Preventing Medication Errors (2007) / Chapter Skim
Currently Skimming:
4 Action Agenda to Support the Consumer-Provider-Partnership
4 Action Agenda to Support the Consumer-Provider-Partnership
Pages 151-220
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 151... ...
. A National Patient Safety Foundation survey found that among those who had personally experienced an error, 40 percent of the errors were due to mistakes in diagnosis and wrong treatments.
|
From page 152... ...
. The following are examples of medication errors with the potential to result in death or serious harm: A child with leukemia was discharged from the hospital with a nasogas tric tube in place for intermittent enteral feeding.
|
From page 153... ...
Some communication problems have been attributed to the fact that many health care providers focus on diseases and their management rather than on people, their lives, and their health issues (Lewin at al., 2005)
|
From page 154... ...
Second, consumers need to be empowered to play an active role in their care through the establishment of patient rights that are ensured at all points along the medication-use continuum, enhancing the presence, power, and participation of consumers in their relationships with providers. Third, certain basic, definitive actions can be taken to minimize and prevent medication errors and other safety issues; for example, the consumer can carry a medication list, and the provider can regularly practice medication reconcilation.
|
From page 155... ...
, the Committee on Identifying and Preventing Medication Errors uses the multifaceted definition developed by Gerteis and colleagues (1993) and espoused in previous Institute of Medicine (IOM)
|
From page 156... ...
Respecting patients' need for information on clinical status, progress, and prognosis delivered accurately in a manner they understand; information on processes of care, how alternative treat ments might affect their subjective well-being and clinical status, and information about the reasoning behind clinical decisions.
|
From page 157... ...
. Conversely, good communication can obviate the need for extensive discussions about the medication regimen with every patient during every visit.
|
From page 158... ...
Glasgow and colleagues (2002) believe this model is different from that used in most health care settings in that it is patient-centered, individualized, and self-correcting, and encompasses the overall care of a patient's health conditions rather than being an isolated activity.
|
From page 159... ...
Informed consent provisions are based on the American Medical Association's Code of Medical Ethics and standards set by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
|
From page 160... ...
Those principles state what patients can expect during a hospital stay in terms of the hospital environment, participation in their care, protection of privacy, discharge preparation, and help with billing. JCAHO evaluates compliance with standards for ethics, rights, and responsibilities in hospital and ambulatory care settings.
|
From page 161... ...
Code Ann. § 41-21-102 BOX 4-3 Improving Medication Safety: Actions for Nurses · Establish safe work environments for medication preparation, administra tion, and documentation; for instance, reduce distractions and provide appropriate lighting.
|
From page 162... ...
Components for consumers include activation and partnership, carrying a medication list, safety practices for self-care, and knowing where to find quality health and medication information. Components for providers include regular practice of medication reconciliation, patient education about medications, increased opportunities for consultation, respect for designated surrogates, and disclosure of errors.
|
From page 163... ...
Consumers who have already been activated with regard to medication safety generally gained this knowledge as the result of personal experience with an adverse event in either their own care or that of a family member or friend. Thus a sizable portion of the population does not know what constitutes appropriate and safe medication use, quality health care, and patient safety, or what practical steps consumers can take to protect themselves and their loved ones (NPSF, 2000)
|
From page 164... ...
Carrying a Medication List The single most important contribution consumers can make to medication safety and good medication self-management is maintaining an upto-date medication list that includes prescription medications, OTC drugs, and dietary supplements; the reasons for taking these products; and all
|
From page 165... ...
Medication Safety Practices for Self-Care When consumers become informed and engaged partners, they can decrease the probability that they will experience a medication error (Cohen, 2000)
|
From page 166... ...
These practices are outlined in Box 4-4 and discussed further later in the chapter. Finding Quality Health and Medication Information Consumers should become knowledgeable about where to find quality health and medication information to support them in self-care.
|
From page 167... ...
Pharmacy Hospital Inpatient Care Consumers should: Consumers (or their surrogates) should: · Make sure the name of the drug · Ask the doctor or nurse what drugs (brand or generic)
|
From page 168... ...
It is a multistep process that entails obtaining a complete and accurate list of the medications a patient is taking (including nonprescription and alternative medications) and comparing this list with both documentation in the patient's medical record during ambulatory care visits and the physician's admission, transfer, and/or discharge orders in inpatient settings (IHI, 2004)
|
From page 169... ...
. Rather than continuing to leave reconciliation as a voluntary process, in 2003 JCAHO incorporated medication reconciliation as a key expectation for compliance with its National Patient Safety Goals (JCAHO, 2004)
|
From page 170... ...
Nursing and pharmacy personnel and physicians can assist in ensuring the accuracy of the list. Ownership for medication · Shift the emphasis in organizational structure from oversight delineation by discipline to patient care.
|
From page 171... ...
initiated the Medical Schools Objectives Project to facilitate the process of enhancing teaching and assessment of communication skills. As a result of this and other efforts,3 interpersonal skills and communication are one of six core competencies of graduate medical education required as part of the United States Medical Licensing Examination (Batalden et al., 2002; FSMB and NBME, 2005)
|
From page 172... ...
