On Patient Safety and the “Five R’s”

One of the biggest preventable causes of patient care complications both in and out of a hospital facility is that of medication errors.  Errors are made for a number of reasons including giving one patient another’s meds, dosing errors, medications with look-a-like names, and unclear medication orders.

In the pre-hospital setting some of those errors are not usually relevant.

However, even when handling one patient alone it is easy to make simple mistakes especially when distracted by stressful circumstances commonly seen in the emergency settings.

One of the key things you can do to support safe practice in the field is to develop good working habits.  The “Five R’s” is one of those important habits.  Making sure you double check dosing, patient information, expiration dates, and routes of administration will help protect you and your patients from costly errors.

The Five R’s

  1. Right Medication – Is this the right medication?  This seems silly but in the heat of a call, you take your eyes off the med just as you reach for it and pull out a bottle, vial, or injection.  Did you really grab the one your were aiming for?  This has happened to me and only because I had developed a regular habit of checking the medication and dose prior to administration did I keep from giving a patient Diazepam (the Wrong Drug) instead of Morphine (the Right Drug).
  2. Right Patient – Is this the right patient?  This is especially true for BLS providers who assist patients with their own meds.  Make sure you check the label.  It should have the patient’s name and usually their date of birth.  Hold it up, look at the label, and ask the patient or their family member for the patient’s name.  For ALS providers, right patient is a reminder to verify patient history and medications for any contraindications prior to administration.  What about recent Viagra use for that angina patient? No nitro for him!
  3. Right Date – Medications expire all of the time.  Go home and look in your medicine cabinet, I’ll bet you’ll find at least one.  For elderly patients with lots of medications, they could have three old bottles of nitro sitting around or an old albuterol inhaler from the 1990s.  As for your own EMS medications, are you willing to trust you career to someone else’s ability to do inventory?
  4. Right Dose – Double check your dose.  Did you grab the pedi epi-pen by mistake?  That dose will not help save an adult patient. If you are measuring and drawing up meds yourself, look at the syringe and make sure you’ve got the correct dose measured just prior to administration.
  5. Right Route – Finally, are you choosing the right route? The epi pen is an intramuscular injection but you can’t give it in just any IM injection site.  Know your proper points of administration for each route.  Oral glucose should be administered so the glucose can be absorbed via the oral mucosa and not swallowed into the GI tract.  The oral mucosa offers a more rapid absorption and onset of action that the oral GI tract route.  Know the options and what they mean.

This is just some of the information and tips on the new NREMT Medication reviews from the MedicCast Test Survivor Series.  These study aids on CD are an invaluable tool for EMS providers, EMT and paramedic students, and educators.  Check them out!

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