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Have protocols in place for high-risk medications

Pharmacy Regulation Resource, May 25, 2005

The JCAHO tabled a proposed 2006 National Patient Safety Goal requiring an interdisciplinary plan for the use of anticoagulants, insulin, and narcotic analgesics due to a lack of support in field review, the accreditor said, but procedures to control these drugs remain important.

A.O. Fox Memorial Hospital in Oneonta, NY, already controls the use of anticoagulants, insulin and narcotic analgesics, says Wendy Fisher, RN, BS, the patient education coordinator and leader of the hospital's medication safety team.

The hospital uses preprinted order sheets for patient-controlled analgesia and other high-risk medications such as heparin, Fisher says.

"It really standardizes everything and permits the physicians and nurses to make sure every item is completed and nothing is forgotten," says Fisher. "It's all in black and white."

Insulin is especially susceptible to look-alike and sound-alike errors, says Fisher. A.O. Fox has tight protocols on insulin dosing and use, she says.

Tall-man lettering help staff more easily identify different medications and reduce errors. Confusing Humalog and Humulin is easy, especially when orders are written in cursive, says Fisher.

Another helpful step involves double checking higher-risk medications. Taking the extra time to have another nurse confirm your medication and dose can greatly reduce errors.

"The doctor orders 10 units of a medication. The nurse draws up 10 units and has it in front of her. She asks another nurse to come up and say, 'This is Humulin R, 10 units,'" says Fisher. "These are things we've been working on."

Editor's note: This tip was excerpted from Briefings on Patient Safety. For more information, visit www.hcmarketplace.com.

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