Improper dosing tops list
Because the ED typically is organized to deliver prompt, life-sustaining care, its role, purpose, and function differ from other patient care areas, according to Rockville, MD-based U.S. Pharmacopeia (USP). The combination of interruptions, intense pressure, and a fast-paced environment can lead to medication errors and fewer error interceptions. In the ED, USP found that 23% of errors were intercepted before reaching patients, as opposed to 39% intercepted in other areas of the hospital.
Although omission errors were most frequently reported among hospital systems overall, improper dosing was found to be most common in the ED. Seventy-seven percent of medication errors cited in EDs occurred during the prescribing and administering phases.
"We’re seeing similarities among hospitals across the country," says Diane Cousins, RPh, vice president of USP’s Center for the Advancement of Patient Safety. "By implementing standardized policies and procedures and maintaining an awareness of the most prevalent errors, emergency department staff can deliver prompt, safe care in an environment that can change at any given moment."
Upon analysis of drug errors submitted to MEDMARX, its anonymous national medication error reporting database, and USP’s Medication Errors Reporting Program, USP identified the following medication errors as those most frequently occurring in the ED:
- prescribing errors — when a physician or other authorized subscriber fails to prescribe the correct medication through verbal or written communication;
- omission errors — the failure to administer a prescribed medication;
- improper dosage errors — when a patient receives the incorrect dose of a medication.
USP offers health care practitioners the following recommendations to help ensure that medication errors do not occur in the ED:
- Educate personnel about the types of errors that occur in the use of high-alert medications (which are known to cause severe injury to patients when administered incorrectly).
- Expand the use of decentralized pharmacists to cover the ED.
- When possible, minimize verbal orders for medications and require that medication orders be entered electronically.
- Design workflow within the ED in a manner that improves communication, minimizes interruptions and distractions, and provides for double checks and verbal confirmations before medications are given to the patient.
- Purchase premixed intravenous solutions and unit-dose medications.
Because the ED typically is organized to deliver prompt, life-sustaining care, its role, purpose, and function differ from other patient care areas, according to Rockville, MD-based U.S. Pharmacopeia. The combination of interruptions, intense pressure, and a fast-paced environment can lead to medication errors and fewer error interceptions.
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