Lessons in Transport: Avoiding Medication Errors

It takes an estimated 80-200 correctly executed tasks to successfully administer a single dose of a medication to a critically ill patient...

Our reality in transport medicine...  We routinely work in an environment that is prone to medical error. An environment that is...

  • Dynamic and potentially dangerous
  • Fast paced... where speed is perceived as excellence
  • Limited in space, resources, and personnel
  • Built on inferred indications with little access to confirmatory tests
  • Frequent patient care hand offs of high acuity patients
  • Defined by actions and inaction that have immediate consequences with little recovery time to stop sequential errors
  • Not reproducible... No mission is ever the same

Tips to avoid medication errors during transport resuscitations:

  • Understand that certain medications are more prone to error in dosing and administration than others: PINCH acronym (courtesy of Bryan Hayes, the Pharm ER Tox Guy)
    • Potassium
    • Insulin
    • Narcotics
    • Chemotherapy Agents
    • Heparin
  • Recognize the effect of IV tubing deadspace when initiating infusion on low ml/hr drips. In some cases this may result in an hour between initiation and a medication reaching the bloodstream.
  • NEVER EVER inject a drug from a non-labelled syringe... (tape the medication vial to the syringe as a quick way of labeling)
  • Do NOT inject a drug that you are not familiar with
  • Keep all empty vials until the resuscitation has concluded
  • Always... Always... Do a readback double check with your transport team prior to administering any medication. (that means physically showing a team member the vial and syringe to confirm the correct medication and dosage)
  • One of the best ways to prevent medication errors is for YOU to report errors and near misses so that we all can learn from the scenario and so that processes can be improved to make our transports as safe as possible... our future patients depend on this!

Content adapted from EMCRIT.org and my 2013 Critical Care Transport Medicine Conference Lecture. For more information listen to these 2 excellent podcasts http://emcrit.org/podcasts/avoiding-resuscitation-medication-errors/http://emcrit.org/podcasts/avoiding-resuscitation-medication-errors-2/