b'| LEADERSHIP GUIDEvided the following general guidelines for Failure of patients to take their medications preventing medication errors and adverseas prescribed is a serious problem and can lead drug effects.When prescribing medications, the clini- to patient-initiated errors. In fact, it is estimated cian must select the appropriate medication, dose, frequency, route, and duration of use.that failure to adhere to medication regimens Avoid prescribing unnecessary medications. A computerized provider order system shouldcauses 30% to 50% of chronic disease treatment be used in conjunction with clinical supportfailures and 125,000 deaths per year in the U.S.systems (Patient Safety Network, 2018a).If transcribing is done via a paper-based system, it is imperative that the prescrip-tion is read and interpreted correctly. Thehigh-alert medications. Reconcile admission orders with home use of computerized medical records isImproving access to information aboutmedication lists. If any pre-admission medi-reducing the need for such interpretationhigh-alert medications. cation is not ordered or is explicitly declared as well as having to deal with variations inLimiting access to high-alertto be inappropriate, the patients physician handwriting. medications. must be contacted. Prescribers should doc-Computerization should be encouragedUsing auxiliary labels and automatedument the reason for excluding any medica-throughout all healthcare facilities (Patientalerts. tion on admission.Safety Network, 201Ba). Reconcile medication orders when At the point of drug dispensing, the phar- MEDICATION RECONCILIATION patients are transferred to other care macist must check for drug-drug interac- Medication reconciliation is the processunits. Prior to transfer to another unit tions and allergies. Then the appropriateof avoiding such inadvertent inconsisten- (e.g. to or from critical care units), a medicine, in the appropriate route and dos- cies across transitions in care by reviewingnurse or pharmacist should compare age, is released (Patient Safety Network,the patients complete medication regimenthe medications the patient was tak-201Ba). at the time of admission, transfer, and dis- ing prior to admission and those that When a medication is administered, thecharge and comparing it with the regi- have been ordered in the sending unit correct medication must be given to themen being considered for the new settingto those medication orders contained patient at the correct time. In hospitals orof care (Patient Safety Network, 20186).in the transfer orders.long-term settings, this is generally a nurs- Discrepancies in the patients medicationReconcile discharge instructions and ing responsibility. In ambulatory care, med- regimen increases the risk of adverse drugprescriptions with the medication ication administration is the responsibilityevents and medication errors. administration record.of the patient or caregivers (Patient SafetyResearch shows that more than 50% Network, 201Ba). of patients have one or more unintendedDO NOT USE ABBREVIATIONSThe ISMP has some general guidelinesmedication discrepancies at the time ofIn 2004 the Joint Commission created its regarding high-alert medications as theyadmission. There is scant clinical evidence,Do Not Use List, which identifies abbrevi-pertain to medication safety. The ISMP cau- however, on the impact of reconciliationations that should not be used in healthcare tions healthcare professionals to be espe- rates and adverse drug events. The evidencesettings. Abbreviations found in the list have cially careful when prescribing, dispensing,that does exist indicates a positive impactbeen linked to an increased risk of medica-and administering high-alert medications.on errors and adverse drug events, but addi- tion errors. This list is found in Table 1.These are medications (e.g. warfarin, insu- tional research is necessary to identify anThe Joint Commission urges healthcare lin) that have an increased risk of causingassociation between decreased errors andorganizations to add to this list depending significant patient harm when involved withadverse events and medication reconcilia- on organizational needs.errors (ISMP, 201Bd). This extensive list cantion (Patient Safety Network, 2018b). The following two tables are part of the be accessed at https://www.ismp.org/sites/ The Institute for Healthcare Improvementinformation management standards. While default/files/attachments/2018-08/highA- (IHI) (2018) notes that poor communicationmany health information technology sys-lert2018-Acute Final.pdf. of medical information is responsible for astems (i.e. electronic medical records or To reduce risk of errors and minimizemany as half of all medication errors and upCPOE systems), may not currently comply harm when dealing with high-alert medica- to 20% of adverse drug events in the hospi- with these standards, they are encouraged tions, the ISMP recommends (201Bc): tal. The IHI recommends that medicationsto standardize the language as these systems Standardizing the ordering, storage,be reconciled at each and every transitionare routinely upgraded.preparation, and administration ofpoint (IHI, 2018):www.elitecme.com |2020| LEADERSHIP GUIDE 17'