5 New Best Practices for Medication Safety All Hospital Pharmacists Should Know

The Institute for Safe Medication Practices (ISMP) recently added new best practices for improving patient safety in hospitals.

According to ISMP, the purpose of the 2016-2017 Targeted Medication Safety Best Practices for Hospitals is to “identify, inspire, and mobilize widespread national adoption of consensus-based best practices on specific medication safety issues that continue to cause fatal and harmful errors in patients, despite repeated warnings in ISMP publications.”

Health-system pharmacists should get familiarized with the following 5 best practices in order to promote patient safety in their hospitals:

1. Segregate, sequester, and differentiate all neuromuscular blocking (NMB) agents from other medications, wherever they’re stored in the organization.

In a lecture devoted to the new best practices, Darryl S. Rich, PharmD, MBA, FASHP, a medication safety specialist at ISMP, noted that the organization has received more than 100 reports of accidental administration of NMBs in recent years. Specifically, he said, inadequate labeling and unsafe storage have been the “root cause of most of these errors.”

As of February 2016, 54% of health-systems report partially implementing this practice.

2. Administer high-alert intravenous (IV) medication infusions through a programmable infusion pump using dose error-reduction software.

This practice applies to both inpatient and outpatient hospital settings and in all situations in which high alert medications are infused by the IV route (eg, anesthesia, patient-controlled analgesia).

Additionally, health-systems should:

· Ensure dose error-reduction software is employed on all smart pumps

· Verify that drug libraries are built and installed on all smart pumps, and make sure staff is using the error-reduction software

· Require periodic maintenance, updating, and testing of the software

· Evaluate alerts regularly

3. Identify which antidotes, reversal agents, and rescue agents should be administered immediately in emergency situations to prevent patient harm.

To comply with this best practice, health-system pharmacists should make sure all appropriate antidotes, reversal agents, and rescue agents are readily available. Additionally, directions for use and administration should be easily accessible in all clinical areas where these agents are used.

According to a report from the Agency for Healthcare Research and Quality, prescription opioid misuse and abuse resulted in approximately 660,000 emergency department visits in 2010 alone.

4. Eliminate all 1000-mL bags of sterile water labeled for injection, irrigation, and inhalation from all areas outside of the pharmacy.

Instead, health-system pharmacists should use alternatives in patient care areas, such as 2-L bags or vials. Dr. Rich suggested that the pharmacy should work with respiratory therapy teams and other relevant hospital departments to establish guidelines.

5. When compounding sterile preparations, perform an independent verification to ensure that the proper ingredients (medications and diluents) are added, including confirmation of the proper amount (volume) of each ingredient prior to its addition to the final container.

At a minimum, health-system pharmacists should ensure verification is completed for the following:

· All high alert medications, such as chemotherapy drugs

· All pediatric and neonatal preparations

· Pharmacy-prepared source and bulk containers

· Drugs administered through high-risk routes

Relatedly, the American Society of Health-System Pharmacists (ASHP) recently launched “Standardize 4 Safety,” a medication safety initiative that addresses the continuity of concentrations and dosing units for adult continuous infusions and compounded oral liquids, especially during transitions of care. The effort is part of a partnership between the ASHP and the FDA’s “Safe Use Initiative,” which provides draft guidance documents clarifying how it intends to enforce the prescription requirement for drugs compounded in health-system pharmacies.

Additionally, the FDA recently issued a series of draft guidance documents for compounding practices within health-systems.