In-hospital medication errors contribute significantly to the estimated 44,000 to 98,000 deaths that are caused each year by medical errors. Cardiovascular medications are one of the most common drug classes that have historically been associated with medication errors. Hospitals have improved since a 2002 medications error position statement was released by the American Heart Association (AHA), most notably advances in electronic medical records and procedures to avoid confusing “look-alike” and “sound-alike” drugs at the prescription, pharmacy, and administration levels.
“It’s everyone’s responsibility to be vigilant and ensure that the right patient receive the right medication, the right dose, and the right delivery route.”
While modest improvement has occurred, other areas are still lacking enhancements. For example, the ED is an area where it’s easy for clinicians to make medication errors because of the speed at which patients receive care. Older patients are often at higher risk because of age-related changes in how their bodies metabolize drugs. They may also take multiple medications, many of which can interact with cardiovascular drugs. Furthermore, there continues to be errors made in the fields of stroke—because of the use of blood thinners and anti-clotting drugs—and cardiac catheterization, where problems frequently occur as patients are transitioned from departments within the hospital.
8 Critical Recommendations
In the April 13, 2010 issue of Circulation, an AHA writing committee released a new scientific statement to help reduce medication errors among hospitalized heart and stroke patients. Eight recommendations were unveiled for medication safety in acute cardiovascular care:
1. An accurate weight should be obtained on admission.
2. Estimated creatinine clearance should be calculated with the Cockcroft-Gault formula on admission and as changes in creatinine occur.
3. Because of age-related changes in pharmacokinetics, pharmacodynamics, and renal function, medication dosage adjustments and heightened surveillance for adverse medication events are recommended.
4. Order forms and protocols for anticoagulation should be standardized.
5. Pharmacists and nurses should be integrated within the cardiovascular care teams in the ED, ICU, and inpatient wards to enhance communication and medication safety.
6. Computerized provider order entry medication, bar-coding technology, and smart infusion pumps should be implemented throughout all inpatient wards, including the ED.
7. Staff should be educated on high-alert medications (particularly anticoagulants), safe medication administration techniques, medication reconciliation procedures, look-alike/sound-alike medications, and automated dispensing device technologies.
8. An organizational culture of safety that promotes no-fault internal and external medication error reporting and interdisciplinary quality improvement review processes to reduce the frequency and impact of medication errors is recommended.
Nurses and pharmacists should be integrated into the cardiovascular healthcare team in the ED, ICU, catheterization laboratories, operating rooms, and inpatient wards. The medical community must work collaboratively with all stakeholders to engage patients and caregivers in becoming active partners in safe medication practices, improve and standardize errordetection rates, and implement safer methods to prescribe, dispense, and track medications.
Readings & Resources (click to view)
Michaels AD, Spinler SA, Leeper BE, et al. Medication errors in acute cardiovascular and stroke patients: a scientific statement from the American Heart Association. Circulation. 2010;121:1664-1682. Available at: http://circ.ahajournals.org/cgi/reprint/CIR.0b013e3181d4b43ev1.
Hayward RA, Hofer TP. Estimating hospital deaths due to medical errors: preventability is in the eye of the reviewer. JAMA. 2001;286:415-420.
Freedman JE, Becker RC, Adams JE, et al. Medication errors in acute cardiac care: an American Heart Association Scientific Statement from the Council on Clinical Cardiology Subcommittee on Acute Cardiac Care, Council on Cardiopulmonary and Critical Care, Council on Cardiovascular Nursing, and Council on Stroke. Circulation. 2002;106:2623-2629.
Kanjanarat P, Winterstein AG, John TE, Hatton RC, Gonzalez-Rothi R, Segal R. Nature of preventable adverse drug events in hospitals: a literature review. Am J Health Syst Pharm. 2003;60:1750-1759.