Patient Safety in the Medical Environment Medicines cure various infectious conditions, avert chronic diseases issues, and alleviate pain. However, an incorrect dosage and usage of drugs could invite negative effects. Errors from incorrect medicine usage are unavoidable and can happen at home, doctor's place, pharmacies, or even at hospitals. Such erroneous activities are one of the prime triggers behind paediatric patients experiencing iatrogenic injuries. Triggers of such medication errors, as put forward by studies, include lack of adequate knowledge, work pressure, lack of awareness that such errors exist, and insufficient training. Avoiding such errors is a clinical and government necessity. Some strategies that have been employed to lower recurrences of such errors include better input from clinical pharmacists, changes in system by using critical incident analysis and using information technology (Simpson, Lynch, Grant, & Alroomi, 2004). This paper looks into two major healthcare system failures, how to lower and avoid recurrences and suggestions to avoid recurrences.

Insufficient Drug Information Medication Error

According to the National Coordinating Council for Medication Error and Prevention (NCCMERP), medication error is "... 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. Such events may be related to professional practice, health care products, procedures, and systems including: prescribing; order communication; product labelling, packaging and nomenclature; compounding; dispensing; distribution; administration; education; monitoring; and use" (The Academy of Managed Care Pharmacy's, 2010).

Precaution

Commercial dispensaries and pharmacies now have messaging in their drug selection procedure. The dispenser triggers a double-check demand, if confusion arises due to similarity in the name and appearance of a drug, to ensure that the right agent is selected. Dispensing systems use an overview process to review DUR responses and decisions. The overview process calls for a thorough professional evaluation in case it detects any excessive ignorance by a dispensing practitioner. This underlines the need for implementation of continuous quality improvement (CQI) procedure that evaluates reporting and other activities that follow reporting. Presence of a continually developing work flow improvement process ensures a disciplinary approach and maximum patient safety (The Academy of Managed Care Pharmacy's, 2010).

Source of Precaution

Pharmacy

Recommendations

Bar Coding

Using standard machine-readable codes helps in lowering medication errors and improving patient safety. Bar coding is an electronic tool that helps in identifying and administering the right drug in the right dose to the patient. Bar codes on packages can be scanned to embed information in a detailed level. The NCCMERP suggests a collaboration of the United States Pharmacopeia, the U.S. Food and Drug Administration (FDA), and pharmaceutical manufacturers to ensure that the following information are embedded in the bar code of a drug:

National Drug Code (NDC) number to identify the unique drug, form of dose, and strength

Lot/Control/Batch number for product recalling conditions

Expiration date to avoid supplying outdated medications

Electronic Prescription Record

An electronic prescription record (EPR) stores various data required to fill, label, and give away, and/or submit prescription payment requests legally. An EPR avoids medication errors by offering pharmacists information regarding duplicate therapies and drug interactions and contraindications. It also offers an opportunity to monitor and review the utilization and enable communication among healthcare providers for better patient care (The Academy of Managed Care Pharmacy's, 2010).

E-prescribing

The Computerized Physician Order Entry (COPE) is a technology that facilitates storing the prescriptions on a computer/device. The physicians can enter their prescriptions on the computer directly, significantly lowering and preventing the errors that arise from handwritten prescriptions. COPE and E-prescribing can be easily adopted by the physicians to prevent errors due to illegible handwritten prescriptions by using the right abbreviations and terminology and averting any omitted information and unclear orders (The Academy of Managed Care Pharmacy's, 2010).

Electronic DUR

An electronic online drug utilization review (DUR) helps pharmacists to examine a prescription when it is handed over for filling, thus proactively avoiding various drug-patient issues like drug interactions, inappropriate usages, and drug allergies. Pharmacists can look into a prescription when the drug is dispensed and check whether the prescribed drug is appropriate, based on pharmacy and/or medical record of the patient. Some of the medication errors that can be avoided using an online DUR include:

Drug-disease reactions

Drug interactions

Incorrect drug dosage

Inappropriate duration of drug treatment

Allergies

Clinical abuse or misuse (The Academy of Managed Care Pharmacy's, 2010).

