The How-to of Safe Medication Administration

Due to the fast-paced nature of the healthcare industry, mistakes occur every day. And unfortunately, these mistakes can carry grave consequences. According to a recent study by Johns Hopkins, medical errors result in more than 250,000 deaths per year in the U.S., making it the third leading cause of death in the country.

What can hospitals do to eliminate these medical errors? At Altus, we know safe medication administration is a good start. Hospitals must implement clear, effective measures to prevent mistakes in medication administration and promote safe practices within their systems.

The experts at Altus created this guide to provide safe, replicable processes for safe administration.

The Six Steps of Medication Management

This list illustrates how safe medication administration is handled from initial ordering to the effect of the medication on the patient.

1. Selection and Procurement

Safe medication administration practices are already in play before the patient is admitted to the hospital. The process starts with the selection and procurement of medications.

Medication selection and procurement include choosing which medications hospitals keep stocked and obtaining those pharmaceuticals from manufacturers and wholesalers. This step can be divided into five sections:

• Formulary assessment and management allow providers to prescribe the safest and most cost-effective medication to patients. A streamlined formulary system also enhances safety and accuracy within EMR entry, pharmacy databases, pump settings, and medication libraries.

• Standard concentrations help avoid errors in dosage calculations, reduce waste, and streamline inventories.

• Safety-alert monitoring ensures pharmacists and providers are aware of potential medication hazards that arise even after the medicines are in the facility.

• Safe procurement is the responsibility of a hospital’s pharmacy department. Medications should not enter the facility without express permission and collaboration from the pharmacy department.

• Medication shortage management keeps hospital pharmacies abreast of shortages and provides guidelines on acceptable alternatives or substitutes. Creating a contingency plan ensures that hospital pharmacies have the medicines they need to treat patients safely and effectively in the face of medication storage.

2. Storage

Careful, organized medication storage prevents medication administration errors and promotes fast and safe delivery. Many hospitals utilize asset tracking technology to ensure accurate medication inventories and disbursement. Tracking tags like RFID or RTLS allow hospital administrations to analyze their stock quickly and place medication orders as necessary.

A lack of stock can lead to the omission of medication administration or medication delivery at the wrong time. This is especially true if staff are unaware of low or nonexistent inventories. But asset tracking tags within medication stock rooms prevent unexpected or surprise lack of medications. Tracking tags immediately deliver inventory data, so hospitals know their pharmacy stock in real-time. Asset tracking tags empower staff to find medications within stock rooms quickly, so a dose is never missed and never late.

3. Ordering and Transcribing

Ordering failures in the prescribing process lead can potentially lead to harming the patient. Providers carry all of the responsibility for medication orders and keeping their patients from harm. Common ordering errors include:

• Omission
• Incomplete or unclear orders
• Wrong medication
• Wrong dosage
• Wrong patient
• Patient allergy

Transcribing errors occur during the transfer of information from order to documentation forms or medication administration records (MARs). Many times, issues with medication orders result in these transcribing errors:

• Incomplete or ineligible orders
• Incomplete or illegible handwriting
• Use of error-prone abbreviations
• Lack of familiarity with drug names, doses, or frequencies

Environmental factors also contribute to these errors. A noisy and chaotic floor, poor lighting, high stress, and lack of sleep contribute to mistakes. Nurses working more than 12.5 consecutive hours per shift are three times more likely to make mistakes than nurses working a typical shift.

4. Preparing and Dispensing

With the distribution of medication, preparation cannot be overlooked. Humans are the ones preparing all the different dosages, and humans can make mistakes. To create a space where mistakes are prevented, hospitals must create an environment that empowered team members to safely prepare and distribute medicine to their patients. Deploying a fleet of computer workstations that are ergonomically designed, and engineered to promote safe medication dispensation is the best route for hospitals to prevent potential mistakes.

When considering medication delivery solutions, hospital administration should seek out mobile medical carts intentionally designed to allow for mobility and space-saving. Workstations that minimize noise, reduce distractions, and are ergonomically designed, reduce strain on nurses and allow them to focus more energy and effort on medication preparation and dispensing.

Mobile carts designed with providers, staff, and nurses in mind promote safe medication administration and reduce errors.

5. Administration

The nurse is often the final safeguard between the patient and medication administration. For this reason, hospitals should take every step possible to make medication administration safe, efficient, and error-proof.

Every nurse is aware of The Five Rights of medication administration: the right patient, the right drug, the right dose, the right route, and the right time. While The Five Rights provide necessary benchmarks for medication administration, they alone cannot eliminate errors. Hospitals must explore more effective methods for eliminating medication administration mistakes.

Medication administration workstations empower nurses with the equipment and technology they need to deliver medication safely and effectively. As stated above, mobile carts provide the tools required to prep medication for delivery. They also aid in accurate administration, reducing the potential for mistakes.

A crucial factor for medication workstations is the implementation of secure, individual locked drawers used to store medicines. The more secure a medication, the lower the chances of medication being mixed up or confused for another. At the time of administration, nurses can access the drawer designated for each medication, which virtually eliminates mix-ups, even in the fast-paced environment of a hospital.

6. Monitoring

After the medication has been administered, patients still require careful monitoring so nurses can identify potential medicine-related harm. This final step of safe medication administration is ongoing and lasts as long as the patient receives medications.

Monitoring patients for adverse effects requires multidisciplinary collaboration as well as education for nurses as they’re the ones interacting with patients most frequently. The Adverse Drug Reaction Profile (ADRe) is a monitoring system designed to support medication reviews and empower nurses to monitor patients more effectively after medication administration. The ADRe is composed of four sections that prompt nurses to

1. Observe vital signs
2. Review symptoms and medicine intake
3. Empathize with the patient
4. Review medication, including OTC drugs

Effective, informed monitoring promotes patient well-being after medications have been administered.

Conclusion

Safe medication administration requires preparation and monitoring from all team members and is an ongoing process. It’s the responsibility of hospital administrators and leaders to implement practices that promote safe medication delivery.

At Altus, we know the critical need for safety protocols and support for providers, nurses, and hospital staff. We provide workstations and healthcare technology to streamline these processes and promote positive outcomes for our clients. Contact us to learn more about our medication delivery workstation and how we help provide safe medicine distribution.