National Patient Safety Goal # 3 Medication Safety
The Joint Commission, which is an organization tasked with accrediting and certifying healthcare programs and organizations in the United States, developed the National Patient and Safety Goals, or NPSGs. The NPSG goal number three is concerned with the safety of using medication (The Joint Commission, 2013, p. 1). The growth of the pharmaceutical industry and increase in use of medication has occasioned errors, increased hazards, and adverse events in relation to the use of medication.
The NPSG goals are usually updated annually and are intended to help healthcare organizations in evaluating the quality and safety of care that they provide to patients. The goals have become a vital means through which the Joint Commission enforces comprehensive changes in patient safety.
The commission uses criteria for establishing the significance of these goals and necessary revisions to them that are based on their effectiveness, cost, and merit of their impact. Latest changes have concentrated on averting medication errors and hospital-acquired infections, as well as the existing goals of fostering correct patient identification, surgical safety, identifying a patient’s predisposition to suicide, and proper communication between staff (The Joint Commission, 2013, p. 1). The latest update to the NPSGs is set to take effect in 2014 and provides an additional goal of improving the safety of alarm systems of hospitals. The NPSG goal number three involves the improvement of safety while using medication. This goal addresses three key points.
The first is the labeling of all medications and medication containers such as basins, syringes, and medical caps. The second involves reducing the chances of harm to patient associated with anticoagulation therapy using approved procedures and individualized care. The last point involves maintaining and communicating precise and correct medical information of patients. This entails obtaining a comprehensive list of the patient’s latest medications such as herbals, supplements, prescription medications, over the counter medications, and vitamins. This goal encourages experts to provide a full list of medication to the patient at the conclusion of the encounter.
A medication error can be defined as any avertable event that may lead to or cause harm to patients. It also comprises improper use of medication when a healthcare professional, consumer, or patient is handling the medication. Such occurrences may be connected to healthcare products, professional practice, systems and procedures such as packaging and nomenclature, product labeling, prescribing, education, distribution, order communication, administration, compounding, monitoring, and use (The American College of Obstetricians and Gynecologists, 2012, p. 3). Several factors occasion medication errors such as nurse’s workload, experience level, time of day, system deficiencies, and transcription errors. In critical care setting, most medication error happens during the prescription and administration phases of the medication delivery. These errors are frequently attributable to system failure. Distraction may be a contributing factor.
The difficulties in prescribing medication are partly attributable to the increased number of agents. Studies have consistently revealed problems of prescription, such as improper use of abbreviations, missing components, and illegible words (Vogenberg & DiLascia, 2013, p. 1). This problem has been made worse in the recent years by the entry of new drugs whose names sound alike and whose packaging look alike, which makes the interpretation of prescription particularly challenging. Similarities in the names of medication and/or packaging can also be problematical.
The improvement of medication safety as envisaged in the NPSG goal number three is important because medications have proven to be useful in the treatment of illnesses and prevention of diseases. This achievement has led to a dramatic escalation in the use of medication in recent times. The use of medication has also become progressively more complex (Ackroyd-Stolarz, Hartnell & MacKinnon, 2005, p. 61). For instance, even though there are improved medications for chronic diseases, many patients use several medications while several other patients exhibit multiple co-morbidities. This escalates the possibility of drug interactions, intense side effects, and errors in administration. In addition, several health care practitioners frequently share the process of medication delivery to patients.
Doctors have to monitor patients who are under medications prescribed by other doctors (in most cases, specialized doctors). As a result, they might not be acquainted with the effects of the medications that the patient is taking. Failures in communication may lead to disconnections in the medication continuity process. Nurses play a very significant part in the use of medication (Vogenberg & DiLascia, 2013, p. 1). Their role includes the administration, monitoring for side effects, and offering leadership at the workplace with respect to use of medication and the improvement of patient care. Medical students must be conversant with the nature of medication errors, discover the hazards pertaining to the use of medication, and the steps that can be taken to ensure safe administration of drugs. All medical practitioners involved in medication use have a responsibility to cooperate with one another to mitigate the harm that medication use may cause to patients.
