Medication Errors in EMS

[makphisto]

I have to write a report about the "Rights" of drug administration and what happens when one of those rights is violated. Specifically, I need to find a case where this happened in EMS. IE, I need a news story, lawsuit, or some actual case where an EMT or Medic gave the wrong drug, used the wrong route, etc.

I'm having trouble finding much. Most "medication error" stories involve hospital treatment, not so much pre-hospital. What I do find are very vague "anecdotes", with no real weight to them.

Someone have something bookmarked that might help?

Thanks.

 

[Scout]

Rights of drug administration?


What does that mean?

 

[makphisto]

The Rights of Medication Administration? Right patient, right drug, right dose, right route, right time? That's the way I learned them, but apparently they're up to 10 now...

http://wiki.answers.com/Q/Ten_rights_of_medication_administration

 

[Scout]

I get you now thanks

 

[VentMedic]

Good article:

http://www.jems.com/news_and_articles/articles/jems/3310/bad_medicine.html


1. Right medication
2. Right dose
3. Right route
4. Right time
5. Right patient
6. Right documentation

 

[PapaBear434]

I'm having trouble finding much. Most "medication error" stories involve hospital treatment, not so much pre-hospital. What I do find are very vague "anecdotes", with no real weight to them.

I imagine it happens a great deal less in EMS, because we typically deal with a lot less drugs than the hospitals. We aren't exactly going to administer steroids, antibiotics, antacid agents, and the like. We have drugs that help save someone's life NOW, and thus have a lot smaller scope of what we'd be using.

 

[silver]

ah i did my entire summer research on administration errors in hospital
It will probably be much more common than you believe because people are reporting what they want, and often times are to scared.
When our data comes out, i might explain more. You are probably right that there are less in EMS, but you would be suspired about the amount of errors out there where the prescriber doesnt notice.
ill come back and explain more later

 

[medic417]

I imagine it happens a great deal less in EMS, because we typically deal with a lot less drugs than the hospitals. We aren't exactly going to administer steroids, antibiotics, antacid agents, and the like. We have drugs that help save someone's life NOW, and thus have a lot smaller scope of what we'd be using.

Let me see I have steroids, antacids, in my choice of meds. Another service in my area actually gives some antibiotics and patients follow up with doctor. So be careful with broad statements.

 

[ResTech]

I read an article that identified EMS med errors are more common than once thought. How do you really track a medication error in the field unless it causes the patient serious effects?

Most EMS math is basic and VERY intuitive. The emergency meds are also concentrated where it makes dosing easy as with single dose vials and ampules and 1:1 ratios. Its all based on 10's so makes it pretty easy. Believe me, for me to say that it must really be! lol... cause math and me never got along.

Even the few drips pre-hospital are easy. And carry a calculator!

EDIT: I don't think antibiotics have any place in EMS. If they are, I would imagine they would be given in very few circumstances.

 

[VentMedic]

For EMS there is the issue of reporting the error. Often there is only one person and that is the one making the error to report it. The old saying "what happens in the truck stays in the truck" happens occasionally. There is also the issue of lax oversight for reviewing patient care reports.

Another good article:

Paramedic Self-Reported Medication Errors

http://www.informaworld.com/smpp/1155423993-2761364/content~content=a759217896~jumptype=rss

The majority of these errors were self-reported to their CQI representative (79.1%), with 8.3% reported by the base hospital radio nurse, 8.3% found on chart review, and 4.2% noted by the paramedic during the call but never reported. Conclusions. Nine percent of paramedics responding to an anonymous survey reported medication errors in the past 12 months, with 4% of these errors never having been reported in the CQI process. Additional safeguards must continue to be implemented to decrease the incidence of medication errors.

 

[medic_texas]

Dealing with a medication the patient needs "now" isn't a situation that happens only in EMS. Regardless of the patient's condition, the RIGHT medication with the right dose, at the right time, for the right patient, given the right route should be done every time.

You could kill someone if dopamine is given incorrectly. Labetolol. What about a tired medic who grabs the wrong vial in the drug box and gives versed for AMI instead of morphine or fentanyl?

I know of an instance where a medic drew up valium instead of morphine; he caught it before he gave the med and reported it (because he had to).

I'm surprised at how many paramedic students lack the basic skill of drawing up medication and able to calculate how much to give.

A good rule of thumb is draw your medication up in a 1:1 ratio if possible.