. The ability of providers to communicate medication information in an understandable manner is critical to adequately informing, educating, and empowering patients.
|
From page 173... ...
. Patients may misunderstand the instruction to "take a tablet X times a day" but understand "take a tablet every X hours." When necessary, providers should have resources available to facilitate the patient's understanding of medication information orally and in writing.
|
From page 174... ...
Hospital providers also serve as important sources of patient education both during inpatient care and at discharge. Research shows that many patients desire more information about their health conditions, treatments, and procedures than they currently receive (Wilson et al., 2002; Scott and Thompson, 2003)
|
From page 175... ...
. Providers can offer written materials to their patients, as well as direct them to specific high-quality sources for information about their health condition, medications, and medication safety (e.g., clinical pharmacists, National Library of Medicine's MedlinePlus)
|
From page 176... ...
Hospital providers must ensure that both patients and their primary ambulatory care providers receive comprehensive information about the discharge plan, including the prescribed medication regimen, disease management if a chronic condition is present, and self-care activities to improve health status. Another critical link in the chain of communication to support medication self-management is the local community pharmacist.
|
From page 177... ...
. Disclosure of Errors Disclosure of medical errors signifies respect for both patient autonomy and ethical standards (Gerteis et al., 1993; Gallagher et al., 2003)
|
From page 178... ...
Moreover, all providers should be trained in good communication skills related to error disclosure. Materials and programs to help accomplish this are starting to become available in the form of courses and educational videos (see, e.g., http:// www.
|
From page 179... ...
. Factors that directly impact the consumer provider relationship and consumers' capacity for medication self-management include the following: · Inadequate continuing education programs and overreliance on marketing materials for new knowledge about medications · Lack of patient educational materials and resources to support providers in this capacity · Use of free samples without appropriate documentation or in lieu of other, more appropriate treatment options (medication and nonmedication)
|
From page 180... ...
; these evalua tions have not found consistent outcomes among patient groups. Part of the rea son for this is that the issue of patient adherence has received very little attention in the literature on patient safety relevant to preventing ADEs.
|
From page 181... ...
. In addition, drug information may not be presented in a way that accommodates the needs of different providers (physicians, nurses, pharmacists)
|
From page 182... ...
. One study of asthma patients found multiple examples of partial or total failure to understand drug information, even though patients had actively sought such information from a variety of professional and lay sources (Raynor et al., 2004)
|
From page 183... ...
Another major factor contributing to the gap in knowledge, awareness, and understanding of medications among both high- and low-literacy groups is the inadequacy of drug information materials that are intended to supplement providerpatient communications and self-management. Few materials and resources are available to support providers in educating patients about their medications.
|
From page 184... ...
Such barriers include visual, hearing, and cognitive impairment; the inability to act on one's own behalf; complex medication regimens and adverse drug side effects; medication labeling and packaging that are difficult to read or use; and a lack of health insurance and the cost of drugs (Cohen, 2000)
|
From page 185... ...
Since they are able to obtain and read written medication information, however, errors can be prevented more easily than for those with visual impairment. Medication management requires not only a defined set of mental and physical skills, but also higher-level cortical processing and integration (Edelberg et al., 1999)
|
From page 186... ...
It must be stressed that any policy or provider action that prevents a patient from having a designated surrogate present whenever the patient is receiving medication can be considered a barrier to safe and effective medication management. Given the amount of evidence for the occurrence of medication errors in hospitals, surrogates should be encouraged to question any professional about medications, routes of administration, and doses, and should be partners in reporting side effects patients may not be able to report themselves.
|
From page 187... ...
Attitudinal Factors At the provider level, attitudinal factors that influence caregiving range from organizational leadership, culture, and priorities to individual providers' personal values. Improvements in patient safety (including medication safety and error prevention)
|
From page 188... ...
. The attitudes embodied in a culture of safety are not widely present within the majority of current health care organizations.
|
From page 189... ...
. Consumer-related attitudinal factors that affect medication selfmanagement are rooted in the individual's belief system, culture, ethnicity, family, personal values, and previous experience with the health system (Cohen, 2000)
|
From page 190... ...
They also believe that general practitioners are too pressed for time to be familiar with the increasing inventory of psychiatric drugs and are happy to take suggestions from their friends. While they understand the risks of illegal drugs, such as cocaine and heroin, they have no grasp of the potential danger of misusing or overusing prescription drugs (Harmon, 2005)
|
From page 191... ...
, most attitudinal factors should be taken into consideration when a medication regimen is being designed. 9Federal laws governing children and health care generally fall into two categories: (1)
|
From page 192... ...
Such efforts require stan dardization of pharmacy medication information leaflets, improve ment of online medication resources, establishment of a national drug information telephone helpline, the development of personal health records, and the formulation of a national plan for the dissemination of medication safety information. · Pharmacy medication information leaflets should be standard ized to a format designed for readability, comprehensibility, and usefulness to consumers.
|
From page 193... ...
