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MEDICATION AND OTHER ERRORS IN EMS

When we review charts and Occurrence Reports we find that there are many different types of errors made as we care for patients. Happily, errors do not happen every day and not all errors result in harm to the patient; but then you also have to wonder how many errors are made that we never catch? The most important thing to remember is that most errors are preventable.

Some common errors in EMS that have resulted in legal action across the nation are:
• Delays in patient care because of an inability to find the patient’s location
• Equipment that doesn’t work or a lack of knowledge on the provider’s part of how it works
• Medication errors
• Esophageal intubation
• Vehicle crashes
• AMA of a patient that is not competent

What can we do as EMS providers to prevent errors?
• Look at your map book and know traffic patterns for different times of the day. If you can’t find a location, call into dispatch early and get help.
• Occupy your downtime productively: Having nothing to do produces boredom or anticipation. Both boredom and anticipation are exhausting and exhaustion can lead to errors.
• Check your vehicle and all of your equipment before you start your shift: Is everything there? Does it work? Do you know how to use it? If you have questions on equipment, ask a supervisor, or the education department.
• Maintain your knowledge base and competency: Attend the monthly CE programs, subscribe to journals, research current trends on the internet and use your education money to attend conferences. Check your mailbox for updates and changes in protocols and equipment.
• Always use the five rights when giving a medication (right patient, right drug, right dose, right time, right route). Don’t rely on the fact that every medication container will always be in the same spot in your med box; look at the label and the strength EVERY time you give a medication. Verify patient medication allergies; check medication name on package; check medication name on container (syringe, vial, ampule, bottle); check/validate expiration dates; check total container quantity; draw the correct dosage and verify the drawn dosage. If you are uncertain about a drip calculation or a dosage calculation, have your partner check and verify your math. Don’t ever give a medication that someone else has drawn up.
• Use multiple methods of confirming tube placement but ALWAYS rely on the best: ETCO2. Secure the tube well, continuously monitor the patient’s cardiac and SPO2 status and immobilize the patient so the patient doesn’t dislodge the tube. Frequently reassess your tube and patient and recheck tube placement after every patient move.
• Take care of yourself and your partner: Fatigue, hunger, thirst, illness, preoccupation and complacency can all lead to errors. It is your responsibility to know when you can no longer perform optimally.
• Document all of the aspects of competency and capability of the patient to make the decision to refuse care. This is one protocol you should know inside and out and never skimp on documentation. You want to document on each of the seven points in the protocol and if the patient refuses to sign or walks away, be sure you document that action. Before allowing any patient to sign AMA be sure you have checked for and documented any possible organic reason for his refusal or that would make him incompetent to sign AMA (hypoglycemia, intoxication, dementia, head injury, hypotension, etc.)
• Work as a team: Teamwork can decrease certain types of errors. Acting alone or without support can lead to patient care problems on a number or levels.
• Communication is key to making positive differences: Confirm medication orders, reaffirm protocols, and repeat information back to the patient to be sure it was heard correctly. If you are ever unsure of your treatment or want further advice with a patient, don’t hesitate to contact a base station physician.

Every error of any magnitude should be reported. Reporting an error immediately protects you and the organization. Sentinel events are errors that have a higher likelihood of causing harm to a patient, attracting media coverage, going on up the chain of command as a complaint, or ending in litigation against the organization and/or the care provider.

In the words of the African American poet, Nikki Giovanni, “Mistakes are a fact of life. It is the response to the error that counts.”

Diane Rolfs, MS RN

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