Medication Safety

Safety And Quality: Medication SafetyHospitalized patients receive a number of medications during their stay. The number and complexity of medications used in healthcare facilities in the US has grown considerably. This growth has created major gains in the treatment of medical conditions, but has also increased the potential for adverse events related to medication use. Organizations such as the Institute of Medicine have called attention to the importance of medication safety, and urged hospitals to review and implement optimally safe practices for medication use.

Approach

At Stamford Health, medication safety is a key part of our overall patient safety efforts. To promote optimal medication safety, we utilize skilled personnel and dedicated technology at each step of the medication process at the hospital.

We’ve mapped out four stages to the medication safety process, and developed safety approaches to each one. Each stage involves workflows for different skilled personnel in the interdisciplinary team, and utilizes customized technologies. Our approach is outlined by each stage below:

Pre-Ordering: Patient Access Representative

Before your physician has ordered the medications you will receive during your hospital stay, we’ve taken a number of steps to ensure you receive those medications safely. Patient registration personnel apply a bar-coded wrist band to patients to ensure that correct medications are administered to patients. Upon your admission, physicians review and reconcile those medications you were taking at home with the ones you will receive in the hospital. The Pharmacy maintains and reviews a list of all hospital medications, a formulary, to ensure that medications with the best benefit and safety profiles are used.

Ordering: The Physician
Physician entering prescription electronically.

Physician entering prescription electronically.

When doctors order medications, prescriptions can be written on paper or entered into a computer. Entry into a computerized electronic record, known as Computerized Physician Order Entry or CPOE, allows for much safer medication use. In addition to prescriptions being much more legible, CPOE allows for dosing calculations, and automatic checks and alerts for allergies, drug interactions, and other medication safety issues. Studies have shown that CPOE can reduce medication errors by nearly 70%. Stamford Health has used CPOE since 2007, and continues to develop rules and alerts in its system to make the medication process safer.

Dispensing: The Pharmacist
Pharmacist using computerized cabinet dispensing machine.

Pharmacist using computerized cabinet dispensing machine.

Pharmacists review and double check every order written by a physician. The Pharmacy uses dedicated packaging for medications. Each dose to be used is sealed in its own package, “unit dose packaging,” and labeled with a bar code; and medications that come from the manufacturer in multi-dose bottles also receive bar codes. Products with illegible or un-scannable bar codes are relabeled and checked by Pharmacists. They then scan and enter each medication into the hospital electronic medical record, to match information in the patient’s medication profile.

Medications are stored in computerized cabinet dispensing machines. These allow medications to be stored in specific computerized "cubies" for each patient, and for smoother information transfer when drug products are removed. These dispensing machines are mobile and found on all patient units, allowing for retrieval of medication based on the patient’s profile in the electronic health record.

Administration: The Nursing Team
Nurse scanning a barcode on patient's wrist.

Nurse scanning a barcode on patient's wrist.

Nurses access medications for patients from computerized dispensing machines on each unit using their fingerprint. Before the medication is given to the patient, the Nurse scans the barcode on the medication, and matches it to the one on the patient’s wrist, a process known as Bedside Medication Verification. This allows Nurses to confirm the patient’s identity and matches the medication against the patient’s electronic medication administration record. This automatically and electronically documents the patient’s identification, exact dose and name of medication given, and time administered.

Results

Because of their expense, complexity, and other factors, the above approaches and technologies have not been universally adopted in US hospitals. A survey conducted by the American Society of Hospital Pharmacy in 2007 evaluated how often these technologies are implemented in hospitals across the US. Results comparing Stamford Health to all US hospitals are summarized in Table 1.

Medication Process Step Medication Safety Technology Percent of US Hospitals Adopting  Stamford Health Adoption
Prescribing Computerized Physician Order Entry with Clinical Decision Support 12.0% Fully Adopted
Dispensing Medication Dispensing and Storage 82.8% Fully Adopted
Administration Bar Code Medication Administration 24.1% Fully Adopted

Table 1. Medication safety technology in US hospitals, adapted from Pedersen CA and Gumpper KF.  American Journal of Health-System Pharmacy.  December 2008


Fully Meets Standards - 4 barsStamford also tests its medication safety systems annually using a test protocol developed by the Leapfrog group, an independent national organization dedicated to improving hospital safety.  In 2013, Stamford was one of only three hospitals in the state of Connecticut to complete the test, and it achieved the maximum possible result of four bars which means, Fully Meets Standard.

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