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Many steps taken to maintain medication safetyAnyone who has spent time in a hospital room, whether as a patient or a visitor, has witnessed this scene: the nurse enters the room and administers medication either by hanging a bag of intravenous (IV) medication from a pole next to the bed, or in pill form. Seems like such a simple, quick activity, doesn’t it? However, the multitude of steps that have taken place before that medication gets to the patient would amaze most patients and visitors. “They are all taken for the sake of patient safety,” said New Ulm Medical Center Director of Patient Care, Dennis Salter. Medication safety begins when the medication is obtained from a wholesaler. “From the time any medication comes through the door, it comes with statements of quality from the wholesaler,” said Pharmacy Manager Reid Horning. “Also, we use only approved pharmaceutical wholesalers that will include a pedigree with every medication. A pedigree is a report detailing every transaction that has occurred with that particular medication.” Take, for example, a “high-risk” medication like heparin. It is considered high-risk because the misuse of the medication carries with it significant risk of injury. When medications are delivered that are high risk, or “sound alike” or “look alike” medications – meaning that they could easily be confused with another medication – they are physically separated and stocked in a special manner in the pharmacy so they do not become confused with another medication. “In fact, we have physically removed some drugs from our facility because of the likelihood that they could be confused with another drug,” Horning said. After a physician orders a medication, it goes through several steps of verification. There is a human element and an electronic element to the verification. With the electronic medical record that was implemented over a year ago at NUMC, prescriptions are checked electronically to make sure the medication will not have a reaction to other medications the patient may already be taking and also to check against known allergies that are listed in the patient’s electronic medical record. “There is also a human factor here, though,” said Inpatient Manager Marilyn Swan, RN. “Each shift the nurses go in and review the patients they are responsible for and make sure they know their allergies.” After a medication is ordered and verified by the pharmacy, staff may then obtain the mediation from the automated medication machine called Pyxis. Pyxis interfaces with the electronic medical record so when a nurse chooses the medication for a patient, the nurse will only be able to choose from the patients to which they are assigned and then only from the medications prescribed to that patient. When the nurse electronically chooses the medication, a drawer with only that medication in it will open up so there is no chance that the nurse will take an incorrect medication. With a high-risk medication, such as heparin, two nurses are required to verify and sign off on the administration of the medication. When the nurse goes to dispense the medication to the patient, they will always ask the patient’s name and date of birth – or check their wrist band – to verify that they have the correct patient. These are just a few of the steps that are taken in the name of medication safety, Salter said. “With the electronic medical record, we have also seen improvement in issues with legibility from the point when prescriptions are written. Also, dangerous abbreviations and misspellings were eliminated with the electronic medical record” Salter said. “We have 24-hour pharmacy coverage thanks to a partnership with St. Francis Hospital in Shakopee – if it is after hours, pharmacy staff there will verify medications electronically. They are also available for staff if clinical questions arise.” The list continues with behind the scenes, pro-active safety measures such as staff education, said Swan. “If we do have a medication error, we develop some education around it with staff. If we have errors in which we see a specific trend, we do a major work-up and look at themes, seriousness and potential for problems,” she said. Backing up all of that work is ongoing monitoring of Institute for Safe Medication Practices (ISMP) reports – which updates facilities nationwide about the latest information and trends in medication management. NUMC also has a Pharmacy and Therapeutics Committee which meets monthly to oversee the activities of the pharmacy, track medication errors and review trends. Activities surrounding medication management are also regulated at NUMC by the Board of Pharmacy, the Food and Drug Administration and the Joint Commission on Accreditation of Hospitals (JCAHO). The JCAHO is a federal regulatory body which surveys hospitals for meeting various standards. “We are fully accredited by JCAHO and part of that accreditation is compliance by the pharmacy department,” Horning said. Last, but certainly not least, is patient participation. “The patient can play a big part in making sure they are safe when it comes to their medications,” Swan said. “We encourage patients to always carry with them a copy of the ‘My Medicine’ form listing their medications, dosage and frequency. If we have that information to start with, we are ahead of the game.” To find a copy of the “MyMedicine” form, go to www.mnpatientsafety.org. |
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New Ulm Medical Center
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