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Changing the Culture of Blame Surrounding Medication Safety

Leanne Huminski, chief nursing officer of McLeod Regional Medical Center, describes the cultural shift that had to occur before McLeod’s medication reconciliation program could be successful.

It’s important to realize that medication safety is a journey, not a destination. While we still have work to do, we have improved the process. It’s good to step back at times to see how far you’ve come, rather than continually focusing on how far you still have to go. Six years ago we had a paper documentation system and med carts that were stocked and exchanged daily. There was a med drawer for each patient, and all the patient’s medications were located in that drawer. There was a culture of blame at that time, with a “three strikes and you’re out” process. In other words, if a nurse made three medication errors, she was counseled, a note was put in her personnel file, and she was asked to attend a remediation course.

We realized we had to change the culture so that people would feel open to reporting errors. At that time, our physician’s orders were “tubed” to the pharmacy via a triplicate form. The bottom copy was sent to the pharmacy, and errors occurred simply because the form could not be read as clearly as if it were a direct form. We did have automated dispensing cabinets (ADCs), but only for the use of narcotics.

When we started our journey in 2000, we received a Robert Wood Johnson Foundation grant for improving the care of patients with myocardial infarction as well as the medication delivery system. At that time, we researched best practices and we’ve implemented many of these practices. We looked to the recommendations from the Institute of Medicine’s (IOM’s) 2006 report entitled “Preventing Medication Errors.” The report recommends implementing electronic prescribing, use of technology such as bar-code scanning and ADCs, use of a medication reconciliation system, adopting a safety culture and using decision support and smart pumps. It also recommends communication of drug information on a real-time basis, access to automated point-of-care drug information, monitoring for errors, communication of adverse benefit information, and segregation of “look alike-sound alike” drugs. Although this report wasn’t available until 2001, we have implemented all of these methods.

Source: Medication Reconciliation Strategies to Reduce Hospital Adverse Drug Events, January 2008

Medication Reconciliation Strategies to Reduce Hospital Adverse Drug Events

In this special report, Donna Isgett, McLeod vice president for clinical effectiveness, describes the hospital's emphasis on quality and perfect care processes, and Leanne Huminski, chief nursing officer, provides the inside details on McLeod's medication management program, which has a goal of eliminating adverse drug events.

Medication Reconciliation Strategies to Reduce Hospital Adverse Drug Events is available from the Healthcare Intelligence Network for $97 by visiting our Online Bookstore or by calling toll-free (888) 446-3530.

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