Healthcare leaders vow to stop intravenous medication errors
People with a stable psychosocial life situation often delay in seeking help for their alcohol problems - even though they are serious. This is revealed in a new thesis from the University of Gothenburg. Working actively to intervene at an early stage in order to prevent alcohol problems and to thereby promote public health is
Full Post: Socially stable individuals delay seeking help for alcohol problems
Intravenous (i.v.) medication errors are twice as likely to cause harm to patients as medications delivered by other routes of administration (such as tablets or liquids), according to research commissioned by the American Society of Health-System Pharmacists (ASHP).
This week, ASHP and leading healthcare organizations released recommended actions to prevent these potentially life-threatening events.
The recommendations, published in the December 15, 2008, issue of the American Journal of Health-System Pharmacy, are a result of an IV Safety Summit convened this summer by ASHP. The Summit’s goal was to initiate actions that prevent harm and death from I.V. medication errors.
Because errors can occur anywhere in the I.V. medication-use process and effects can be immediate and serious, healthcare leaders and experts participating in the Summit agreed that the issue of i.v. safety urgently needs to be addressed. They achieved consensus on a core set of best practices that everyone should follow to ensure safe i.v. medication use.
Best practices included standardization of infusion concentrations and dosages; comprehensive standardized procedures for ordering, preparing, and administering i.v. medications; and the use of ready-to-administer doses whenever possible.
Participants identified actions that are needed to support universal adoption of best practices.
Actions recommended to be taken within the next one to three years include:
- Universally standardizing concentrations of “high-alert” i.v. medications (those most likely to cause harm if an error occurs) for all patients, including highly vulnerable patients, such as elderly, newborns, and those with chronic medical conditions;
- Streamlining the process to bring ready-to-administer standardized infusion concentrations to market;
- Using “intelligent” i.v. pumps (e.g., those with safety features that help prevent unsafe rates and doses);
- Making the business case for i.v. safety to hospital leadership;
- Establishing multidisciplinary medication safety committees in hospitals to address the prevention of i.v. medication errors.
Long-term recommendations include:
- Using standardized, easily readable bar codes to verify i.v. drugs and doses;
- Establishing multidisciplinary medication safety training for healthcare professionals;
- Providing tools and resources to facilitate adoption of the i.v. safety practices;
- Exploring new methods to stimulate error reporting and share lessons learned; and
- Developing a framework for future research on i.v. medication safety.
Co-conveners of the Summit, along with ASHP, include the ASHP Research and Education Foundation, the United States Pharmacopeia, the Institute for Safe Medication Practices, the Infusion Nurses Society, the National Patient Safety Foundation, and The Joint Commission.
Seven percent of adults and 19 percent of children taking chemotherapy drugs in outpatient clinics or at home were given the wrong dose or experienced other mistakes involving their medications, according to a new study supported in part by HHS’ Agency for Healthcare Research and Quality through its Centers for Education and Research on Therapeutics
Full Post: Medication errors among adults and children with cancer in the outpatient setting common
Intravenous patient-controlled analgesia (PCA) allows patients to control their own pain medication, but a new study published in the December 2008 issue of The Joint Commission Journal on Quality and Patient Safety shows that errors related to this practice are four times more likely to result in patient harm than errors that occur with other
Full Post: Patient harm more common with patient-controlled pain medication
Even though nurses routinely disclose nursing errors to their patients, a new study published in the January 2009 issue of The Joint Commission Journal on Quality and Patient Safety shows that nurses often are not included when physicians tell patients about more serious mistakes. Nurses play such a hands-on role at the bedside of their
Full Post: Study finds failure to include nurses in process of admitting errors to patients, families
The use of new information technology could significantly reduce the number of drug-related injuries in Australian hospitals, according to Professor Johanna Westbrook. While virtually no data exists on local medication-related error rates, overseas figures indicate that one-third of all preventable medication-related harm is caused by drug administration errors. Professor Westbrook is currently heading research into
Full Post: Medication error rates to be reduced by technology
The U.S. Food and Drug Administration has issued three guidances designed to help ensure the safety of FDA-regulated products in the supply chain. The documents issued today include the following: Final Guidance for Industry on Voluntary Third-Party Certification Programs for Foods and Feeds; Draft Guidance for Industry on Submission of Laboratory Packages by Accredited Laboratories;
Full Post: New FDA guidelines for foods and feeds