Here are four ways to safely store meds
The way you store and access medications can greatly impact the number of errors you make, according to Sue French, RN, care center director for pediatric and adult emergency medicine at The University of Chicago Hospitals. Here are ways to avoid medication errors involving storage and access:
1. Avoid look-alikes.
At University of Chicago’s ED, potassium chloride is sent to units only in a mixed intravenous piggyback bag for drug administration, not a vial, says French. "This was due to heplock solution and potassium being in a similar bottle and label. Luckily, the two were never mixed up here, but we did this as a preventative measure."
For example, if an ED patient needed an intravenous piggyback of 10 meq of potassium, in the past the ED would mix it themselves, says French. "Now, we send down a request and it comes up labeled, mixed, and ready to go," she explains. "The label also tells you how fast you can administer the potassium."
Cut opportunities for mix-ups
2. Reduce the number of medications used.
By using fewer medications, there is less opportunity for mix-ups, says Robert Wears, MD, MS, FACEP, professor in the department of emergency medicine at the University of Florida College of Medicine in Jacksonville.
"If we only stocked vecuronium, we’d eliminate some of the Narcan/Norcuron problem," he notes.
The trouble is, people still sometimes make the logical substitution, says Wears. "For example, I order Narcan, and the nurse hears Norcuron, knows we don’t stock that because we switched to vecuronium, and draws that up," he explains, adding that a check-back or call-out system would help to reduce this problem.
At Rhode Island Hospital in Providence, the ED has developed its own restricted formulary, even smaller than the hospital’s, reports Andrew Sucov, MD, FAEM, ED medical director. "This way, there are fewer medications that need to be remembered, and all staff have a better idea of dosages, side effects, and indications," he says.
Administrators supported the separate ED formulary because of the potential to save money, says Sucov. "From all the approved medications, we selected the ones that we commonly use. Then we chose between agents of the same class to ensure that the best medication was being used," he explains.
When appropriate, the cheaper of two equivalent choices was picked, says Sucov. "For example, we utilize cimetidine as our H2 blocker of choice, and Valium over Versed for sedation," he explains. "Both agents have similar pharmacokinetics, but there are big differences in price."
Use a tackle box
3. Store neuromuscular blocking agents in a separate box.
At a Chicago hospital, an ED nurse recently made the mistake of giving Pavulon (a paralytic agent) instead of Pepcid (famotidine, a drug used for peptic ulcer disease), notes French. "It paralyzed the patient, and it resulted in a poor patient outcome," she says.
The nurse didn’t double-check the label, notes French. "The two medications have similar colored labels, and both begin with P. They were located near each other in an open bin in the refrigerator," she says.
In response to the incident, all neuromuscular blocking agents were put in a separate tackle box. That ensures that those agents aren’t mistaken for other refrigerator medications, says French.
4. Don’t use an "open-bin" system.
At University of Chicago’s ED, staff switched to an automated dispenser (manufactured by the San Diego-based Pyxis Corp.) for medication storage, from an open-bin system. "This prevented staff from throwing drugs with similar names into the wrong bin or putting a medication back into the incorrect bin," says French.
Before the ED invested in the automated medication dispenser, the ED had more than 25 bins filled with a variety of medications stored in a cabinet, says French. "Every day, the charge nurse would inventory the bins and send an order to pharmacy. Pharmacy later in the day would deliver the order; and the charge nurse, who had multiple responsibilities, would put the order away," she explains.
Sometimes some medications would end up in the wrong bin, says French. "There were no lids on these bins, so it was due mostly to people pulling a drug out of the open bin and throwing it back, sometimes in the wrong place," she recalls.
With the automated unit, there is a par level set for medications. When the ED falls below that level, pharmacy is automatically notified by computer, says French. "They refill the medications, so the charge nurse doesn’t have to do an order," she adds.
The unit also tells staff what numbered drawer the medication they request is in, and it opens only that drawer, says French. "To return a medication, the nurse goes into a single return bin, and pharmacy puts the medications into the correct bin," she explains. "That way, there is less of a chance it will wind up in the incorrect bin."
Systems are available from Pyxis Corp., including advanced point-of-use dispensers that automate the distribution, management, and control of medications. For more information, contact:
• Pyxis Corp., 3750 Torrey View Court, San Diego, CA 92130. Telephone: (800) 367-9947 or (858) 480-6000. Fax: (858) 480-6541. E-mail: [email protected]. Web site: www.pyxis.com.
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