Medication Safety is a Team Effort
Washington Hospital Takes Extensive Measures to Ensure Patient Safety
Do you take any medications?
Most likely, your doctor has asked you that question at some point. If you are taking any regular prescription medicines, you’ve probably answered "yes." But what about medications you use only "as needed," such as a prescription for seasonal allergies? Or common over-the-counter drugs such as aspirin or heartburn medication? Or vitamins, herbs or other nutritional supplements?
Medications are usually beneficial, but occasionally they can produce an undesirable effect, called an "adverse drug event" (ADE). ADEs are sometimes due to potential side effects of medications that generally are not preventable. However, in many cases, ADEs can be prevented, especially those that result from not taking medications properly or by combining medications that should not be used together.
According to the Institute of Medicine of the National Academies, approximately 1.5 million Americans are sickened, injured or killed each year by preventable medication errors – and the key word is preventable.
"A substantial number of medication errors happen because patients’ current medications are not identified when they are admitted to an emergency room or a hospital," says Washington Hospital Medication Safely Officer Nasim Karmali. "That’s why one of the Joint Commission’s National Patient Safety Goals is ‘medication reconciliation,’ which means making sure doctors and other health care providers know what medications patients are already taking." (The Joint Commission is responsible for hospital accreditation.)
Washington Hospital follows a stringent medication reconciliation process to find out what medications patients are taking at home when they are admitted to the hospital or ER.
Keep a List
"When patients are admitted, nurses and pharmacy technicians interview them about their current medications," Karmali explains. "They also try to speak with the patient’s family, since a lot of times people don’t remember what drugs they’re taking – especially over-the-counter medications and supplements. If needed, the pharmacy techs will follow up with the patients’ regular doctors and pharmacies for current medication information."
Karmali recommends that people keep a current list of medications with them at all times in their purse or wallet. "Write down the names of all the drugs you take, the dosages and how often you take them," she says. "If you’re admitted to the hospital or ER, tell the health care providers when you took the last dose of each medication."
At Washington Hospital, medication reconciliation is an interdisciplinary process involving the pharmacy, nursing and medical staffs to compare patients’ most current list of medications with new physician orders. This process is especially important if the patient is on medications for chronic conditions such as high blood pressure or diabetes.
"We need to be sure that patients will continue to receive their regular important medications while in the hospital," she notes. "Also, any time a physician prescribes a new medication, a nurse will explain to the patient what the medication is for, how to take it and what potential side effects might be expected. As part of our ‘Please Ask’ campaign at Washington Hospital to promote patient safety, we encourage patients – and their friends and relatives to ask any questions they have about their medications."
The hospital has pharmacists stationed in patient-care areas of the hospital to monitor medication therapy and confer with the patients’ physicians to provide safe and effective dosing. Nurses can consult these pharmacists, asking questions about the patient’s medications.
"Not all hospitals have pharmacists in patient-care areas," Karmali says. "We also have a pharmacist in the ER. Having a pharmacist as a resource in the fast-paced environment of the ER enables us to respond much faster to emergency medical situations."
Focusing on Medication Safety
In her role as Medication Safety Officer, Karmali works closely with physicians, nurses and pharmacists to reduce the risks of medication errors, evaluating where errors might occur and taking steps to avoid them.
"There are several areas that warrant close scrutiny," Karmali explains. "A physician who is prescribing drugs must be aware of whether or not a patient has any allergies to certain medications as well as what medications the patient has been taking at home. When it comes to dispensing medications, the pharmacist must review all the prescribed medications to prevent interactions, access the status of the patient’s kidney and liver function, and evaluate the patient’s ability to swallow pills.
"When administering medications, the nurses must observe what we call the ‘five rights’ – giving the right medication to the right patient at the right time in the right dosage by the right route (orally, by injection or IV)," she adds. "It’s also important to monitor patients closely to make sure medications are having the desired effects and not having any undesired effects."
When patients are discharged from Washington Hospital, they are given a printed list of all the medications they should be taking, including the dosages and frequency.
"It’s important to keep your list of medications updated and take it with you to any doctor appointments," Karmali emphasizes. "And you should always ask questions about any new prescription, including the name of the drug, the correct dosage, what the drug is used for, potential side effects or drug interactions, and any special instructions for taking or storing the medication.
"Patients need to take an active role in their own care by asking questions," she adds. "Patients who are unable to ask their own questions or understand the answers need an advocate – a family member or friend – who can do that for them."
"Please Ask" About Your Care
Washington Hospital’s "Please Ask" Campaign educates patients to ask questions of the staff if they do not understand something about their care including their medications. To learn more about Washington Hospital’s patient safety initiatives, visit www.whhs.com/quality.