Create Barriers Between Patients and Medical Errors

Implementing a medication administration cross check helped St. Charles County Ambulance District reduce dosing errors and win recognition for its Just Culture.

EDITOR'S NOTE: This article originally appeared on EMS1.com and was authored by John Romeo, deputy chief medical officer, St. Charles County Ambulance District.

In April, the Center for Patient Safety awarded St. Charles County Ambulance District with the EMS Patient Safety First Award. The Center for Patient Safety cited SCCAD’s establishment of a Peer Review Committee, development of a safety plan involving all staff, and the adoption of a Just Culture as rationale for the selection. The group also lauded the implementation of the medication administration cross check as a measure to reduce dosing errors.

EMS providers are at increased risk for medication error due to the emergency nature of their work, environmental conditions and time pressures. Providers work long hours, and fatigue often plays a role. In 2014 in “Prehospital Emergency Care,” Lammers et al. published a simulated study on the treatment of pediatric anaphylaxis. Fifty percent of providers gave incorrect doses of epinephrine. The root causes for these medication dosing errors were identified as:

• Weight estimation errors
• Incorrect recall of doses
• Inaccurate references
• Calculation errors
• Dose estimation errors
• Communication errors

The medication administration cross-check was first designed and implemented by the Sedgwick County, Kansas, EMS System in 2012. It was developed by Dr. Sabina Braithwaite (medical director for the Sedgwick County EMS System at the time), Captain Paul Misasi and Major Jon Friesen of the Wichita/Sedgwick EMS System.

CROSS-CHECKING THE 6 RIGHTS OF MEDICATION ADMINISTRATION

Most providers are familiar with the six rights of medication administration. The sixth right of safe medication administration – the right documentation – is frequently used as a guidepost, and provides the basis for the medication administration cross check. It is a simple, two-provider verbal procedure, which requires the providers to confirm the planned:

• Drug name
• Dosage
• Administration route
• Administration rate
• Rationale for administering

Contraindications (or lack thereof) are considered as a second step by both providers. Next, providers confirm volume or quantity to be administered. Finally, they concur and provide dual positive visual verification for the drug concentration and volume (or amount) to be given before administering it to the patient.

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