Policy Manual sample

MDT Home Health Care Agency, Inc. REDUCING HARM FROM HIGH RISK MEDICINES Various Medical report finds that the medicines most frequently associated with severe harm are: • Anticoagulants • Antibiotics (allergy related) • Sedatives • Chemotherapy • Opiates • Antipsychotics • Insulin • Infusion fluid What are high risk medicines? High risk medicines are medicines that are most likely to cause significant harm to the patient, even when used as intended. The Institute for Safe Medication Practices (ISMP) reports that incident rates with this group of medicines may not necessarily be higher than with other medicines, but when incidents occur the impact on the patient can be significant (serious). Some common Medicine group in our Community are: Anticoagulants Management of warfarin therapy spans across primary and secondary care and this can make the pathways complex. Whilst management takes place largely in the outpatient setting, problems frequently occur when these patients are transferring between the community and hospital setting. This can be due to issues around medicines reconciliation or failure to stop or start therapy appropriately when patients are admitted for surgical procedures. A lack of current information has the potential for serious harm, for example where an International Normalised Ratio (INR) is unavailable or communication systems are flawed. Incidents from interactions with warfarin can also be problematic so safeguards are required in order to avoid patient harm. Harm events with warfarin and heparin have been associated with a lack of dosing guidelines and appropriate monitoring. Risk assessment of patients commencing anticoagulation is beneficial, to consider selection of a lower dose regimen. Sedatives The NPSA has received notable ‘wrong dose’ patient safety incidents concerning midazolam injection up to our days, where the dose prescribed and/or administered for the patient is inappropriate. Of these, some incident resulted in the death of an elderly patient and others were graded as causing severe harm. Other sedatives present similar risks, particularly when administered to elderly patients. Insulin The introduction of new insulin formulations has resulted in potential risks in the care of diabetic patients. Errors may also occur from inadequate monitoring. Patients may not have blood glucose monitored at the correct frequency or before administration of insulin. Again, Home Health Agency Nursing Care & Procedures K-203