Example - morphine 5mg in 1ml vial. Draw up 4ml of saline, ad the 1ml of morphine for 5mg/5ml (1mg per 1ml = 1:1 ratio). Don't forget to gently invert your syringe to mix the medication. Want to give 3mg? Give 3ml. 2.5mg? 2.5ml. etc etc

 

[PapaBear434]

Let me see I have steroids, antacids, in my choice of meds. Another service in my area actually gives some antibiotics and patients follow up with doctor. So be careful with broad statements.

I stand corrected, then. Are you a transport service, or a 911 response service?

 

[akflightmedic]

We carried steroids and antacids in Florida....911 service.

All 3 flight programs I worked for (911 as well) we carried antibiotics.

 

[PapaBear434]

Huh... Guess our system is a bit more limited. I don't know if it's because we are a more urban area and are so close to hospitals, or if our Director just doesn't trust us, but we really don't have that kind of meds on board.

Then again, I am pretty low on the ALS scale as of yet, so it's also possible (likely) that I am just grossly misinformed as well.

 

[VentMedic]

We carried steroids and antacids in Florida....911 service.

All 3 flight programs I worked for (911 as well) we carried antibiotics.

We carry antibiotics and steroids also on Fight that did both 911 and IFT. As well, we have an extensive list of meds for Specialty transport. However, it was often to prevent medical errors as we would switch to what was initiated at the hospital to our medications. We might also change antibiotics as the receiving physician would have already reviewed the lab results with the sending physician prior to our arrival and change coverage for certain protocols. The same for pressors.

On kids and babies, all meds and fluids were switched to ours. Thus, we carried a well stocked bag but for different reasons.

Initiating steroids for asthma was of course a possibility but that was dependent on the patient and what meds they were already taking. SCI is controversial so that is still left up to the physician's discretion.

Do you still transport the patient after giving antacids? Or, do you give them for other reasons than "heartburn" or "indigestion"?

 

[akflightmedic]

Vent, you ask the question that I wanted others to ask..why would a ground 911 service carry antacids?

As for the steroid aspect, we did indeed initiate this treatment for asthmatic patients. In the flight program due to remoteness, we administered abx prophylactically most times for certain injuries, and back to the ground program we had a spinal injury guideline as well for steroid administration.

 

[Ridryder911]

I imagine it happens a great deal less in EMS, because we typically deal with a lot less drugs than the hospitals. We aren't exactly going to administer steroids, antibiotics, antacid agents, and the like. We have drugs that help save someone's life NOW, and thus have a lot smaller scope of what we'd be using.

Hmm... let's see.

Anaphylactic shock.. H1 Blockers (Benadryl), H2 blockers such as Pepcid (antacid), Zantac (antacid) then should follow by steroid such as Solu Medrol. So yeah, EMS routinely gives steroids and antibotics.

Sorry, but I am beginning to wonder about some EMS protocols?

R/r 911

 

[akflightmedic]

Dang it Rid, you took the fun out of it...I threw a question back out there and you and Vent tried to jump on it....shame shame...

 

[PapaBear434]

Hmm... let's see.

Anaphylactic shock.. H1 Blockers (Benadryl), H2 blockers such as Pepcid (antacid), Zantac (antacid) then should follow by steroid such as Solu Medrol. So yeah, EMS routinely gives steroids and antibotics.

Sorry, but I am beginning to wonder about some EMS protocols?

R/r 911

Vent, you ask the question that I wanted others to ask..why would a ground 911 service carry antacids?

As for the steroid aspect, we did indeed initiate this treatment for asthmatic patients. In the flight program due to remoteness, we administered abx prophylactically most times for certain injuries, and back to the ground program we had a spinal injury guideline as well for steroid administration.

Damn you both and your incessant logic, facts, and knowledge!

Yeah, you guys are right. Looking over my protocols, yes, we do administer both of those classifications. Not often, but we do. I have never given a steroid in response to a spinal injury, but as akflightmedic said, that might because we are NOT remote to a hospital almost anywhere in our system.

I do give Benadryl, and I am allowed to but never gave Solu Medrol as of yet. Most of my ALS administration revolves around shock/trauma. Start IV, fluid load, diabetic calls, allergic reactions, ect... EMT-Enhanced is VERY much the lowest grade of ALS there is, and is admittedly little more than Basic level with IV and extremely basic drug administration rights.

In addition, can you tell that I posted the initial with no sleep for way too long? Completely forgot my basic pharm classifications. Though I just started my second pharm class, so hopefully it gets drilled back into my head. You know, basic classifications of drugs and stuff.

I'm going to go hang my head in shame and go hide. I know when I'm out of my league.

 

[medic417]

I stand corrected, then. Are you a transport service, or a 911 response service?

911 as is the other service I mentioned.