Automated Medication Dispensing

Automated medication dispensing systems avoid medication errors by performing the tasks of a pharmacist. These include exhaustive, repeated movements, tasks requiring high levels...

The pharmacists may become tired from repetitive actions, triggering medication errors. Automated medication dispensing systems, when used appropriately, lower these errors and keep the patients safer. Automated dispensing systems can use bar coding process mentioned above to assure that the right drugs are prescribed in the right dose and usage form to the right patient (The Academy of Managed Care Pharmacy's, 2010).
The language barrier

Certain individuals can be identified as "limited English proficient" (LEP); these individuals predominantly speak a non-English language at home. Language barriers increase medication errors. Hence this group needs assistance while communicating with healthcare providers. This calls for access to various expert language services such as written materials translation and oral communication interpretation, by the healthcare providers and patients. The provider should always take care to ensure an effective provider-patient communication (Quan & Lynch, 2010).

Limited English proficiency (LEP) increases the risk factor of various health issues. It could make preventive health services less accessible; lower satisfaction levels with care offered; lead to improper understanding of medications or instructions; lead to extended hospital stays; and result in more misdiagnoses and medical error occurrences. However, using professional interpreters enables better patient care by improving communication, better patient satisfaction, lower service utilization disparities, and better clinical outcomes (Diamond & Jacobs, 2010).

Precaution

Educating trainees and clinicians on topics related to healthcare disparities arising from language barriers for the limited English proficiency (LEP) individuals, and how to avoid such issues would be an excellent addition to clinical education. It is also essential to avoid using interventions that aggravate such health disparities with the LEP patients. For example, studies reveal that including courses such as Medical Spanish could actually worsen the existing health care disparities when they are used inappropriately by the clinicians. Studies suggests that teaching courses related to language barriers in healthcare and the appropriate way of including an interpreter can lower such disparities. This will improve the chances that physicians include an interpreter while communicating with LEP patients (Diamond & Jacobs, 2010).

Which discipline is the precaution from?

The precaution is a product of health education.

Research being done

"Let's Not Contribute to Disparities: The Best Methods for Teaching Clinicians How to Overcome Language Barriers to Health Care," Lisa C. Diamond, MD, MPH corresponding and Elizabeth A. Jacobs, MD, MPP.

There are five topics that the authors identify as part of educational intervention to solve language barriers in healthcare: (1) recognition of the role played by language barriers in triggering health disparities; (2) considering ideal interventions that can be used to eliminate such disparities while handling LEP patients; (3) working with interpreters (potentially with some background in medical topics); (4) awareness of how the interpretation procedure is transpiring and being prepared to address miscommunication issues; and (5) when to use one's non-English language talents ((Diamond & Jacobs, 2010).

Recommendations for Malpractice Carriers

Continuous monitoring and tracking claims of LEP patients arising from ineffective communication should always be explored by medical malpractice carriers. Specific codes should be established for various cases to identify the languages used by providers and patients and whether providers offered any language services. Establishing unique codes will help a carrier to analyze the claims put forward by the LEP patients and healthcare providers, identify corrections if required, and educate the providers with respect to the relationship between language services and effectual communication. Carriers should also provide suggestions to improve the way the language requirements of the claimants are documented by the healthcare providers as well as the provisions provider has to record the language services. One of the ways this can be done is to make changes to the contract language with the providers by asking them to include the documentation required for recording the language needs and services offered to such LEP patients. It can also offer incentives to the healthcare provider for offering such language services (Quan & Lynch, 2010).

Recommendations for Providers

Using competent language services help in lowering the risk LEP patients face from poor medical care. It also shields healthcare providers from legal exposure risk. This can be done by adequate collection and recording of language data, recognition of language needs of the patients, and documentation of language services offered, with proper plans for offering language services when required. It could also include arranging an interpreter before the appointment, collecting information related to health benefits, vaccination notices, and other education topics potentially required, as well as obtaining the translated forms of various essential documents used in the health encounters such as discharge forms (Quan & Lynch, 2010).

Conclusion

Medication errors, unfortunately, are perhaps unavoidable parts of the healthcare system without rigorous attention on the part of the healthcare personnel…