists as well as discussing a medication error as it occurs. Take some time to evaluate your own error reporting system…
There are many other medication safety considerations. Let's discuss some now, such as adverse drug events and other resources for medication safety…Adverse drug events or ADRs. An adverse drug event results from the use of medication including allergic reactions, side effects over medication and medication errors. It is estimated that eighty two percent of adults keep at least one medication. And twenty nine percent of adults take five or more medications. This leaves a lot of opportunity for people to experience an adverse drug event. ADR's account for approximately one point three million emergency rooms at this each year. This results in roughly three point five billion dollars in medical cents as annually. More than forty percent of these costs could be preventable with just a few best practices, such as patient counseling and follow-up, collecting complete medical histories including all of supplements and over the counter medications, and providing clear information that the patient and caregiver can understand…
There are many contributing factors to why adverse drug events are so prevalent. The important thing is to have a strong process in place to learn about new medications to market, new uses for established medications, and even new therapies for certain conditions…
There are certain drug classes that have a greater risk of adverse drug events. It is best to prepare the patient and caregiver in case they experience in ADR and what to do if those occur? Blesseners, antibiotics, diabetic medications, and opioids are at the most risk for ADRs…Antibiotic for one of the most prescribed medications classes in the United States, which contributes to the high number of the emergency department visits for adverse drug events from these medications. But even after accounting for how often antibiotics are prescribed, There is a substantial risk of an emergency department visit for an antibiotic associated drug events…from two thousand four to two thousand six. There was approximately one in one thousand risk that a person prescribed an antibiotic would require a visit to the emergency department because of this antibiotic use side effect…
Narrow therapeutic index drugs pose a good risk for adverse drug events as a small change in dosage can cause serious adverse effects. Including incapacity and death. Pain attention when prescribing and dispensing these medications can help to mitigate these issues…Anticoagulants are another class of medications that are considered NTI medications. Anticoagulants can cause serious harm, if dosing is incorrect…Finally, allergies contribute to potentially serious adverse events with medications. Tools like these help you investigate drug allergies or sensitivities and avoid adverse drug events with your patients. Such as investigating possible drug allergy or sensitivity…
Another consideration when looking at medication safety are the vulnerable populations. Pediatric and geriatric patients are particularly vulnerable to medication, adverse effects and errors. When looking at pediatric patients, medication errors are three times as likely to occur in infants and children than in adults. Up to one in four pediatric medication orders result in an error. And just over five percent of pediatric in patients may experience the medication error. About one third of medication errors in kids have the potential to cause serious harm…There are many aspects of pediatric medication use such as weight based dosing, lack of commercially available dosage forms, and complex calculations posing safety challenges. General safety strategies should always be used but in addition, regulatory and safety groups recommend maintaining current pediatric drug information resources, ensuring appropriate twenty four hour coverage of pediatric pharmacy services. And including a pharmacist with pediatric training and oversight of technology and pediatric medication use committees.
And we cannot forget about our geriatric patients as they also have special considerations that can make them more prone to medication errors or adverse drug events. Such as medication overuse or over prescriber, physiological conditions, such as reduced kidney or liver function.
PAM PIOTROWSKI:
So in summary, how can we promote patient safety? There's a few things that we can do. One, have a plan in place. This can include resources and policies for safe practice while providing care and what to do when an issue arises. Communicate expectations to your team, ensure that everyone understands the importance of and the whys behind the expected workflow…Share the responsibility. The entire health care team plays a role in promoting medication safety…Include the patient and the caregiver in the process. Ensure they understand their treatment plan and how to avoid complications…So in closing remember that we all play a part in medication safety every day. It truly does take a village to keep our patients safe and healthy so they can lead their best lives…
PAM PIOTROWSKI:
And now it's time for our questions portion of the program. This is the time when we get a chance to answer some of those questions and comments that you've been sending in throughout the presentation…
MARY FRANKS:
So one question that keeps coming up very frequently is about handwritten prescriptions…versus digitally electronically sent ones What percentage…would be still handwritten? I personally only write handwritten prescriptions on two locations and that is one because I don't have electronic prescribing for narcotics just because I work PRM usually with the clinic. So if I prescribe narcotics I do a handwritten prescription. But then also dual partner therapy for STIs. That way I used to work in school based health and that way we could still get those partners treated who weren't in the school. So that was one thing that I did. Pam how often do you see handwritten prescriptions in the pharmacy.
