Pharmacists Can Reduce Medication Errors During Emergency Codes

Health-system pharmacists can help save lives by reducing the risk of medication errors before, during, and after hospital emergency codes.

In a session at the 2015 American Society of Health-System Pharmacists (ASHP) Midyear meeting called “Code Response! More than Meds to Prevent a Total Eclipse of the Heart,” panelists described the value of the pharmacist in mitigating the risk of potential medication errors during codes.

Cardiac or respiratory resuscitation is an exceedingly stressful situation, and health care providers usually have little-to-no time for discussion and verification of a patient’s medication regimen.

Andrew North, PharmD, BCPS, MBA, told ASHP Midyear attendees that pharmacists are “often the most consistent member of code efforts” and that clinical pharmacists’ participation on a CPR team has been found to reduce mortality rates and rates of neurological damage among survivors.

“Effective resuscitation through a coordinated team effort is possible when each member of the team anticipates the next step in the procedure and complements the efforts of the other,” he explained.

As medication experts, pharmacists have a great responsibility in ensuring that the odds of a medication error are as low as possible. Dr. North recommended that pharmacists consider adopting certain strategies to help them optimize their role during codes.

First, he said pharmacists should be responsible for stocking and restocking all code medications. Having all necessary drugs ready to go on all code carts in all code areas is critical for reducing the amount of time the patient is without his or her needed medications.

“Time between onset [of cardiac arrest] and provision of care is fundamental, and shortening that time is one of the best ways to reduce the risk of death or disability,” Dr. North explained to session attendees.

He also suggested that all medications should be provided in ready-to-use syringes or premixed solutions. Having premade drugs can help to reduce the possibility of miscalculating a dose, which is highly possible during a chaotic situation like a code, he noted.

According to an Institute of Safe Medication Practices (ISMP) review of a study on mock pediatric resuscitations, approximately 20% of all medication-related verbal orders do not specify a dose, while 50% do not identify the route of administration.

In the same mock study, researchers analyzed syringes used during code simulations and found substantial deviations from the expected dose in 16% of the syringes, suggesting that unrecognized medication errors could be a major source of morbidity and mortality in resuscitated patients, ISMP reported.

Additionally, Dr. North asserted that emergency facilities should conduct regular code simulations, which he claims are beneficial for pharmacists in several ways, including the opportunity to “develop resuscitation and anticipation skills for pharmacy residents” and “clarify roles and responsibilities for post-code procedures.”

Dr. North also told attendees that conducting regular simulations helps prolong retention of information, as the likelihood of being able to recall duties and responsibilities from just a one-time training may be low.

“Evaluate your current roles and duties in codes and optimize based on the needs identified,” he concluded. “Quality improvement opportunities exist with respect to codes, go find yours.”