Promoting Safe Use of Medications in the Ambulatory Setting

Presenter: Miriam M Chan, PharmD

Institution: Riverside Family Practice Residency Program Riverside Methodist Hospital, Columbus, OH

Introduction: The Institute of Medicine reported in January of 2000 that 44,000 to 98,000 hospital patients die each year in the United States as a result of medical errors. Of this total, approximately 7,000 deaths occur due to adverse drug reactions (ADRs). These statistics do not include the number of ADRs that occur in the ambulatory setting because it is not known. Our residency has moved to competency-based education. We have chosen 50 competencies that we want the residents to demonstrate mastery of by the end of their third year. Three of the competencies are directly related to proper prescribing, documentation and patient education.

Methods of Measurement – Assessment/Outcomes:

Project Description: At our Family Practice Residency Program, an education project has been developed to promote the safe use of medications in the ambulatory setting. In the beginning, our resident physicians or faculty identify the potential for medication errors and initiate a focused quality improvement project. A 360 degree evaluation is completed to determine what action needs to be taken to promote safety. Some examples might be physician or staff education. As part of the project patients are educated about their medications and taught how to become an active partner with their family physicians in preventing medication errors.

The secondary objective of this program is to raise the awareness of health care providers to work as a team in preventing medication errors. The patient’s physician and nurses participate in the patient education process continuously throughout the care of the patient and very actively throughout this quality improvement process.

An Example of Our Current Focused Quality Improvement Project: "High-alert" drugs were the first project chosen. We selected warfarin (Coumadin), insulin, and liquid acetaminophen to be our "high-alert" drugs. Warfarin is a blooding-thinning medication that has a narrow therapeutic index. Hemorrhage is the most common cause of hospitalization in patients who are taking warfarin. Insulin is one of the drugs most frequently involved in errors that harm patients. Hypoglycemia often occurs as a result of dosing error. As for liquid acetaminophen, infants and young children are vulnerable to receive wrong dosages from their parents who may not recognize the different concentrations of liquid acetaminophen. Physicians and nurses often given acetaminophen advice over the phone, which adds to the chance for error.

Conclusion: By taking steps to reduce medication errors, educating patients and fostering a "teamwork" environment, our Family Practice Residents can be part of the solution for patient safety.