Guardian of the Night Pharmacy: part 2

In: Health

5 Jun 2010

Unfortunately, the expense of such sophisticated systems can outstrip the constrained budgets of small hospitals. Under

The views expressed in this article are those of the authors and do not necessarily reflect those of P&T.

These circumstances, redundancy procedures (for example, a log documenting medication review and approval by two nurses before a drug reaches the patient) rise in importance. When process improvements seem out of reach, teams must increase their reliance on the training and enforcement of content. However, overreliance on content control frequently becomes an authoritarian venture, as coercive schemes and a culpability culture typically follow. Coupled with this is a tendency in small hospitals and medical systems to underestimate risk and to cultivate the illusion that community relations are a reliable buffer against litigation. An opposing assessment may be more protective of a rural or community hospital’s future, because smaller hospitals are usually less well equipped to absorb liability claims. These reasons alone may justify investing in error-resistant process innovations and improvements.

The foundation of all safety systems is reducing exposure to potentially harmful agents. To minimize errant nocturnal exposures, P&T committees can “front-load” safety by developing an overnight formulary that determines which drugs are so urgently needed that they may bypass a pharmacist’s pre-dispensing review. Medications administered in this fashion should be limited to clinical situations in which the patient would suffer unduly if a dose were withheld until a pharmacist became available. In the absence of an “urgent formulary,” a confirmatory telephone call to the prescribing physician may be necessary to ascertain which drugs can be delayed until morning. Of course, for emergency situations, hospitals should always have a pharmacist on call who can quickly and competently clarify and verify any concerns about medications. canadian discount drugs

The on-call and urgent formulary are iterative systems. Each formulary variance or unanticipated pharmacist summons should be critically analyzed with the goal of designing techniques for averting deviations and integrating improvements into the after-hours medication-management plan.

These systems are just one layer of protection against medication errors and harm to patients. They require refinement and reinforcement to fit the specific needs of different types of hospitals and to have lasting effects on patient safety. Hospitals and health systems can take a lesson from the legend of the ever-vigilant Horus—day or night, there is never a time to close your eyes to patient safety.


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