Patient Safety Tips
- Use two forms of identification. Having the patient state their name and show an ID number is a common practice. ID cards should have a picture, if possible. Incarcerated persons may exchange cards and use the name of another to obtain what they perceive as valuable medications.
- Be sure someone, preferably a custody officer, is checking that the medication is swallowed. Jeff Keller, over at the JailMedicine.com blog has a great piece on ways inmates ‘cheek’ medication for use for other purposes.
- Set up an efficient system for finding the patient in the MAR (medication administration record). Many facilities keep the MAR in last name order. Some also divide MAR’s by housing unit. For example, one cart may go to Pods A & B and another to Pods C & D. Many have an electronic medication administration record, either a stand-alone program or one integrated into their electronic health record. Nurses can then scan the card/wrist bracelet of the patient and the medication administration is automatically entered. If a patient refuses one or all of their medication, the nurse can easily document that in the e-MAR. Sometimes the refusal form is generated right then and there for easy signature.
- Keep the patient medication cards organized. All medication cards should have the patient name and ID affixed. Keep all the patient’s medication together, and preferably in alphabetical order by medication. It helps if someone is responsible for keeping order, such as a pharmacy tech or the nurse primarily on that cart.
- Discard patient-specific discontinued medication to avoid confusion and error. Keep discontinued medications off the cart or out of the administration area.
- If a calculation is needed to administer the correct dose, write a double-checked calculation on the MAR. For example, 1.5 tabs = 75mg.
- A variety of strengths of a single medication in stock can lead to dose errors in administration. Keep choices to a minimum.
- Drugs that look alike or sound alike should be separated and clearly labeled with the name. Some units underline the differences in the name to emphasize the differences for staff when selecting medication for administration.