Use your pre-admission process to enhance safety

From the October 30, 2002 issue

Are you using your pre-admission process for elective admissions to help protect patients from medication errors? In most inpatient and outpatient settings, surgical (and even some medical) admissions to the facility are planned several days in advance. Before the day of admission, many patients visit the facility to undergo diagnostic tests and to provide some preliminary information. But often, the initial contact is brief and does not include important issues that could avert serious medication errors.

For example, are patients who are likely to receive PCA given an opportunity to see the device, learn about its use, and warned about the risk of oversedation if a family member pushes the button? Are complete medication histories obtained? If patients are poor historians, are they asked to bring all prescription medications to the facility on the day of admission? Or are their primary care physicians or pharmacies contacted for verification of medications before admission? Is complete allergy information obtained and sent to the pharmacy along with the initial set of preoperative orders? Are patients specifically questioned regarding overthe- counter (e.g., aspirin, vitamin E) and herbal (e.g., ginkgo biloba) medications that may interfere with the ability to perform a procedure safely or interact with medications prescribed after admission?

One hospital recently estimated that about 75% of all order clarifications that pharmacists performed after admission could have been fixed before the patients were admitted. The hospital also reported concern that staff may be missing medication and other safety problems that would be brought to light more easily with an improved pre-admission process. It’s worth the time to meet and discuss possible improvements, maybe even adding a pharmacist to the pre-admission team for selected patients. Or how about a pharmacy technician? Another hospital reported an 85% reduction in “home medication” discrepancies by placing a pharmacy technician in the admissions department to call each patient before their scheduled admission. The technician obtains a full medication history and calls physicians and pharmacies to verify the information, if needed. A pharmacist then reviews the medication history so it’s available for the physician to reference upon the patient’s admission. This process has been so successful that it is being expanded to other areas such as the ED.