long must it be taken and at what intervals?
•What are the side effects to watch out for? If they occur what must be done?
•Are there any potential drug-food interactions that may cause a problem by enhancing or hindering the action of the medicine?
•Are there any activities to avoid while on the medication?
Pharmacists must provide information about each medicine they dispense. The patient must read this information and have questions answered before ingesting the medication.
With liquid medication, a marked syringe is more accurate than a kitchen teaspoon or tablespoon.
A hospitalized patient who receives an unfamiliar appearing medication must not take it without clarifying the issue first. This is critical in the era of generics when the same generic made by different pharmaceutical companies have a dissimilar appearance.
When hospitalized and receiving intravenous medication, the nurse knows how long the intravenous is supposed to drip before it runs out. Patients should be told as well and if not they should ask and inform the nurse if the run-out timetable is behind schedule.
If hospitalized, a nurse must check the patient’s identification wristband before dispensing medication. The failure to do this can not only lead to medication errors, but also testing errors, transfusion errors, and the discharge of infants to the wrong family.
Medication use during care transitions
Patients are often transferred from unit to unit within the hospital: regular room to intensive care; intensive care to regular room; acute care hospital to the rehabilitation unit; emergency department to intensive care or regular room; and so on. Medication errors occur during these transition points. This is a common occurrence and the cause of many medical errors.
Case in point:
A woman was walking her dog down a residential side street and noticed a neighbor lying unconscious on her garage floor. She rushed in, was unable to revive her, and called the paramedics who transported her to the closest hospital emergency department. Examination revealed a seventy-five year old unconscious woman with a bruised head. An emergency CT scan of the brain revealed a collection of blood under the lining of the brain known as a subdural hematoma. This hematoma was very small, so her physicians elected watchful waiting rather than surgery. The patient regained consciousness, but was very restless and agitated, a state that persisted over the next few days. She also had some difficulty in walking, lost strength in one of her extremities and required the use of a walker. She was rational, but stated she “Was jumping out of my skin.” This persisted until her physician prescribed a tranquilizer in an attempt to calm her. The anxiety improved, but the patient then became confused and disoriented. This worried her physicians who ordered further tests thinking that perhaps the hematoma had enlarged or other cerebral pathology had developed, or there were undiagnosed medical problems. There were no new findings identified. Thinking that perhaps the confusion and disorientation was due to the tranquilizer prescribed to calm his patient, the physician discontinued it. Indeed, within two days the patient’s problem had resolved. All this time the rehabilitation transfer was not possible because this requires a clear mind and a cooperative patient, neither of which was possible while she was having her symptoms. Different physicians and a new healthcare team attended to her in the rehabilitation unit. They started her on rehabilitation, but after a day or two they found her to be confused and disoriented making progress impossible. They called her hospital physician to tell him what had happened. In the meantime, she was in the rehab unit for a full week and could not make any progress due to her altered mental state. When her physician arrived, he discovered why the patient had relapsed. Somehow—and no one could tell him how—the medication that he had discontinued because it caused her confusion and disorientation had been restarted. He never found out why. This medical error caused considerable delay, set back the patient’s progress and could have resulted in serious consequences.
Patient identification
Misidentification in a hospital can cause the following:
Wrong blood could be administered that could harm or kill
•A wrong test is performed
•A wrong procedure is performed
•A test could be performed that was meant for another patient
•Wrong treatment or intravenous fluids or medication meant for another patient may be dispensed
Therefore, patients must never object to wearing a wrist identification bracelet. There have been considerable identification errors, so safety measures are now in place. First, it has been determined that using two identifiers improves reliability. The possibility that there can be more than one patient in the hospital with the same name is the reason for the double identification process. The two identifiers come from the following list:
•Name
•An identification number
•Telephone number
•Address
•Photograph
•Social security number
•Other patient-specific identifiers
An example: in a surgical suite, the operating room staff should ask all conscious patients their name, date of birth or another identifier and check this information against the wristband, consent form and other documents. Only then should the surgical site be marked.
Barcode technology is another patient identifier. The wristband, patient specimens, medications and blood all have the same barcode and they must match with every therapeutic or diagnostic procedure performed.
Patients must be certain that they undergo proper identification when approached by hospital or clinic personnel.
Wrong site procedures include wrong person, wrong site, wrong organ, and wrong implant. This error is preventable, but does occur. Eighty-eight cases occurred in 2005. Preventive protocols are in place:
•During the pre-procedure stage, verbal questioning, by wristband and by consent form must identify patients. The procedure, site, and any prosthesis or implant must also be identified
•Whoever performs the procedure must mark the preoperative site while the patient is awake and aware
•The entire operating room staff will take a “time out:” a time period where no clinical activity is taking place and all staff can concentrate on identification verification, positioning, procedure site and any prosthesis or implant necessary
Performance of correct procedure at correct body site
A patient must sign a consent form when undergoing surgery or an invasive test of any type. The patient reads the consent form. Patients are entitled to understand the nature of the procedure, the benefits that are supposed to accrue, other possible alternatives to the procedure and the risks of the procedure.
Personnel mark the surgical site. Wrong site or wrong side surgery is a tragedy that cannot be undone.
Communication
