It’s often been said that to eliminate medication errors in nursing, we have to get five things right: the right medication, right patient, right dose, right route, and right time. That’s why hospitals often invest in technology that helps to prevent these errors at various points in the process. These include like the barcodes that nurses check at the bedside when administering a drug, for example.
Yet an increasingly popular approach to medication management is based on the idea that no technology should stand alone. It should integrate with all other steps in the medication process. It’s known as “closed loop medication management,” to reflect its focus on eliminating gaps in information and minimizing the opportunities for error when tasks are handed over to another department.
There are four steps in the medication process where errors can occur:
1. Prescribing. Physicians may inadvertently prescribe a drug that is inappropriate for a patient because of known allergies, potential drug interactions, or existing medical conditions like high blood pressure. When they are working from memory, they may jot down the wrong dose or frequency—or even get the name of the drug wrong, since so many sound alike. Many studies have found that the majority of all medication errors (up to 50 percent) occur at the prescribing stage.
2. Transcribing. Transcription errors occur at the pharmacy and generally involve illegible handwriting on a paper prescription. Even when a prescription is written legibly, a busy pharmacist may enter it into the system incorrectly. Transcription faults are the smallest category of medication errors.
3. Dispensing. When pharmacy staff is busy or distracted, they may grab the wrong medication or dosage off the shelf or count pills incorrectly. It may also be considered a dispensing fault if the pharmacist fails to catch a known drug allergy or potential drug interaction.
4. Administering. Errors at the bedside make up the second largest category of medication errors—between a quarter and a third, depending on the study being cited. These occur anytime a patient gets the wrong drug or wrong dose, misses a dose, or is medicated at the wrong time.
THE ROLE OF TECHNOLOGY IN MEDICATION MANAGEMENT
To “close the loop” and eliminate gaps in the four steps above, technology is used to automate every part of the process and eliminate many of the most common types of errors. In a closed loop system, the process might go like this:
1. A physician places a medication order using computerized provider order entry, or CPOE. This tool is integrated with the EMR, so providers receive instant alerts regarding patient allergies or other potential safety issues. CPOE eliminates handwritten paper prescriptions from the process.
2. The pharmacy receives the electronic order almost immediately. No manual transcription is needed. The order is automatically re-checked for safety issues, contraindications, and appropriate dose. The system may also automatically prioritize drug orders and place them into an integrated workflow, so the most critical orders are filled first.
3. The order is filled and delivered to the nursing unit. Pharmacists may fill orders manually or may rely on automated dispensing systems to eliminate counting errors. Once filled, the order is placed in a secure cart for transport and delivery. At this point, medications are barcoded to ensure they are going to the right patient.
4. Nurses administer the medication. Barcodes and other bedside technologies help nurses ensure the right patient is receiving the right dose of the right medication. Ideally, nurses have access to all prescription and pharmacy information, as well as the patient’s clinical data, so they can speak up if they see a discrepancy that has slipped through the cracks.
Closed loop medication management is an example of a patient-centric technology, designed to protect patients from adverse drug events. If you have a keen interest in healthcare, nursing, and informatics, you might want to consider a career specialization in this area. Healthcare is in need of nurses who can analyze technologies from both the bedside and IT perspectives to help create patient-centric tools. These new technologies can go beyond addressing medication errors in nursing by addressing other issues in the profession.