• Regularly make targeted follow-up calls to patients (e.g., those with asthma, chronic pain, hypertension) to assess how they are faring with new medications, learn about any side effects or potential ADEs, and ensure that medications are being taken properly. (Amb)

  • Work with nurses to make regular targeted follow-up calls to discharged patients (e.g., those with asthma, chronic pain, hypertension) or use mailed questionnaires to assess how these patients are faring with prescribed medications, learn about any side effects or potential ADEs, ensure that medications are being taken properly, and answer any questions patients may have.

NOTE: Amb = ambulatory care pharmacist; Hosp = hospital pharmacist.

BOX 5-3

Improving Medication Safety: Actions for Nurses

  • Establish safe work environments for medication preparation, administration, and documentation; for instance, reduce distractions and provide appropriate lighting.

  • Maintain a culture of rigorous commitment to principles of safety in medication administration (for instance, the five rights of medication safety and crosschecks with colleagues, where appropriate).

  • Remove barriers to and facilitate the involvement of patient surrogates in checking the administration and monitoring the effects of medications wherever and whenever they are administered.

  • Foster a commitment to patients’ rights as coproducers of their care.

  • Develop aids for patient (or surrogate) self-management support.

  • Enhance communication skills and team training so as to be prepared and confident in questioning medication orders and evaluating patient responses to drugs.

  • Actively advocate for the development, testing, and safe implementation of electronic health records.

  • Work to improve systems that address the most common near misses in the work environment.

  • Actively participate in or lead evaluations of the efficacy of new safety systems and technology.

  • Contribute to the development and implementation of error reporting systems, and support a culture that values accurate reporting of medication errors.

BOX 5-4

National Patient Safety Goals of the Joint Commission on Accreditation of Healthcare Organizations Relating to Medication Use

Goal 1: Improve the accuracy of patient identification

1A. Use at least two patient identifiers (neither to be the patient’s room number) whenever administering medications or blood products, taking blood samples



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