Introducing our speakers
Bruce Anderson
speech abstract
The future of bedside verification
Improving medication safety
Those working in the New Zealand heath sector are dedicated professional people who strive to provide the best care possible to their patients. However, errors can and do occur despite the best efforts of staff and organisations. Medication errors continue to be a recognised problem in the New Zealand health and disability sectors.
An extrapolation of results by the New Zealand Quality of Healthcare Study (NZQHS) suggests that in New Zealand each year, about 5,000 patients are subject to preventable adverse medication events. As a result about 150 patients die, over 400 are permanently disabled, and nearly 3,500 are disabled for less than one year. Many will argue that is either an exaggeration or an under-estimate. These results are consistent with those from other countries.
However, regardless of whether medication errors result in 100, 1,000 or 10,000 deaths, permanent disabilities or other patient impacts, we have an opportunity to put in place measures to reduce the incidence of adverse medication events. While adverse medication events occur both in the community and hospitals, this paper deals only with medication administration in DHB hospitals.
Potential medication errors occur throughout the medication process. Starting when a clinician prescribes medication to a patient, the clinician hand writes a prescription on a medicine chart – this is a legal document that authorises dispensing and administration of medication. These prescriptions may be transcribed into the pharmacy information system, the pharmacy then fills, checks and then dispenses the medication to the ward and the medication being administered to a patient. Alternatively, many hospital pharmacies supply medicines via an imprest system – this is a storage cupboard in the ward which is pre-filled with an agreed selection and quantity of medicines. Nursing staff then access this stock according to what is prescribed on the medicine chart.
The final checks occur just prior to the patient receiving the medication and these checks are know as the “five rights” – the right medication is given to the right patient in the right dose at the right time by the right route; Conversely, a patient may be injured when;
- the wrong medication is given to a patient or by administering a medication to the wrong patient
- the wrong dose is given
- the medication is administered to a patient who is known to be allergic
- the medication is administered incorrectly or using the wrong formulation (eg, orally instead of by injection)
- the medication is administered at the wrong time or when doses are missed completely.
As an enabler to increasing the penetration of patient safety systems in the United States the Food and Drug Administration mandated the use of linear barcodes on unit of dose for drugs ordinarily used in hospitals. This has allowed for a rapid expansion of the number of hospitals implementing barcode point-of-care and associated medication safety systems. These systems have significantly reduced the number of medication errors and consequently prevented large numbers of patient deaths and injury.
Barcode verification of medication at the point-of-care is a possible solution. This is not the whole answer as the system would need to be combined with a range of other measure. For examples changes some hospital pharmacy systems, introduction of e-prescribing or electronic medication records and repackaging pharmaceuticals at unit of dose. In isolation each of the components are likely to improve medication safety but the maximum gain is to be obtained from implementing all systems in a coordinated manner. These data capture, decision support and checking systems have been successfully implemented in many hospitals in the United States.
At each stage of the medication sequence, data is compared to the patient's electronic medication record. If there is a problem, an error message alerts the staff member, requiring them to stop and investigate the problem. As an example, bedside verification could prevent a patient from receiving medication intended for someone else, a child from receiving an adult dosage of a drug, or prevent a patient from mistakenly receiving a duplicate dose of a drug he or she had already received. A bedside verification of medication system also records the time that the patient receives the medication, the person administering and the location of administration. The information collected will ensure more accurate medical records
biography
news and information
Wise Use of Antibiotics 2007
08-August-2007
The Wise use of Antibiotics is in its tenth year. It aims to raise...
Launch of the Wise Use of Antibiotics campaign
10-August-2006
Do you need pills for winter ills?
With cold and flu season upon...
One Heart Many Lives campaign up and running in the Hawke's Bay
02-June-2006
The PHARMAC team are working together with Hawke's Bay DHB and a ra...
Conference DVD available now
22-November-2005
The 2005 WCMAD Conference DVD is available in two versions. The edited...
Antibiotic resistance still growing
10-October-2005
Some bacteria are becoming resistant to a number of antibiotics at a...
PHARMAC and Social Marketing
10-October-2005
PHARMAC uses social marketing techniques in the development and...