It is important for medical students and other medical practitioners to understand properly the steps involved in the use of medication. Medication use has several discrete steps (The American College of Obstetricians and Gynecologists, 2012, p. 4). The main three steps are prescription, administration, and monitoring. Patients, together with other health professionals, have a role in each of the three steps. For instance, patients may self-prescribe over-the-counter drugs, and do the administration and monitoring on their own to observe if the medications have any therapeutic effects. In the same manner, doctors, in a hospital setting, may prescribe medication. Nurses will be charged with the administration of the medication while a different doctor may monitor the progress of the patient and make decisions regarding the ongoing medication regimen.
Every step in the process of prescription, administration, and monitoring has the potential for error, which can occur in several ways. Errors in prescription may include inadequate knowledge on the drug contraindications, indications, and drug interaction. Prescription errors may also result from failure to consider individual patient aspects that would change prescribing such as pregnancy, allergies, co-morbidities such as renal stultification, and the patient’s use of other medications. With respect to administration, errors may include administering drugs to the wrong patient, using the wrong method or drug, in incorrect doses, and at the incorrect time. Other errors in drug administration include complete failure to give a prescribed drug and errors in documentation. For instance, medication may be administered but not recorded as having being given. In this case, another staff member may inadvertently administer it for the second time.
Such errors result from poor communication, lapses and slips, lack of vigilance, medication packaging designs, lack of procedural checks, calculation errors, and suboptimal workplace design. On the other hand, errors in monitoring include poor monitoring of side effects, failure to complete the prescribed course of medication, and the failure to cease medication use upon the completion of the prescribed course (Anthony et al, 2010, p. 26). Evidence based practices suggest certain interventions that can assist in achieving NPSG goal number three. These include the use of generic drug names, early and timely communication, encouraging patients to participate actively in their own care, ensuring safe practice, and adhering to the five “rights” of medication prescription. The five “rights” include the right medicine, the right dose, the right patient, the right time, and the right route.
Medications have a generic name (the name of the active ingredient) as well as a brand name or trade name. Different companies may manufacture the same drug formulation under varying trade names. While it may be hard to be acquainted with all existent generic medications, it is almost impossible to recall all the related brand names. To reduce the confusion and make communication simpler, medical practitioners should use generic names. Nonetheless, it is also important to recognize that patients will frequently use brand names since this is what they see on the packaging (Anthony et al, 2010, p. 25). This may occasionally be puzzling for both patients and practitioners.
In addition to the above interventions, the NPSG goal number three also provides for guidelines in ensuring safety in the use of medication. These include labeling medications and medication containers, reducing the risk of patient harm due to anticoagulation therapy using sanctioned protocols and individualized care, and keeping and communicating accurate patient medical information (Hartman & Pinchevky, 2009, p. 8). The process of maintaining and communicating accurate medical information of patients involves obtaining a comprehensive and up-to-date list of the patient’s medications and comparing it to the list of any medications ordered. It is important to provide a comprehensive list of medications to the patient at the end of their visits. Medical practitioners can also ensure safety of medication use by reminding patients on the importance of bringing an updated list of their medications whenever they are visiting a doctor.
References
Ackroyd-Stolarz, S., Hartnell, N., & MacKinnon, N.J. (2005). Approaches to Improving the Safety of the Medication Use System. Healthcare Quarterly, 8(1), 59-64.
Anthony, K., et al (2010). No Interruptions Please: Impact of a No Interruption Zone on Medication Safety in Intensive Care Units. The Journal of High Acuity, Progressive, and Critical Care Nursing, 30(3), 20-28.
Hartman, C., & Pinchevky, L. (2009). Medication Safety and Quality. Pharmacy Practice News, 1(1), 8-9.
The American College of Obstetricians and Gynecologists (2012). Improving Medication Safety. Committee Opinion, 531(1), 1-5.
The Joint Commission (2013). Facts about the National Patient Safety Goals. Washington, DC: The Joint Commission.
Vogenberg F., R., & DiLascia, C. (2013). Medication Reconciliation Efforts Meeting Needs and Showing Promise. Fomulary Journal. Retrieved from http://formularyjournal.modernmedicine.com/formulary-journal/news/medication- reconciliation-efforts-meeting-needs-and-showing-promise
