Inside Duke Medicine

Focus on: The Right Time

The fifth part of “Six Rights in 6 Months” patient safety series

By John Howe

Thanks to search engines like Google, we can tell that there are hundreds of song titles and thousands of expressions which speak about “Time.”

“Time in a Bottle,” “Got No Time,” “This Time” and other songs lament lost time. And, in literature, notable expressions that highlight how time affects all of us come from sources that range from Ecclesiastes to Mark Twain to Jesse Jackson.

When it comes to the process of safe medication administration at Duke University Hospital, the expression “Time is of the essence” may well summarize the importance of the Right Time. Yet, it’s not just about the speed of the process. It is about being safe and making sure that the right time is part of the administration equation at all times.

In 2006, the Institute of Medicine of the National Academies published a landmark report 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 of $3.5 billion per year. The medication safety leaders at Duke continue to work to maximize safety and minimize the possibility of error in the medication use process.

As part of the efforts to reinforce this equation of medication safety, the Medication Safety Education Committee at Duke University Hospital has developed the “6 Rights in 6 Months” campaign. The campaign is focusing on one of the 6 Rights of medication use process each month.

This month’s focus is the Right Time.

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 medication to the patient at the right time. A few examples of steps that can be taken to help assure the right time of a medication include the following:

• For     prescribers, use STAT and NOW designations     only when truly needed. They should not be used to simply “hurry the     process up;” they should only be used when medications are truly needed in     a short, defined time.
• For     pharmacy, proactively communicate with     the care nurse when a therapeutic drug level is ordered to assure timely     delivery of the corresponding dose.
• For a     nurse administering a medication, consider care routines and     patient condition that may affect when a patient may receive a medication.    Follow guidelines for modifying medication times on the Medication     Administration Record.
• For     patients or family members, be comfortable in asking     questions when a medication is to be given to you or your family member.    The nurses and doctors expect that and will be glad to answer your     questions.

Another part of making safe choices in the medication delivery process is remembering a few “non-negotiable behaviors,” including:

• Always taking the medication administration record with you and using it 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 involved to maximize the safety of our medication use processes.

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/

Read the previous right here.