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The guidelines on the prevention of medication errors in hospitals were released on October 1, 2018, by the
American Society of Health-System Pharmacists (ASHP).[1]
The American Society of Health-System Pharmacists (ASHP) guidelines on preventing medication errors in
hospitals lays a framework in which pharmacists are provided guidance and best practices in order to proactively,
rather than reactively, prevent and mitigate harm due to medication errors in health-system settings. These
comprehensive guidelines provide recommendations for each step in the medication-use system, as follows:
1. Planning
3. Storage
4. Patient admission
6. Preparing
7. Dispensing
8. Administration
9. Monitoring
11. Evaluation
Medication safety should be prioritized at both an organizational and departmental level, and a system for
supporting medication safety should be established. Essential to this framework are appointment of a medication
safety leader, established steps to ensure medication safety, and a strategic plan.
This step involves identifying which medications are needed at the institution (the formulary) followed by safe
procurement of those medications.
Decreasing the likelihood of errors during medication selection and procurement is composed of five elements, as
follows:
• Standard concentrations
Storage
Medications should be arranged and stored carefully to reduce the likelihood of medication errors; minimize the
likelihood of unintended selection of the wrong product or dosage form in the pharmacy as follows:
• High-alert medications and look-alike and sound-alike (LASA) medications should be segregated.
Patient Admission
A medication history and medication reconciliation must be obtained for patients upon admission. The pharmacy
should be involved in procuring an accurate medication history. This process should be standardized across the
institution.
Ordering
Providers must consider numerous steps when medications are ordered, as follows:
• Patient assessment
• Diagnoses
• Patient history
• Concomitant therapies
• Therapy duration
An error during any of these steps could result in an adverse drug event (ADE).
Current pharmacotherapy practices and clinical practice guidelines should be referenced when new or additional
medications are prescribed, and the patient's health status and existing drug therapy should be reviewed.
Transcribing
Factors that contribute to transcribing errors are as follows, and avoidance steps should be taken:
Environmental safeguards include keeping the transcription area well-lit and quiet to reduce distractions. EHRs with
computerized physician order entry (CPOE) reduce the risk of transcription errors. Reduce the use of handwritten
orders, verbal orders, and standardized order sets, when possible.
Reviewing
A pharmacist must review medication orders to ensure appropriateness before medications are prepared or
dispensed, with few exceptions. Common errors to avoid during the review process are as follows:
• Incorrect drug
• Incorrect dose
• Incorrect patient
• Incorrect route
• Incorrect rate
• Incorrect diluent
• Incorrect time
• Missed allergy
Preparing
Medication preparation should be conducted in an environment with proper conditions (ie, sanitary, well-lit,
appropriate temperature, appropriate moisture, well-ventilated, segregated, and secure).
Dispensing
A pharmacist (or advanced pharmacy technician with proper qualifications and training) should review all
medications in nonemergent situations before dispensation. The original medication order should be reviewed. At
minimum, a self-checking process should be undertaken in reading prescriptions, labeling, and dosage calculations.
High-risk drug products (eg, chemotherapeutic agents, medication for children, total parenteral nutrition [TPN])
should be checked independently by a second individual, preferably another pharmacist at a different time. In
particular, the drug, labeling, packaging, quantity, dose, and instructions should all be confirmed as accurate.
Administration
The list of safeguards for administering a medication is continually evolving but is based on the "5 Rights of
Medication Administration" (ie, the right patient, the right drug, the right dose, the right route, and the right time).
Barcode medication administration (BCMA) can facilitate safe medication administration. If smart infusion pumps are
used, the concentrations of medications should be standardized, the interoperability options between pumps and
other technology should be evaluated, the lower and upper dosing limits should be set, and soft and hard limits
should be used carefully. Additional priorities in terms of administration include educating both the practitioner and
the patient (when possible) on correct procedures to prevent medication errors.
Monitoring
Patient Discharge
To facilitate good outcomes, pharmacists should educate and counsel patients upon discharge to motivate and
prepare them to adhere to their medication regimens and monitoring plans. Emphasis should be placed on the
following:
• Ensure that patients are prepared to obtain their medications (drug availability, personal transportation,
insurance coverage).
• Ensure that patients understand how to schedule follow-up appointments and laboratory visits.
• Ensure that patients are discharged with all prescribed medications and/or necessary equipment.
Evaluation
Systems and processes that have been put in place to prevent medication errors should be continually evaluated
and adjusted to provide optimal outcomes.
References
1. Billstein-Leber M, Carrillo CJD, Cassano AT, Moline K, Robertson JJ. ASHP Guidelines on Preventing
Medication Errors in Hospitals. Am J Health Syst Pharm. 2018 Oct 1. 75 (19):1493-1517.
http://www.ajhp.org/cgi/pmidlookup?view=long&pmid=30257844
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this article: Medication Error Prevention in Hospitals Guidelines (2018) - Medscape - Nov 05, 2018.