The medication circuit... This title alone demonstrates a reflection on making medication administration more reliable. An overall process that has become quite complex due to the diversity of pathologies, interactions, computerized prescriptions, degrees of urgency, the diversity of therapeutics, and the involvement of different healthcare professionals in the care process.
The risks of accidents of all causes (also called serious adverse events or SAEs) have never been so significant, as evidenced by institutional statistics on this issue.
Among these accidents, those related to medication errors account for a large proportion. The ENEIS national survey on serious adverse events related to care, carried out in 2009, shows that:
- ADRs related to drugs account for 32.9% of all healthcare-related ADRs,
- among the SAEs related to drugs, 51.2% are considered avoidable and 54.5% resulted in hospitalization.*
To ensure the safety of care, improving the patient's medication management is a matter of international, European and national concern: the World Health Organization (WHO) has made it its 2nd major challenge and the Haute Autorité de Santé has published a guide on this subject and has also integrated medication management into the certification of hospitals since its origin, regularly reinforcing the requirements in this area.
Secure drug administration to patients
According to the Société Française de Pharmacie Clinique, a medication error is defined as "adeviation from what should have been done during the therapeutic management of a patient's medication. A medication error is the omission or unintentional performance of an act relating to a medication, which may result in a risk or adverse event for the patient"*.
Specifically, medication error results from an unintentional dysfunction in the organization of the patient's therapeutic medication management.
It may concern one or more steps in the medication circuit, such as prescription, dispensing, galenic preparation, the form and design of the medication, delivery, administration, therapeutic monitoring, but also its interfaces such as transmissions.
Among these different levels of implementation, administration error is mainly responsible for medication errors. In 2009, according to the ENEIS survey, it accounted for more than 60% of these errors.
To secure against administration errors, the 5 Rights (5Rs) is one of the educational prevention tools to implement. This rule should guide every action taken during medication administration.
The mission, should you choose to accept it, is to administer the right medication, at the right dose, at the right time, via the right route, to the right patient. To succeed in this mission, we offer a few ideas:
- the right patient: ensure that the right medication is administered to the right patient.
To this end, it is essential to verify the patient's identity each time medication is administered. If the patient's condition allows, they should be asked to identify themselves (last name, first name, date of birth). For more information, you can find the SafeTeam Academy article on identitovigilance.
- the right medication: ensure that the prescribed medication is given to the right patient.
This involves taking the time to carefully read the drug label and perform 3 successive checks: when collecting the drug from the stock, when preparing it, before administering the drug to the patient. However, as you will discover by reading Patient Safety Report No. 18 (http://www.patientsafetydatabase.com/pdf/fr/2021-01-PSR18-fr.pdf), reading is not enough. Carry out cross-checks and work as a team!
- the correct dose: ensure that the correct concentration, dilution or dose of the prescribed medication is administered.
This step involves verifying the dose calculations performed and, if necessary, having them verified by another professional. Knowing the "usual" doses of medications will also allow questioning the prescriber or pharmacist when the prescribed dose differs from the usual dosage.
Double-check if in doubt about calculations, and systematically for the administration of medications considered at risk.
- the correct route: ensure that the prescribed route is used.
During this step, it is necessary to ensure that the route is appropriate and secure. For certain high-risk routes, such as the intrathecal route, it is recommended to request confirmation.
- the right time: ensure that administration is carried out at the right time.
Certain medications are administered at specific times and frequencies. It is advisable to reconcile the patient's optimal timing with the constraints related to their treatment.
And to top it off, in order to secure this process and allow for the proper implementation of this rule, it is essential to limit task interruptions.
SafeTeam and medication errors
SafeTeam Academy has made medication error a recurring theme in its training courses.
Most immersive video courses stage simulated care situations, questioning healthcare professionals about their practices in terms of medication administration, task interruptions, and handovers, and prompting them to constantly verify a number of fundamental elements for patient safety.
One course in particular focused on these themes, and many pharmacists, risk management coordinators and care managers loved it.
If you too would like to play your part in improving the reliability of care within your facilities, SafeTeam Academy training courses are for you! To find out more, write to contact@safeteam.academy.
