Dr. Sabina Braithwaite presented strategies to reducing medication errors at EMS Today in Baltimore, Md. Braithwaite, the EMS system medical director for Wichita-Sedgwick County, Kansas, discussed some of the science behind medication errors, how the EMS environment can create risk for errors and tools that can help reduce them. Braithwaite gave attendees information to help prevent errors and improve patient safety in their own service.
Overview
For most EMS systems there is rarely a process, especially a non-punitive process, to report errors; therefore the frequency of medication errors is unknown. Braithwaite discussed some research of pediatric medication errors that showed the error rate is high; 66 percent of pediatric doses were found to be wrong in one study.
Medication error reduction requires tracking near misses and errors, as well as categorizing the types of errors that occur:
- Error made, no harm to the patient and no change to patient’s outcome
- Error made, harm to the patient resulted. Harm comes in varying degrees to the patient
- Error made, death resulted to the patient
Memorable Quotes
- “There is zero validation that the ‘5 rights,’ ‘7 rights,’ or ‘9 rights’ work to reduce medication errors.”
- “Use a medication administration cross check for every med, every time.”
Key takeaways: Reduction of medication errors
- Situations that make errors more likely included disorganized workflow, interruptions and distractions, fatigue, time pressure and high stress (in other words the EMS workplace lends itself to errors).
- Additional risks for medication errors include emergency situations, lack of written orders, no external cross check, high risk medications, and drug shortage issues and substitutions.
- An environment needs to be created where it is OK to disclose errors; a just culture.
- Allow and encourage dosing decision support with protocols and apps. Braithwaite’s medics are allowed to use protocols as a reference during tests and the protocols include a colored dosing chart that matches the Broselow tape.
- Use a medication administration cross check – a simple standardized tool to verify the correct medication and dose is given to the patient. The check is a two-person verbal procedure that contains intentional error traps to find mistakes.
ADDITIONAL RESOURCES
- Reducing the 7 types of medication errors
- ‘From oxygen to ketamine’: Why dosing matters, regardless of drug type
- 10 tips for learning pharmacology
This article, originally published in March 2015, has been updated.
