It doesn't take much to cause a medication error. Misplace a decimal point. Change a couple letters in a drug's name. Write down the wrong dose. Any one of these mistakes could severely harm a patient.
Vital to preventing these and other causes of medication errors is the capturing of accurate medication information from patients and receiving of correct information during care transitions. Once you are working with incorrect information, it's impossible to make the best clinical decisions for patients.
Follow these six steps to help ensure you obtain the most accurate medication information from patients and providers.
Patient Best Practices
1. Encourage the bringing of medications
If you want to assemble the most accurate list possible of all medications a patient is taking (which should include details such as drug name, dosage, route, and frequency), ask patients to bring their medications to you. Request they bring all prescriptions, over-the-counter (OTC) drugs, vitamins, health supplements, herbals, respiratory therapy-related medications, and intravenous solutions.
If the medications are physically in front of you, this eliminates the need for patients to recall the medications they are taking and the details about them that you want to document. Remembering this information for a single medication can prove challenging — a challenge that will magnify with each additional medication. One very effective option to this “brown bag” strategy is to request that your patients use their smartphones to take pictures of each of the labels on their medication bottles and share those images with you.
For patients taking several medications, you can also recommend that they use a mobile application to record their medication list and adherence behavior. In our post Our Favorite Healthcare Mobile Apps of 2018, we discussed Medisafe and Round Health, two apps which would serve nicely for patients taking several medications.
Note: When patients bring you their medications, don't assume what is brought in represents all their medications. Ask questions about non-prescriptions and drugs that patients may not think of as medications (e.g., vitamins, supplements).
2. Focus on communication
If patients are unable to bring in their medications, or at least provide a list of their medications, it will likely prove more difficult to capture the critical details about their medications. The key to improving success is effective communication, which should include the following:
- communicate using a patient's preferred language;
- use open-ended questions (which a study showed helped improve patient medication list accuracy);
- be on the same physical level (e.g., sitting, standing) and make eye contact with patients while discussing medications to help provide comfort;
- avoid distractions that can disrupt your conversation flow (and patient recollection); and
- don't rush the discussion as doing so can increase the risk of patients forgetting medications.
3. Be wary of look-alike sound-alike medications (LASA)
The list of confused drug names published by the Institute for Safe Medication Practices spans nine pages. As an example, hydroxyzine is a prescription drug used to help control anxiety and tension caused by nervous and emotional conditions, control anxiety and produce sleep before surgery, and relieve the symptoms of an allergic reaction. It can be confused with hydralazine, which is used to treat high blood pressure. If you record that a patient is taking hydroxyzine instead of hydralazine (or vice versa), their wellbeing may be in jeopardy.
Watch out for LASA drugs when discussing medications. If patients say a name of a drug on this list, ask them to repeat the name and explain the purpose of the drug to help correctly identify the medication. When documenting LASA drugs, use "tall man" letters to differentiate medications.
Provider Best Practices
4. Don't make assumptions
When reviewing information about a patient's medications shared by another provider, consider any confusion you experience a red flag. If a spelling is wrong (LASA risk!), decimal point seems out of place, dosage appears off, or any other issue that casts even a shred of doubt on the information's accuracy, reach out to the provider. Discuss your concerns and verify details rather than trying to correct it on your own. Even though this will take some time, it will better help ensure the accuracy of the information, and ultimately the safety of the patient.
5. Watch for abbreviations
In addition to its LASA list, ISMP maintains a list of error-prone abbreviations, symbols, and dose designations. As ISMP notes, "These abbreviations, symbols, and dose designations should never be used when communicating medical information." If you see any of these abbreviations in provider notes, follow up with the provider to verify information and revise the information in the patient's chart.
6. Report and learn from errors
Medication errors are inevitable. When they do occur, this provides an opportunity to identify and fix process problems that contributed to the error, which can help improve medication information accuracy and reduce the likelihood of the error happening again. As Margaret Plews-Ogan, MD, MS, notes in an ENTtoday article, "Admitting mistakes is the first and [an] essential step in learning from them. Talking about them openly expands that learning to your colleagues."
If you observe a medication error (such as one caused by issues described above) or learn you made one yourself, share it with your organization's leadership. Your organization likely has an error reporting policy — hopefully one that is nonpunitive. Note: Also consider reporting the error to ISMP and its National Medication Errors Reporting Program to help other organizations benefit from your experience.