Dr. Bossard says his group has a second pharmacist who provides requested educational information on a day-to-day basis, in terms of article and literature reviews. “It’s a great relationship,” he says. “They love to do that, and we love the information that they get for us.”
Work as a Team
Sondra May, PharmD, medications safety coordinator at the University of Colorado Hospital, says teamwork is the best way to avoid errors. “This would include the pharmacist who would determine appropriate in-house drug therapy, whether that would be determining dosage or specific drugs for specific patients’ needs. It would include making sure they’re providing sufficient information to the nurse at the bedside,” Dr. May says. “I think one of the biggest contributing factors to medication errors is poor communication.”
Dr. Sachdeva agrees direct communication is vital.
“I think hospitalists are in a unique position because we interact with almost everyone who cares for the patient,” Dr. Sachdeva says. “When I’m working, I’m talking continuously with the nurses. I think it’s important to have an open dialogue. I’ve learned that if I make a change, whether it’s on paper or on the computer, if I talk to the nurse, there is more chance it will happen earlier and it will happen correctly.”
When Errors Occur
Early detection of errors is imperative. “You want to make sure patient monitoring is frequent and specialized to the drugs they’re receiving,” Dr. May says.
If an overdose occurs before an error is detected, it’s important to strategize the treatment based on the error in question. Treatment depends on how much drug the patient received and what specific drug was given in error, Dr. May explains.
“Many hospitals have a rapid response team that will go to the bedside of patients who are showing signs of acute change in their condition, including overdoses,” Dr. Bossard says. ”The response team will assess that patient immediately and then contact the primary care physician or the hospitalist to address those issues. On the process management side, each sentinel event is reviewed in exceedingly fine detail, so processes can be adjusted and made safer in the future.”
In fact, more hospitals are creating an environment where it’s OK to admit that you’ve made a mistake. “We need to move away from blame and realize that these are patient safety issues about which we all need to be honest,” Dr. Basco says. “Part of that means full disclosure to the patient once you detect that an error has occurred. There’s no benefit to you or from a medical-legal standpoint of trying to keep it hush-hush. In fact, there’s a lot of evidence that disclosing [the error] early is beneficial.”
The Usual Suspects
A few classes of drugs are considered especially risky, Dr. May says, including narcotics, anticoagulants and insulin. These drugs aren’t necessarily involved in medication errors at a higher frequency, but they receive a lot of attention because, when an error does occur with these medications, the outcome tends to be more serious, she says.
Anti-epileptic agents, chemotherapeutic agents, and immuno-suppressants, especially in patients who have undergone transplants, can be risky. “What may be a therapeutic level for one patient may not be for a transplant patient,” Dr. Wright says.
Dr. Ferrance says he finds narcotics to be the riskiest class of drugs, especially in post-operative patients. “The dosing range is so wide to begin with,” he says, “Surgeons are afraid of not treating pain adequately, and they’re afraid of an overdose.”