Giving medication in a hospital setting isn’t always as straight-forward as it seems. It’s certainly not something to be rushed.
One nursing publication describes the 10 rights of drug administration as:
• Right drug
• Right patient
• Right dose
• Right route
• Time and frequency
• Documentation
• History and assessment
• Drug-drug interaction and evaluation
• Drug approach and right to refuse
• Education and information
Hospital pharmacists have robust responsibilities when it comes to patient safety. One peer reviewed journal described it like this: “Our primary role as pharmacists is to be the medication therapy experts in the health care system. Within this role, we are committed to patient care by ensuring the safe and effective use of medications. We may also have generic roles as educators, advocates, managers, mentors, collaborators, and scholars.”
A significant benefit of a hospital pharmacy is that it’s tied into the electronic clinical systems that process medication orders and dispensing. The Joint Commission’s hospital accreditation Standard 4.10 requires the hospital pharmacist to review all medication orders before a medication is dispensed, removed from floor stock, or removed from an automated storage and distribution device.
Automated medication cabinets are located throughout hospitals and are routinely used every day. When a doctor, physician assistant, or nurse practitioner orders a medication, the hospital pharmacy will clear the order for dispensing.
When a medication is ordered that’s contraindicated or potentially dangerous or inappropriate for a particular patient, it will trigger warnings for the nurse, prescriber, and the hospital pharmacy.
Despite the warning, nurses and providers can override the medication cabinet and dispense the drug before the hospital pharmacy reviews the potential patient safety issue.
The idea behind the override option is that the nursing staff should only use it in urgent or emergency situations.
Peer-reviewed studies have found that when nurses or providers administer medication before a pharmacist reviews the situation, it increases the risk of medication errors. One study looked at nearly 500 medication overrides. The research found that:
• Around 11% of medication cabinet overrides were for medications that hadn’t even been ordered by a physician.
• 10% of the overrides didn’t have properly documented orders.
• 2% of the medication overrides involved close calls where a wrong medication was removed from the cabinet.
We’re currently working on a case where a patient was seen in a Texas hospital emergency room (ER) for respiratory distress. Let’s call the patient Bill.
Bill was a young man who had undergone a chest surgery about five months earlier and was periodically having fluid buildup, called pleural effusion. The excess fluid made it hard to breathe and had to be periodically drained with a needle.
During this particular visit to the hospital, the emergency department registered nurse decided to administer a sedative, Ativan, even though Bill had already received a powerful narcotic pain medication, fentanyl, and had grossly abnormal respiratory rate.
When the nurse went to obtain the medication, the system generated a medication warning. The nurse did a cabinet override and proceeded to dispense the Ativan and administer it by IV (intravenously). Almost immediately, Bill’s demeanor changed. He started looking off into space and drifting away. In less than 30 minutes, the Ativan depressed the little residual respiratory he had left, and he went into respiratory and cardiac arrest.
The registered nurse ignored a medication warning in a situation that wasn’t urgent or an emergency. It left Bill with a permanent brain injury.
If you’ve been seriously injured because of a medication error at a Texas hospital, contact a top-rated, experienced Texas medical malpractice attorney for a free consultation about your potential case.