· A national plan should be developed for widespread distribu tion and promotion of medication safety information. Health care provider, community-based, consumer, and government organiza tions should serve as the foundation for such efforts.
|
From page 194... ...
-- the computerized printouts that are attached to or placed in the prescription bag at the pharmacy -- are now the most common form of medication information received by consumers. Neither the FDA nor state boards of pharmacy regulate the content of the leaflets, although the FDA did produce the Keystone report (DHHS, 1996)
|
From page 195... ...
However, those criteria need further improvement to address critical barriers experienced by consumers when trying to read, understand, and act on medication information in the leaflets. Remaining concerns about leaflet readability, comprehensibility, and usefulness to the consumer must be resolved to support safe and effective medication use.
|
From page 196... ...
At the community pharmacy, almost all medications are dispensed in similar-looking brown, bottle-shaped containers with white labels providing basic drug information. Warnings (e.g., may cause drowsiness, take with food)
|
From page 197... ...
Side effects (occurrence rate and what to do about them) Contacts for emergencies and patient safety information Additional information sources (e.g., MedlinePlus)
|
From page 198... ...
Drug Information on the Internet The proliferation of Internet-based health information over the last decade has given consumers immediate access to valuable resources such as medical journals and libraries, disease management guidelines, medication
|
From page 199... ...
Moreover, the most respected sources of drug information-the NLM, the FDA, other government sources, peer-reviewed journals, health care provider organizations, consumer organizations, and pharmaceutical companies -- are available online in multiple formats, at various levels of detail, and often with data that conflict with each other, further confusing consumers (Eysenbach et al., 2002)
|
From page 200... ...
In addition to providing standardized health information, the NLM has a leadership role in the development of standardized electronic drug information for providers through the DailyMed program. The DailyMed database, as its name suggests, is intended to provide updates of medication information to the public on a daily basis (Brown et al., 2003)
|
From page 201... ...
· Maintain a patient safety library for consumers, containing general informa tion on medication safety practices and where to report problems. · Work with other government agencies or private groups to develop criteria for evaluating the quality of health information for consumers on the Internet.
|
From page 202... ...
The committee believes establishing a national drug information telephone helpline (a "drugline") could serve this purpose.
|
From page 203... ...
Personal Health Records Emerging information and communications technologies have great potential to improve consumers' self-management of their health and health conditions (Markle Foundation, 2005)
|
From page 204... ...
Specifically, the following functionality should be required for PHRs: information about safe medication use; printable medication record sheets with areas for listing drug allergies; patient safety reporting forms; and links to online
|
From page 205... ...
The information available should include general medication safety practices or tips, as well as guidelines for specific medications and polypharmacy regimens, medication self-management strategies, and methods for reporting ADEs and medication errors. Also, information should be available in both paper and electronic format, with variations to accommodate the consumer's individual needs and preferences.
|
From page 206... ...
Waiting areas in ambulatory care offices could serve as venues for patient education through videotapes, computers, and/or paperbased information on health conditions and on good medication selfmanagement practices. The waiting area could display lively posters explaining the patient's rights and responsibilities with regard to medication safety (e.g., why it is important for the doctor to know if the patient is taking herbal or other dietary supplements)
|
From page 207... ...
· Providers should utilize ambulatory care, hospital, or pharmacy space and resources to make even limited medication information available. · Government and consumer organizations should utilize their extensive communications networks to expand dissemination activities to include basic pa tient safety tips, medication safety information, and guidance on where to access quality health and medication information on the Internet.
|
From page 208... ...
. APDIC (Arizona Poison and Drug Information Center)
|
From page 209... ...
2001. Health information on the Internet: Accessibility, quality, and readability in English and Spanish.
|
From page 210... ...
2003. Changing the culture of patient safety: Leadership's role in health care quality improvement.
|
From page 211... ...
1999. Rx medication information for the public and the WWW: Quality issues.
|
From page 212... ...
2004. Development and evaluation of a point-of-care interactive patient education kiosk.
|
From page 213... ...
2003. One Hospital's Journey Toward Patient SafetyA Cultural Revolution.
|
From page 214... ...
2004. 2005 Joint Commission National Patient Safety Goals.
|
From page 215... ...
Paper presented at: Enhancing Patient Safety and Reducing Errors in Health Care, Rancho Mirage, CA.
|
From page 216... ...
1997. National Patient Safety Foundation at the AMA.
|
From page 217... ...
2004. Enhancing the traditional hospital design process: A focus on patient safety.
|
From page 218... ...
2000. Reading level of drug information printouts: A barrier to effective commu nication of patient medication information.
|
From page 219... ...
Patient Education and Counseling 50:167177. Silberg WM, Lundberg GD, Musacchio RA.
|
From page 220... ...
2002. The vision of electronic health records.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.