1. Woods, Anne RN, APRN,BC, CRNP, MSN, Clinical Director of Journals

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We've had almost four years to digest the Institute of Medicine's (IOM) sobering patient safety statistics: An estimated 98,000 medication-related deaths occur per year, increasing inpatient health care costs by approximately $4,700 per hospital admission. 1 As a manager, your duty is twofold: to serve as a patient advocate and as a nursing advocate. Let's take stock of where you and your organization stand regarding patient safety.


Change, from the ground up

Consider the most common reported medication errors: inappropriate drug for the condition, incorrect dosage or frequency of administration, failure to recognize drug interactions, lack of monitoring for adverse reactions, delayed drug administration, and inadequate communication. 2 While most of us recognize that these result from system flaws, how many managers still view them as a reflection of human error alone?


If a nurse makes a medication error, do you write it up for inclusion in her personnel file? Do you discipline her? Ten years ago, the majority of us would've said yes on both accounts.


In a recent survey, 58% of nurse respondents cited error reporting as a valuable tool for measuring a nurse's competency when administering medications. 3 But, in reality, what we should be focusing on is the much broader necessity of evaluating a nurse's overall ability to deliver safe patient care. 4


Review your organization's reported error rate. If it's lower than four years ago, either your organization has made great strides to improve patient safety or your managers still take a punitive approach to medication errors, so nurses don't report them. If it's the latter, you need to initiate change.


Don't overlook this indisputable fact: Medication safety starts with you. Sound management practice entails that you become an informed consumer, selecting only the best equipment and processes to comply with existing regulations.


Research clearly demonstrates that the use of computerized prescriber order entry and barcoding successfully decreases error rates. 5 These systems often offer fail-safe features that alert prescribers if the ordered medication exceeds the appropriate dosage range or poses an allergy threat. Unit-based medication dispensing systems that communicate with the pharmacy system also decrease errors.


Next month, Nursing Management brings you a detailed review of available information technology solutions. Endorsed by the American Association of Critical-Care Nurses and the Healthcare Information and Management Systems Society, this supplement will enable you to make educated purchasing decisions to meet and exceed patient safety expectations.


Follow through into the future

Do you have adequate pharmacy personnel to prepare and dispense medications? How about enough nurses to safely administer the medications? Is your medication formulary and medication policy and procedure manual accessible to all prescribers and pharmacy and nursing staffs? Is the formulary standardized across your organization?


Do you provide nurses with adequate products to administer medications? The Institute of Safe Medication Practices has received numerous reports of errors, some fatal, when nurses drew up liquid oral medication into parenteral syringes and then gave the medication through I.V. lines. Oral syringes are specially designed to be incompatible with I.V. ports and needles to prevent this kind of mistake. If your hospital still uses parenteral syringes for oral medication delivery, remedy the situation immediately.


Care standards and equipment change continually. Keep abreast of the "latest and greatest" with the journal's 2004 Guide to New Technology. coming this December. Remember, it's your responsibility not only to initiate change, but also to ensure compliance now and into the future.




1. Institute of Medicine, Committee on Quality Health Care in America:To Err is Human: Building a Safer Health System. Report of the Institute of Medicine. Washington, D.C.: National Academy Press, 2000. [Context Link]


2. Committee on Drugs and Committee on Hospital Care: "Prevention of Medication Errors in the Pediatric Inpatient Setting," Pediatrics. 112( 2):431-436, August 2003. [Context Link]


3. Cohen, H., Robinson, E., Mandrack, M.: "Getting to the Root of Medication Errors: Survey Results," Nursing 2003. 33( 9):36-45. [Context Link]


4. Ibid. [Context Link]


5. Committee on Drugs and Committee on Hospital Care: loc cit. [Context Link]