The most common medication errors seen in LTC facilities include dispensing errors, delivery delays, and expired inventory.
In long-term care (LTC) settings, pharmacists are essential in preventing medication errors. We must strive to minimize or even eliminate the most common medication errors to ensure that we are providing the highest quality care to our patients.
The most common medication errors seen in LTC facilities include dispensing errors, delivery delays, and expired inventory. Dispensing errors result in an incorrect dose, incorrect medication, incorrect patient, incorrect route, and incorrect time. Similar and similar drugs are among the leading causes of medication errors seen in pharmacies.
For example, hydroxyzine and hydralazine are a prime example where, if not careful, a completely different drug with a different indication would be dispensed. The pharmacy should use the list provided by the Institute for Safe Medication Practices to help minimize these types of errors.
Non-compliant blister packs and foil packaging also account for a significant portion of dispensing errors in LTC pharmacies. The blister pack ensures that the right dose is delivered at the right time effectively. The pharmacy should inspect each bubble and verify the accuracy of the sheet. For example, the sheet should have the correct lot number, drug name and expiration date.
Partial tablets are another category where dispensing errors occur frequently. According to the regulations of many LTC facilities, nurses must rely on the pharmacy to take part in any order (if authorized) that is not readily available in the required strength. The pharmacy can avoid these types of errors by adding warning notes in pharmacy software to check for partial tablets and to educate pharmacy technicians and pharmacists to check the instructions on each label before filling and dispensing. .
Delays in delivery can also lead to medication errors as the medication will not be available in a timely manner for the facility to administer. The pharmacy can improve and prevent these problems by having open and constant communication with staff and the facility.
Delays are typically associated with a high number of prescription days, staff shortages, or failure to dispatch drivers on time. Communication with the pharmacy is essential to provide alternatives to the facility if prescribed medications are not delivered on time. The dispensing pharmacy can also transfer the drug, if allowed, to a local retail pharmacy, where it can be picked up by a local driver or staff member to avoid delay in delivery.
For expired stocks, the pharmacy can help prevent errors by proactively performing monthly checks. In addition, when filling medication, staff should always check expiration dates and lot numbers before releasing the medication for the pharmacist to review.
The transition from hospital to LTC can be very complicated and confusing. Patients may be new admissions or readmissions to the facility. Most medication errors occur when a resident is transferred to the hospital and then readmitted to the facility with different medications depending on what the hospital ordered.
As pharmacists, we should always check the medication history and confirm that medications that were prescribed in the hospital are meant to be continued upon admission to the LTC facility. Pharmacies can help minimize these errors by questioning any discrepancies and contacting nurses when duplicating treatment, adding new medication, or changing existing medications.
In order to improve and minimize preventable medication errors, each pharmacy should use a Medication Incident and Gap Report. Each reported medication error, whether internal to the pharmacy or external where the drug was dispensed to the establishment, must be documented.
The form should include all the details of the type of incident (e.g. incorrect dose, incorrect medication, incorrect patient, expired medication, etc.) and the incident description of what happened. The pharmacy will assess the severity of the error and document it. This would allow the pharmacy to have accountability while providing ongoing training to staff on trends in the type of errors that have been made.
In conclusion, medication errors will occur from time to time, but as pharmacists we can do our part and strive to become more vigilant to minimize these errors by addressing common issues and proactively educating our staff to ensure that we improve the quality of care for our patients. .
About the Author
Nirav Pandya, PharmD, RPh, is a supervising pharmacist at Community Care Rx, a long-term care pharmacy serving assisted living, nursing homes, OPWDD group homes and other long-term care facilities. Community Care Rx has offices in Hempstead, NY, and Totowa, NJ.