Drug dosages and med errors
By Arthur Hsieh
Recent research by the University of Utah's Drug Information Service has shown that hospitals across the U.S. are scrambling for medications as drug shortages continue to increase.
EMS systems began experiencing shortages of key cardiac medications years ago, and it appears that the trend will likely continue.
A recent report released by the Drug Information Service shows a wide variety of drugs that are not readily available, and includes medications such as magnesium sulfate, sodium bicarbonate, lorazepam, diazepam and others. Not all are in injectable form, but it is telling that there are issues in the drug supply chain that may continue to impact daily EMS operations. (Click here for a list of drugs in short supply).
One key point in the article is the report of dosage errors committed when a drug in short supply was replaced by another medication. Locally, there were reports of paramedics having to revert back to old-fashioned vials and syringes to deliver key medications such as epinephrine.
Privately, several of them mentioned that it wasn't something they thought about until they actually had to do it. So, as a quick review of basic prehospital medication administration:
1) Confirm the 5 rights: Right Patient, Right Medication, Right Dose, Right time/frequency, Right Route of administration. If you don't do it routinely, or sort of breeze through it, it would be good to refresh that basic skill.
2) Preplan: If your system has a drug substitution, then make sure you review the drug and its dosing regiment during your next shift. Think about what it would take to draw up the proper dose, i.e. which syringe size? What needle length?
3) Read the info: There is the possibility that the substitute might have side effects and contraindication that are uniquely different from the drug that was normally used. Make sure you pay attention to the appropriate manufacturer's information.
4) Do the math: If you need to draw up a med, be very careful and deliberate in your calculations. Remember the carpenter's rule: measure twice, cut once. There are drug calculation apps out now for a variety of smartphone platforms; good old fashioned calculator or really antiquated pencil and paper would also work in a pinch. Yes, I'm that old.
5) Look before you push: Just before you depress the plunger, mentally recheck everything. It'll only take a couple of seconds.