BOX 5-1

Improving Medication Safety: Actions for Prescribers

  • Reconcile medications at transition points, e.g., admission, discharge, transfer. (All)

  • Make routine the reconciliation of medication changes with the pharmacy record. (NH/AL, Out)

  • Avoid verbal orders except in urgent situations and emergencies. (In)

  • Be aware of other medications the patient is taking when prescribing. (NH/AL)

  • Keep an accurate medication list (including over-the-counter and complementary and alternative medications). (Out)

  • Ask patients to bring their medications in periodically. (Out)

  • Ask about allergies when prescribing a new medication. (Out)

  • Inform the patient of indications for all medications. (Out)

  • Ask regularly whether patients are taking their medications, including as-needed drugs, as nonadherence may signal issues other than knowledge deficits, practical barriers, or attitudinal factors. (Out)

  • Ask the primary pharmacy about the patient’s refill history. (Out)

  • Consider that new complaints may represent side effects of medications. (NH/AL)

  • Explain common or significant side effects when prescribing. (Out)

  • Ask regularly about side effects or adverse drug events (ADEs). (All)

  • Prescribe electronically when possible. (All)

  • Use readback with verbal orders when feasible. (All)

  • Avoid abbreviations. (All)

  • Include patient age and weight when applicable. (All)

  • Work as a team with pharmacists and nurses. (In)

  • Work as a team with consultant pharmacists and nurses. (NH/AL)

  • Work as team with the primary pharmacist and nurses. (Out)

  • Adhere to Class I clinical indications and guidelines. (All)

  • Use special caution with high-risk medications (All), especially warfarin. (NH/AL)

  • Exercise particular caution in high-risk situations—when stressed, sleep-deprived, angry, or supervising inexperienced personnel. (All)

  • Consult electronic or other reference sources for questions. (All)

  • Report errors and ADEs. (All)

  • Include medications when transferring patients between providers. (In)

  • Standardize and improve transfers between covering physicians and other providers. (NH/AL)

  • Standardize communication about prescriptions within the practice; standardize and improve handoffs to the primary pharmacist. (Out)

  • Actively monitor the patient for response to medication therapy, and use validated instruments when possible. (Out)

  • Minimize the use of free samples; when dispensing free samples, apply standards similar to those a pharmacy would use. (Out)

NOTE: All = all prescribers; In = inpatient prescriber; NH/AL = nursing home/assisted living prescriber; Out = outpatient prescriber.

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