EMS Patient Safety: Preventing Medication Errors

May 22, 2018 Dawn Mangine

The National Institutes of Medicine reported in its well-known paper “To Err is Human: Building a Safer Health System,” that as many as 98,000 people were dying due to medication errors in hospitals – errors that the institute believed were preventable.

Although to date, no related studies have been done involving out-of-hospital medication errors, it stands to reason that similar rates of medication error are made in the field. Additional risks faced by first responders, EMS, and paramedics are:

Emergency situation
No external crosscheck
No electronic decision support
High-risk medications
Drug shortage issues and substitutions

In acknowledgement of these risks and as a way of addressing them, Dr. Sabina Braithwaite, MD, MPH, FACEP, developed a process to help identify and correct for system errors. The Medication Administration Cross-Check (MACC) is a standardized method for administering medications every time for every medication. The MACC requires two providers to verbalize the procedure.

Medication error reduction tracking:

Error made, no harm to patient and no change to patient’s outcome
Error made and resulting in harm to the patient; harm comes in varying degrees
Error made, and results in patient death

Simulation Activities to Prevent Medication Errors

Simulation activities can support reducing or eliminating medication mistakes in at least two ways: 1) Identify where errors occur and 2) Develop and reinforce safe medication administration behavior.

Objective 1: Adhere to the “five rights” of medication administration: right patient, right drug, right dose, right route, and right time; use a verbal cross-check system like MACC.

Simulation activity 1: Use task trainers to provide students a choice of administration routes and appropriate medications.

Objective 2: Identify medication error gaps and reinforce proper administration.

Simulation activity 2: Create complex simulation scenarios using higher fidelity manikins or standardized patients that require medication administration under higher cognitive loads in team settings.