Do Medication Carts Improve Patient Safety?
December 17, 2018 | by Brian Shoenfeld
By the Numbers
When we are cared for in a hospital, we assume many things. Primarily, we expect to receive good care from qualified caregivers, such as doctors, nurses, pharmacists, and related staff. That care, we assume, will include the administration of some medications during our stay. While we may dread a hospital stay for various reasons, few of us fear we will be given the wrong dosage or worse, the wrong medication: medication that the doctor did not prescribe. Unfortunately, medication errors are more common than we’d like to think.
The Institute of Medicine estimates patients are exposed to “at least one medication error per day” and at least 25 percent of these errors are completely preventable. One medication error per day is one too many, particularly when those medication errors can cause life-threatening results. At the very least, medication errors can result in adverse events that prolong hospital stays or require a return to the hospital in the near future. In fact, medical errors, such as with medication administration, is the third leading cause of death in the United States. Not exactly what we anticipate encountering when we check into a hospital. We are focused on getting better, not on all of the bad things that could happen due to incompetence, errors or neglect.
While these medical statistics are sobering, to say the least, hospitals have made great strides in addressing medication errors. Perhaps one of the greatest leaps in reducing medication errors was with the introduction of electronic prescribing through a computerized provider order entry (CPOE) system. The success of this technology was so revolutionary, so critical, it has become the norm. The system greatly reduces the risk for medication errors due to poor handwriting, a habit doctors are known to espouse and one that easily resulted in improper dosing. The CPOE system also flags potential adverse drug interactions before medications are administered. It serves as a clinical reference for dosing and medication decisions. As much as this system has helped, there’s still more that is being done.
Medication Carts Further Reduce Medication Errors
While medication errors may have been reduced with the introduction of digitized prescribing, the seemingly simple task of delivering and dispensing medications had room to improve. In the past and still for some hospitals, the relationship between the hospital pharmacy and the hospital nursing staff remains disjointed.
The pharmacy receives the doctors’ prescriptions, fills them, then delivers them to a decentralized medication room. These rooms contained bulk medications and patient-dosed medications ready for nurses to retrieve and administer. This introduced risk. The risk for nurses to inadvertently grab the wrong medications or dosages, thus putting patients are high risk for medication errors. The risk for medications to “disappear,” making it hard to track medication whereabouts and increasing the potential for criminal activity. The risk for bulk medications to be wasted, increasing hospital costs.
To reduce these risks and improve efficiencies at the same time, hospitals employ the help of medication carts. Medication carts are typically used by nursing and because of their mobility, can be brought directly to patient rooms or used as a mobile cabinet in medication rooms. The medication carts contain bins that are secured with digitized locking mechanisms only accessible by authorized personnel. These bins securely hold prescribed, patient-specific unit-dosed medications in a form ready to be administered to the patient.
Medication carts instantly minimized all of the aforementioned risks. Any benefits, however, are dependent upon the effectiveness of the prior operating model and will vary because every hospital is unique. The goal is to give the pharmacy more control, remove as much burden as possible on nurses, and enable the hospital to maintain the integrity of their mission to provide excellent patient care.
The Best Features of Medication Carts
Medication carts come in many flavors and are generally customizable to fit the workflows of hospital units. Their intent is to provide controlled, precise, secure administration of medications. With many sizes, features, and functionalities from which to choose, hospitals and medical facilities have plenty of options.
Secure access is a must. Most will offer an electronic keypad locking mechanism or an ID badge access point. This ensures only those nurses who are authorized can retrieve the medications from the pull-out drawers within the cart. Pharmacy technicians fill the drawers with patient-specific medications, then lock the drawers into place. Nurses need only to log into the cart, pull out the drawer specific to their patient, and administer the medications. The unit self-locks behind them and requires another nurse login to access to administer medications to another patient.
The medication carts should contain integrated software that not only grants access but also tracks that access, the “comings and goings” of users, if you will. In this way, hospitals can keep tabs on who entered the carts and the medications they retrieved. This feature provides a “paper trail” of sorts, giving hospitals assurance during audits and holding nurses accountable for their actions.
