Managing Hospital Safety: Common Safety Concerns Part 1 of 4

Objectives Focus on the impact of medication errors, “never” events and hospital-acquired conditions on patient safety Highlight the significance of needlestick injuries and practices to help prevent their occurrence Review the role of the health care team in maintaining hospital safety Discuss best hospital practices when handling high-alert medications Identify strategies and solutions to improve safety with insulin therapy

Patient Health and Safety Is the Primary Goal of Hospitals “First, do no harm” — Galen

Common Safety Concerns Within the Hospital Setting Medication errors Needlestick injuries “Never” events Hospital-acquired conditions

Medication Errors A medication error is defined as "any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer" 1 May lead to adverse outcomes and potential fatalities 2 Health care staff often worried about inflicting harm on patients and associated consequences 2 1. Phillips J et al. Am J Health-Syst Pharm. 2001;58(19): Pelegrin GM. Medication errors in hospitals: an analysis. Pharmacy Times. October Accessed January 29, 2009.

Medication Errors Within the Hospital Setting Are a Significant Burden ~1.3 million Americans are injured yearly as a result of medication errors that occur in both the inpatient and outpatient setting 1 At least 1 death per day is due to a medication error 1 Typically, medication errors occur in nearly 1 out of every 5 doses given to patients within the hospital 2 Preventable inpatient adverse drug events, including medication errors, may cost ~$2 billion per year 3 1. US Food and Drug Administration. Medication errors. Accessed January 29, Barker KN et al. Arch Intern Med. 2002;162(16): Kohn LT et al. To err is human: building a safer health system Accessed January 29, 2009.

Prescription and Transcription Errors Illegible orders Missing or misplaced zeroes and decimal points Use of abbreviations Unintended drug ordered based on variety of drug formulations Dispensing Errors Look-alike, sound-alike medications Incorrect preparation Administration Errors Incorrect dosage, drug, or infusion rate Medication given to wrong patient Lack of drug monitoring or double-checking Jackson MA, Reines WG. US Pharmacist. 2003;28(6): Types of Medication Errors

Errors Associated With Adverse Drug Events in the Inpatient Setting * SelectionDosageSurveillance Patient cases reported (n) Serious Moderate Significant * Patients studied were in Swiss hospitals. No patients studied were located in the United States. Of 6383 Swiss patients, error-associated adverse drug events were identified in 28 patients. Hardmeier B et al. Swiss Med Wkly. 2004;134(45-46): Type of Error

Needlestick Injuries Injuries due to needlesticks can be caused by hypodermic needles, blood collection needles, intravenous (IV) stylets and needles used to connect parts of IV delivery systems 1 Health care workers are concerned about increased risk of exposure to bloodborne pathogens and infection 1 Incidence of these injuries is often underreported 2 1. National Institute for Occupational Safety and Health. Preventing needlestick injuries in health care settings. November Accessed January 29, American Nurses Association study of nurses’ views on workplace safety and needlestick injuries. oStudy.aspx. Accessed January 29, 2009.

National Institute for Occupational Safety and Health. Preventing needlestick injuries in health care settings. November Accessed January 29, Identify Source of Potential Injury