Medication Safety and Communication Skills

Types of Errors: Possible Causes and Potential Solutions

Communication with Health Care Providers

• Over the phone
  • Distractions and noise that interfere with the transactions
  • Heavy accents as well as other language barriers
  • Obscure terminology or big terms
  • Similar medications when spoken
  • Numbers that sound alike
• Handwritten communication
  • Poor handwriting
  • Names that look alike
  • Wrong name in the drop-down menu
  • Decimals either in the wrong spot or are unclear
  • Unclear abbreviations
  • Alert fatigue
• How to Compensate
  • Get rid of distractions
  • Try changing the lighting
  • Provide feedback and open communication with other healthcare professionals
  • Take advantage of barcoding
  • For sound-alikes, add accentuates on certain syllables
  • For verbal order, repeat it back to verify

Communication with Patients

• Common problems
  • Can’t comprehend
  • Accent
  • Terminology
  • Hearing or visual impairments: cannot understand written information
  • Not correctly identifying the patient
  • Patients not speaking up with questions
• How to fix
  • Allow the patients to paraphrase what you just told them
  • Give them a written copy of the information so they can refer to it later
  • Allow them to ask questions
  • Take advantage of your resources

General Strategies to Enhance Patient Safety

Reporting Errors

• To error is to be human: creating a safe environment where errors are nonpunitive is essential to have an open and honest atmosphere
• The purpose of reporting errors is not to get someone in trouble but to learn from it and possibly better the safety precautions
• The majority of errors are caused by the system and not the person

Organized Strategies to Minimize Errors

• Failure Mode and Effects Analysis and Root Cause Analysis are two ways to identify and prevent possible errors
  • FMEA identifies both sources and consequences of failures based on past events
  • RCA focuses on specific root causes of error
  • It asks why not how
• These systems cannot prevent 100% of errors
• They can only minimize how often and how severe they are

When Errors Occur

Initial Discovery

• Avoidance: denial that the error happened and refusal to help fix it
• Blame: “It was someone else’s fault they messed up”
• Rationalizing: it wasn’t that important: it is not a big deal
• Assuming someone else will catch their mistake

Initial Contact with Patient

• When meeting try to go somewhere private
• Explain what happened and the short-term consequence
• Tell them how the problem is being resolved
• Assure them they have not been forgotten about

Further Contact

• Once the patient has a clear idea that an error has occurred and how it is being resolved, you may want to provide additional insights into why it occurred.
• Some patients might want to know how it occurred and what steps you are going to implement to prevent future occurrences.
• Be honest and upfront with the patient about the long-term consequences of the error. They may be interested to learn how they will be compensated for their inconvenience or injury
• You should make sure that you do not rush through the experience and allow patients time to ask questions and express their feelings.
• This feedback will help you determine whether you need to conclude the interaction or continue to address the patient's remaining concerns.
• A sincere closing statement, such as "This rarely happens, but it happened with your prescription and I want to resolve it," may put the error in perspective.

Contacting Other Health Care Providers

• Be the one who controls the information
• Revealing errors to other providers is helpful for their quality assurance efforts as well.

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