At the most basic level, medication carts provide pharmacy a means to transport medications. Hospital pharmacies are rarely located on the patient floor and are never on every patient floor. They may be in the hospital basement, a separate floor or even an adjacent building. By making medication carts mobile, the pharmacy is able to travel to patient bedside. While decentralized medication rooms enable the pharmacy to bring medications to various hospital floors, medication carts extend that mobility to actual patient rooms.
With nursing shortages and workflows being a constant pain point for hospitals, any improvement in efficiency only serves to promote better patient care. By reducing the amount of time nurses spend walking back and forth from each patient room to a central medication room, and reducing the amount of time nurses spend retrieving those medications and validating them, the more time can be spent caring for patients.
Additional Helpful Features
Many medication carts add work and storage space, facilitating medication administration. This may include a writing shelf, extra drawers or bins with additional supplies, and computer workspace.
The #1 Benefit of Medication Carts
Medication carts may not be the end-all for proper medication management, but they do provide something that is priceless for hospitals, pharmacists, nurses and patients alike: peace of mind.
Medication carts are one of many steps hospitals and healthcare facilities can take to promote patient safety while reducing their risk for medication errors. Hospitals and healthcare facilities can have confidence they are being proactive in securing medications so patients receive their prescribed medications at the right doses. They have peace of mind there is an audit trail with accountability. They are actively reducing the cost of keeping so many bulk medications in stock on every floor, many of which is wasted and expires before being administered. They are also giving their nurses more time to care for patients.
The pharmacy has certainty of where the medication prescriptions they fill are. While they gain control in the management of that medication, they can also rest assured nurses are dispensing those medications as directed. This improves the relationship between pharmacy and nursing as both parties trust each other are doing what they are supposed to do and empowering each other to do so.
Nurses have assurance they are dispensing the right medications to the right patients. They are no longer expected to find the medications themselves, count out bulk medications or do anything other than bringing the right medications to their patients. They reduce the amount of time they spend running errands and increase the time they spend with patients. Nurses often use that extra time counseling patients on proper at-home care, listening to patient concerns, following up with doctors and ensuring patients receive the best care possible.
Patients, of course, are the ultimate winners. With the use of medication carts, the risk for them receiving the wrong medication or dosages plummets. Not that they were informed enough to recognize their risk, but now, it’s an issue that doesn’t need to be on their radar at all. Their nurses have more time to spend with them and they receive more prompt care. It’s peace of mind for them and their families.
Ensuring The Best Results Using Medication Carts
As with any solution, correct usage is the only way to maximize benefits. Medication carts are no different. Even though there is a secure access mechanism, individualized bins, and pharmacy control, there is still room for human error. Reducing that element is a different beast but one that is surprisingly simple to impact.
According to The Journal of Continuing Education in Nursing, contributing factors for medication errors include distractions, lack of focus and failure to follow standard operating procedures. “The nursing unit is vulnerable to a multitude of interruptions and distractions that affect the working memory and the ability to focus during critical times.”
Hospitals, therefore, must do more than provide medication carts. They must also implement and enforce proper protocols. Something as simple as providing a medication administration checklist was proven in the Journal’s study to improve focus and standardize practice. In the same study, visible signage also reduced nurses’ distractions and improved focus. These are inexpensive, yet proven methods for establishing best practices in using medication carts.
Hospitals have more solutions at their fingertips than ever before. Thanks to technology, integrated software, and more traditional methods, hospitals can improve their risk stance considerably. Medication carts are a relatively simple and cost-effective way to improve patient safety, nurse efficiency, and pharmacy reliability.
About the Author
Brian joined Talon in 2014 and brought with him a proven track record for project managing, product development, and increasing operational efficiency. Using his knowledge of STEM, business prowess, and healthcare experience, Brian leads Talon’s operational improvements to create better products and improved customer service. When he’s not in the office, Brian spends time with his wife and two sons and cheers on Syracuse.