Alas, at the end of the tunnel, there is light! After exploring the potentially catastrophic effects of medical errors – due to simple mistakes or complicated, historically engrained hierarchy – the past three articles in this series are certainly grim. However, this final piece of the series will focus upon something more uplifting: solutions.
Minimizing Medication Errors:
- Bar coding medication scanning systems: These allow for nurses to verify correct medication, patient, rout, dose, and time.[1]
- Know the medications being administered and their adverse reactions: A nurse who tells each patient what they are receiving and why will help build trust and better recognize when something goes wrong.[2]
- Adopt computerized physician order entry: This technology allows physicians to enter orders for a patient, while the database checks for appropriateness of the medication and dosage against the patient’s information.[3] It then alerts a physician before ordering the medication if, say, he clearly typed a decimal in the wrong place.[4] This system eliminates the need to decipher handwriting and lessens the fear that a physician could make a simple, but potentially deadly, typo.
- Consult others to double-check: Having a second nurse verify that the patient, drug, dosage, and route are correct prevents up to 95% of all nursing errors.[5]
- Avoid Interruptions: When interrupted, nurses and physicians can lose focus and forget where they were in the ordering or drug administration process. Some hospitals have created visual reminders – such as vests, red tape, and signs – on nurses and carts so that nurses’ distractions are limited.[6]
- Differentiate similarly named drugs: To reducing confusion, labels can use tall-man lettering (such as DOPamine and DOBUTamine) or drugs – and even dosages – can be packaged distinctly.[7]
Easing Communication:
- Patient admittance cannot compromise quality of care: Emergency departments need to find a balance between patient satisfaction in admittance times and taking the proper time to care for patients. Thorough assessments need to be made in the ED and then communicated in detail to the department the patient is being transferred to, allowing new nurses the time to review reports before taking on the patient.
- Mutual respect: Physicians need to inform themselves of nurses’ scope of practice and acknowledge their contributions to patient care, and nurses need to understand the unique problem-solving process used by physicians and provide information in a timely, accurate manner.[8]
- Nurses need to be assertive: To challenge the hierarchy, nurses need to step up and advocate for patient needs so physicians clearly understand how to take appropriate action and correct patient concerns.[9] Hospital systems need to commend and support such behavior.
- Co-education and shadowing: In order to encourage empathy and value differences, nurses and doctors need to have some communal training and shadowing experience. If a medical resident follows a Med-Surg nurse and an ICU nurse followed an ED physician for a day, everyone can better understand differing approaches, time-saving strategies, and what questions are appropriate to ask. This allows for fewer miscommunications between departments, and within them.
Changes in medication processing and medical team communication won’t change overnight, but they can change with deliberate measures and effort. With them will come ease of mind for both medical professionals and patients, and lead to a safer future for all.