The National Institutes of Medicine reported in its well-known paper “To Err is Human: Building a Safer Health System,” that as many as 98,000 people were dying due to medication errors in hospitals – errors that the institute believed were preventable.
Although to date, no related studies have been done involving out-of-hospital medication errors, it stands to reason that similar rates of medication error are made in the field. Additional risks faced by first responders, EMS, and paramedics are:
- Emergency situation
- No external crosscheck
- No electronic decision support
- High-risk medications
- Drug shortage issues and substitutions
In acknowledgement of these risks and as a way of addressing them, Dr. Sabina Braithwaite, MD, MPH, FACEP, developed a process to help identify and correct for system errors. The Medication Administration Cross-Check (MACC) is a standardized method for administering medications every time for every medication. The MACC requires two providers to verbalize the procedure.
Medication error reduction tracking:
- Error made, no harm to patient and no change to patient’s outcome
- Error made and resulting in harm to the patient; harm comes in varying degrees
- Error made, and results in patient death
Simulation Activities to Prevent Medication Errors
Simulation activities can support reducing or eliminating medication mistakes in at least two ways: 1) Identify where errors occur and 2) Develop and reinforce safe medication administration behavior.
Objective 1: Adhere to the “five rights” of medication administration: right patient, right drug, right dose, right route, and right time; use a verbal cross-check system like MACC.
Simulation activity 1: Use task trainers to provide students a choice of administration routes and appropriate medications.
Objective 2: Identify medication error gaps and reinforce proper administration.
Simulation activity 2: Create complex simulation scenarios using higher fidelity manikins or standardized patients that require medication administration under higher cognitive loads in team settings.