PAM PIOTROWSKI:
Yeah It's it's really interesting we see very few handwritten prescriptions now. Most of them are submitted through the electronic prescribing which is wonderful because…it's already semi populated for us So it takes away all those handwriting issues and not being able to necessarily read them. And it makes it a lot easier for the prescriber to insert the diagnosis codes and things to really help us avoid errors. And it even it's interesting because even when you take it think about pure handwritten prescriptions. Many offices have even moved to a typewritten prescription where they just sign it. Which helps a lot too So there's no question about what the drug name is or what the dosage is or should the decimal point be there?
MARY FRANKS:
We had another question…given the numbers of electronic prescribing. There was one question that came through about electronic prescribing, leading to other types of errors. Have you experienced many errors in medication prescribing in the pharmacy with electronic prescriptions?
PAM PIOTROWSKI:
Yeah There we've seen a few I mean there was when electronic prescribing first started to be used a lot One of the things that we would see a lot was they had that special comment section. So for instance they would prescribe that form in but they would put the extended release formulation notation…in those special modes which when it reaches the pharmacy it's sometimes in a smaller type, or it's not as prominent as the rest of the prescription instructions. So that was a that was a big thing that we had to retrain our folks to make sure that they looked in those areas and made sure that there wasn't any comments in there that would pertain to the actual prescription…
MARY FRANKS:
Perfect. And then one last question is how do you take a step back to avoid the autopilot feeling? I know if I am feeling overwhelmed by the end of the day, I do feel like I'm on autopilot especially if I've had a twelve hour shift in the clinic and by eight nine o'clock, my brain is just ready to shut down for the day So I really have to really double check myself triple check sometimes to make sure I did click the right medication in the electronic prescribing…double checking the patient's weight especially if they're a pediatric patient. What do you personally do especially in a retail pharmacy…
PAM PIOTROWSKI:
Yeah That's a that's another really great question And it is it's super easy in all of our practices We're so busy now. In all of our practices that autopilot…is really something that's that's sometimes tough to avoid. And really it's just a matter of the simple things of you know can you change stations So if you're in…specifically for your technicians if they're in a data entry station, can they move over into a dispensing station just to kinda help them have a fresh set of eyes or a a fresh set of duties to perform sometimes breaks that autopilot…up and and makes them practice safer. As a pharmacist Jeff as we're doing It could be simple things as doing the data entry check You know we typically start top to bottom. Is there of your screen is there a way to start bottom to top or start in the middle and just mix it up on what you're checking so that way you're not constantly going and checking the same five things in the same order. The other thing is a lot of times it's, you know it's a matter of key clicks So is there a different way of performing that versus using a mouse versus a keyboard sometimes that can split things up too.
MARY FRANKS:
Yeah That's another good a good example as well I I enjoy when I'm getting you know, towards the end of the day I'll actually stand out with some of my coworkers instead of sitting back in the office finishing my charting just to get a different scenery. As well by like windows too, so if I have an office that doesn't have windows for a while I'll go out so I can sit somewhere where there's windows and more lighting as well.
PAM PIOTROWSKI:
Yep absolutely.
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We hope you enjoyed and gained practical insights from listening in to this discussion!
Now that you’ve listened, pharmacists, physicians, and nurses can receive CE credit. Just log into your Pharmacist’s Letter or Prescriber Insights account and look for the title of this podcast in the list of available CE courses.
You'll also be able to access and print out additional materials on this topic, like charts and other quick reference tools, from the Pharmacist’s Letter and Prescriber Insights websites.
If you’re not yet a Pharmacist’s Letter or Prescriber Insights subscriber, find out more about our product offerings at trchealthcare.com.
Be sure to follow or subscribe, rate, and review this show in your favorite podcast app. Or find the show on YouTube by searching for ‘TRC Healthcare’ or clicking the link in the show notes.
You can also reach out to provide feedback or make suggestions by emailing us at ContactUs@trchealthcare.com.
Thanks for listening to Medication Talk!
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