Risks – Medication safety risks are inherent in the many steps and processes in providing medications to residents, including but not limited to: medication orders; transcription of medication orders; medication preparation, labeling and dispension; medication administration; medication self-administration by residents; medication storage; medication disposal; and medication reconciliation on admission and return after hospitalization.
Risk Management Strategies:
- Medication Reconciliation – Establish a formal process for medication reconciliation on admission and return after hospitalization. Compare physician medication orders with provided medical history documents and resident/family information about current medications. Clarify any discrepancies with the resident’s primary physician.
- Restocking of Medications – Assign accountability for checking in a new supply of medications including verifying medication labels on the blister packages/cartridges with the Medication Administration Record (MAR).
- Medication Administration – Ensure medication administration consistently includes the “seven rights” of medication administration – right medication, right resident, right dose, right time, right route, right reason and right documentation. An eighth right is the right to refuse medication. Document resident refusal, verifying what concerns the resident about taking the medication, and ensure primary physician communication about the refusal (as appropriate for the situation, noting the resident may have repeated situations of refusing medications).
- Resident Medication Self-Administration – Develop a formal process for evaluating resident competency for medication self-administration including the name of medication, dosage, medication times and proper medication storage. Have a registered nurse or pharmacist review continued competency on a quarterly basis and with significant change in condition.
- Staff Medication Skills and Competencies – Verify the medication skills and competencies of team members assigned the responsibility for medication administration. Perform medication administration audits.
- Staff Medication Skills and Competencies – Ensure staff that administer medications have a basic understanding of the indication for the medication, proper route and dosage (e.g., diabetes, pain management, hypertension).
- Resident Pain Evaluation – Develop a tool for resident pain evaluation that includes interventions that support comfort, mobility and pain relief (e.g., mobility, positioning, massage).
- Psychotropic Medications – Identify residents taking psychotropic medications pre-admission (when possible) or at the time the medication is prescribed, including indications for the medication(s). Provide staff education on medication side-effects.
- Storage of Medications – Regularly verify appropriate storage of medications in residents’ rooms (as applicable), medication carts or other medication storage areas.
- Narcotics and Controlled Substances – Ensure that narcotics/controlled substances are appropriately double locked. Document count reconciliation and appropriate disposal.
- Medication Disposal – Establish a formal process for medication disposal of unused medications.
- Medication Errors – Track and trend medication errors including an evaluation of the systems and processes involved in medication delivery (e.g., number of steps involved in the medication transcription process and the potential for error – is it possible to reduce the number of steps or simplify the process?)