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Twilight (The Flamingo Hotel)
Monday, 29 January 2007
6:30 PM - 8:00 PM
Twilight (The Flamingo Hotel)
Tuesday, 30 January 2007
4:30 PM - 6:00 PM
Nurses Improve Medication Safety with medication Allergy and Adverse Drug Reports
Sharon Valente, APRN, Ph.D., FAA, Lillian Murray, and diane Fisher. Nursing, Department of Veterans Affairs, Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Bldg 500, Rm 6208, mc 118R, Los Angeles, CA 90049
Administering medications safely is a nursing responsibility with significant impact. The Institute of Medicine highlighted medication errors as a major threat to patient safety. National Council on Patient Information and Education reported that up to 50% of prescriptions are improperly used or administered and lead to preventable medicine-related illnesses that annually account for over $75 billion in clinic visits, unnecessary prescriptions, increased emergency room visits, hospitalizations, nursing home admissions and death. Adverse drug reactions (ADR or ADE) are the 4-6th leading cause of death in the U.S. Although electronic prescribing and computerized drug management systems improve the prescribing safety and quality, nurses have a major role in preventing errors by reporting medication allergies and adverse drug events. In a population of veterans in a metropolitan area, approximately 30% have drug allergies and approximately 600 and 900 adverse drug events are reported per month. A retrospective review of chart documentation reflected that from 20% to 50% of patients had a medication allergy that was not correctly recorded. Incorrect recordings included misspellings of drug names and failure to enter medication allergy in computer records. However, staff nurses report less than 1% of these ADRs. To improve the reporting of medication allergies and adverse drug reactions, we replicated a best practice from the NYVA and conducted an educational campaign with these components: (1) Allergy Awareness Campaign - Distribution of Patient Allergy Update Questionnaire; (2) Staff Nurse Training on entry of allergies/ADRs into the Computerized Patient Record System (CPRS); and (3) Patient Oriented Brochures – Partnering with the Patient/SPEAK-UP Campaign to encourage patients to report allergies and ADRs and ask questions about their medications; and (4) Fact Sheet about reporting ADRs. When 300 patient allergy forms were returned and entered in the computer, 30% of patients reported medication allergies. The most common allergies reported were codeine, morphine, penicillin, and other antibiotics. Over 90% of the patients rated the brochures highly satisfactory. In the process of checking each allergy form and comparing it to the computer, we learned that about 10-15% of patients have allergies listed in the chart that they do not remember so the chart becomes an important link in accuracy when the patient's recall is faulty. In addition, patients have listed many allergies to medication and to food, dye, or latex that were not recorded in the chart. As a result, the documentation of medication allergies for over 300 patients was improved and Adverse Drug Events reported by staff nurses improved five fold.
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See more of The NDNQI Data Use Conference (January 29-31, 2007)