Image: Medication review sessions raise nurses’ awareness about pharmaceutical errors and other safety issues.
Contacts
Marlene Malcolm, RN
mmalcolm@montefiore.org
Vic Yaghdjian, PharmD
vyaghdjian@montefiore.org
Strategy
Medication errors are among the most common types of errors that occur in hospitals, often resulting in otherwise preventable adverse events.
Most medication errors can be classified into one of five categories:
- dose error (e.g., excessive drug dosage for the patient’s age, weight, underlying condition, and/or renal function)
- known allergy
- wrong drug/wrong patient
- route error (e.g., IV medication given through a feeding tube)
- frequency error
Over half of these errors occur either when the physician places the prescription order or the nurse gives the medication to the patient. The potential for error is directly related to the number of drugs the patient is receiving.
In 2008, Marlene Malcolm, RN and Vic Yaghdjian, PharmD began conducting lunchtime medication review sessions to raise nurses’ awareness about pharmaceutical errors and other medication-related safety issues.
Review sessions provide a comprehensive overview of the medication, including the following areas:
- history/evolution of the drug
- actions and uses
- abuse and dependence issues
- therapeutic outcome (desired treatment effect)
- equianalgesic dose
- comparison with similar drugs
- nursing process (how to administer the drug to the patient)
- administration (whether the drug is given orally, subcutaneously, intramuscularly, or intravenously; specialized procedures for administering controlled substances)
- dosage
- signs and symptoms of overdose
- treatment of overdose
- Montefiore availability
- US boxed warnings
- side effects
- adverse effects
Past review sessions have focused on the following medications:
- Heparin
- Insulin
- Methadone
- Digoxin
- Potassium
- Dilantin
- Albumin
- Coumadin
- Beta blockers
- Vancomycin
- Ace inhibitors and angiotensin receptor blockers (ARBs)
- H2 blockers and proton pump inhibitors
Malcolm and Yaghdjian’s intention is to empower nurses to notify doctors when they see a potential conflict in the medication a patient is about to receive, thereby reducing the number of potentially fatal errors.
Results
Review sessions have been well attended and are now conducted in response to nurses’ requests to learn about specific commonly prescribed medications.