Medical errors can be costly for both patient and hospital. As defined by the Joint Commission (www.jointcommission.org/assets/1/18/Hot_Topics_Transitions_of_Care.pdf [10]), in order to keep patients safe, clinicians should focus on the three key points along the patient’s continuum of care. To help, free resources are available.
Upon admission
Patient admission is a critical time for risk assessment. Clinicians should employ screening tools to identify high-risk patients before procedures. For patients potentially receiving opioids, this can include the Risk Index for Serious Prescription Opioid-Induced Respiratory Depression or Overdose (RIOSORD).
Patient recovery
As patients recover from procedures, it is common for patient-controlled analgesia (PCA) pumps to be employed to manage pain. The Physician-Patient Alliance for Health & Safety (PPAHS) PCA Safety Checklist is a free downloadable resource developed by a panel of experts to reduce the risk of opioid-related adverse events (www.ppahs.org/pca-safety-checklist-download [11]).
Patient discharge
Clinicians should take steps to actively engage patients and their families as partners in their health. Patients are encouraged to ask the following five questions about their medications:
1. Have any medications been added, stopped, or changed, and why?
2. What medications do I need to keep taking, and why?
3. How do I take my medication, and for how long?
4. How will I know if my medication is working, and what side effects do I watch for?
5. Do I need any tests and when do I book my next visit?
We encourage clinicians to download a PDF version of these five questions and share it with their patients (www.ismp-canada.org/medrec/5questions.htm [12]).
For more resources dedicated to patient safety, visit the Canadian Patient Safety Institute (CPSI) and PPAHS websites (www.cpsi.com [13], www.ppahs.org [14]).
—Stephen Routledge, MPH
Patient Safety Improvement Lead
Canadian Patient Safety Institute
—Michael Wong, JD
Founder and Executive Director
Physician-Patient Alliance for Health and Safety
Links
[1] https://bcmj.org/cover/januaryfebruary-2018
[2] https://bcmj.org/author/stephen-routledge-mph
[3] https://bcmj.org/author/michael-wong-jd
[4] https://bcmj.org/node/262
[5] https://bcmj.org/print/news/resources-prevent-medical-errors-during-transfer-care
[6] https://bcmj.org/printmail/news/resources-prevent-medical-errors-during-transfer-care
[7] http://www.facebook.com/share.php?u=https://bcmj.org/print/news/resources-prevent-medical-errors-during-transfer-care
[8] https://twitter.com/intent/tweet?text=Resources to prevent medical errors during transfer of care&url=https://bcmj.org/print/news/resources-prevent-medical-errors-during-transfer-care&via=BCMedicalJrnl&tw_p=tweetbutton
[9] https://bcmj.org/javascript%3A%3B
[10] http://www.jointcommission.org/assets/1/18/Hot_Topics_Transitions_of_Care.pdf
[11] http://www.ppahs.org/pca-safety-checklist-download
[12] http://www.ismp-canada.org/medrec/5questions.htm
[13] http://www.cpsi.com
[14] http://www.ppahs.org
[15] https://bcmj.org/modal_forms/nojs/webform/176
[16] https://bcmj.org/%3Finline%3Dtrue%23citationpop