Medication management challenges: A pharmacist offers unique insights into solutions
According to the healthcare professionals who participated in the survey, pharmacists (99.3 percent) are the most frequently mentioned as stakeholders in the medication management process, followed by nurses (98.7 percent) and prescribers (98 percent). How can pharmacists best lend their expertise to patient safety efforts?
At the end of the day, pharmacists are responsible for ensuring that providers have access to the right medications when and where they’re needed, which sounds like an easy task, but it’s not. There are many variables that come into play. For example, drug shortages are causing significant patient-safety challenges, as clinicians could be called upon to use new medications that they’re not familiar with and not appropriately educated on, from an administration and prescribing point of view.
As a result, pharmacists need to take on more of a clinical and educational role to help drive medication therapy management. Implementing systems that take care of administrative tasks or turning over administrative tasks to lower level staff can help to get pharmacists out on the floor where they can be educating other clinicians as well as patients on medication issues and patient therapy. That’s really where I see the pharmacist having the biggest impact on patient safety.
Patients now feel more protected than ever before when entering the hospital, yet 38 percent of survey respondents know someone who experienced a medication error. What’s behind this dichotomy?
This gap between expectations and reality demonstrates why it is important to look at medication management as a system to drive improvements, not merely focused on individual process steps. Patients feel safer because technologies such as barcode administration and computerized physician order entry have been implemented at the bedside. There’s been a culture change, and patients now understand why clinicians are scanning barcodes before administering medications – and they feel safer because of it.
In essence, patients feel safe because they see the precautions that are being taken at the bedside. But it’s what they don’t see that might be harming them – the 30 some behind-the-scene steps that lead up to that medication administration. And, unfortunately, many breakdowns can happen during this elon-gated process. Data shows that there is a 45 percent risk of error across all those medication management processes. Of course, many of those errors could be minor and won’t really have any tangible impact on the patient, but they could snowball or cascade into errors that will harm the patient. So, these errors continue to persist because many healthcare organizations have yet to address this as a systemic problem.
Less than half of the survey respondents said that their medication management process captures more than 90 percent of errors – leaving significant room for improvement. What are some strategies that can help?
Moving from silo’d disparate systems – across the med use process from procurement and preparation all the way to administration – to a connected medication management approach that covers the entire medication management process and complements the EHR can help. Taking a systems approach will enable alignment of data and information needed to make decisions to flow seamlessly across the system and support continuous improvement. The goal should be to leverage integrated technology to reduce the opportunity for human error. For example, interoperable IV pumps with the EHR at the bedside allows infusion parameters from the EHR to be pre-populated in the pump, reducing the opportunity for programming errors. Similarly, implementing a standardized IV preparation process can reduce variability and drive out human errors in the upstream compounding process of IV infusion medications.
According to the HIMSS survey, organizations that have successfully reduced medication errors attribute this accomplishment to closed-loop tools and attention from leadership. Why are these factors important?
Closed-loop tools help to minimize the errors that can happen from the hand-offs in data from one system to the next. In addition, these closed-loop tools use data to drive workflow, which also helps reduce medication errors.
Some of the workarounds that occur today include bypassing dose-related medication alerts or borrowing and hoarding medications from one patient care area to use on other patients in another area. These workarounds – which can negatively impact patient safety – can be eliminated if clinicians have confidence in a closed-loop system and can proceed knowing that they will be able to access the medications needed to provide the best care to patients. It’s the attention from leadership, though, that’s important to really support the change management and ongoing process improvement required to successfully use closed-loop tools and to ensure that workarounds do not exist in the system, which leads to variability.
“Taking a systems approach will enable alignment of data and information needed to make decisions to flow seamlessly across the system and support continuous improvement.”
– THOMAS UTECH, BD
BD is a global medical technology company that is advancing the world of health by improving medical discovery, diagnostics and the delivery of care. BD leads in patient and healthcare worker safety and the technologies that enable medical research and clinical laboratories. The company provides innovative solutions that help advance medical research and genomics, enhance the diagnosis of infectious disease and cancer, improve medication management, promote infection prevention, equip surgical and interventional procedures and support the management of diabetes.
Disclosure: The survey conducted by HIMSS Analytics, 2017 Medication Management and Safety Study, was sponsored by BD.