Inside Duke Medicine

Focus on: The Right Route

The fourth part of “Six Rights in 6 Months’ patient safety series

Like our transportation system, medication administration has followed a path that is increasing complex. What were once only a one or two primary routes of administration have become many. Read below about ways Duke Medicine is working to prevent that complexity from leading to errors.

Routes of administration are somewhat like routes of travel. For many years, “old Route 1” was the only road that travelers took when they wanted to drive north-south on the East Coast.

It was well-traveled, a tried and true route that drivers knew would get them safely to their destination. As more and more vehicles took to the roads and drivers demanded fast, effective routes of travel, other routes were developed. Today, there are multiple routes that travelers can take to reach their destinations.

The history of medication administration has followed a somewhat similar path, starting with only a few medications that were given via only one or two primary routes. Today, the sheer number of medications, combined with new routes of administration, make safe and effective medication administration a challenge to everyone involved in the medication use process.

In 2006, a landmark report was published by the Institute of Medicine of the National Academies titled Preventing Medication Errors. This report, which started a nationwide conversation and drive to maximize medication safety, notes that approximately 1.5 million people are harmed by medication errors each year, with an estimated cost of these potentially fatal errors at $3.5 billion per year.

The medication safety leaders at Duke have taken this charge very seriously and continue to work to maximize safety and minimize the possibility of error in the medication use process. To help in this journey along the safety highway, the Medication Safety Education Committee at Duke University Hospital has developed the “6 Rights in 6 Months” campaign.

Designed to help keep awareness of medication safety in the minds of all people involved in the medication delivery process, the campaign is focusing on one of the 6 Rights of the medication use processes each month.

This month’s focus is the Right Route.

Route-related questions arise frequently: Can this medication be given intravenously, or is it only given orally? Is there a different form of it that is used when given via an enteral tube? Is it available in liquid form or is that tablet crushable to administer it through the tube? And is it available in a certain form to facilitate administration to a particular patient?

It’s not as simple as it used to be. But identifying the correct route is an extremely important step in the process as we strive to maximize the safety of the medication use process at Duke.

As with each of the 6 Rights, there are multiple steps and considerations for each member of the healthcare team involved in the process of getting the correct dose to the patient.

A few examples of steps that can be taken to help assure the right route of a medication include the following:

• For prescribers, assure the medication is ordered for the appropriate route for the patient’s condition (e.g., order for tetanus vaccine subcutaneously, order for enoxaparin to be given IM).
• For pharmacy, check for the correct formulation and concentration for the route to be administered and include any warnings as appropriate (e.g., “Do not give intrathecally”, or “Give via G tube only”).
• For a nurse administering a medication, check the route against the medication administration record or order. Use only oral syringes for orally administered medications.
• For patients or family members, be comfortable and assertive in asking questions about a way a medication is to be given to you or your family members.

But, the Right Route is just one of the 6 Rights of Medication Safety. Another part of making safe choices in the medication delivery process is practicing a few “nonnegotiable behaviors,” including:

• Always taking and using the medication administration record with you to obtain and administer medications;
• Taking medications in the original packaging into the patient’s room;
• Labeling any medication prepared at the time of preparation, and
• Reviewing or returning to the last step prior to any interruptions that may occur in the process.

These behaviors and safety steps are considered important enough to be included each month, even as we focus on a different “Right.”

Throughout the six months of our “6 Rights in 6 Months” effort, the Medication Safety Education Committee continues to stress the importance of the basics of effective processes combined with vigilance by all persons in the medication use process to maximize the safety of our medication use processes.

Our patients deserve no less.

Want to know more about the Medication Safety Education Committee and its efforts? Contact committee coordinator John Howe, RN, at howe0003@ mc.duke.edu, or visit the Medication Safety Web site at http://PatientMedSafetyEd.duhs.duke.edu/.

View previous article in this series here.