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EMS Patient Safety: Preventing Medication Errors

Posted on May 22, 2018 by Dawn Mangine

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.

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