Patient Identification and Order Verification

Krummrey, G., Sauter, T. C., Hautz, W. E., Müller, M., & Schwappach, D. B. (2024). Risk factors for wrong-patient medication orders in the emergency department. JAMIA Open, 7(4). https://doi.org/10.1093/jamiaopen/ooae103

         This study investigates the risk factors associated with wrong-patient medication orders in emergency departments (EDs) by analyzing intercepted ordering errors identified through the "retract-and-reorder" (RaR) metric. The research examines variables such as patient demographics, electronic medical record (EMR) interface design, and temporal factors to determine their influence on the occurrence of these errors. Key findings indicate that RaR events are more likely when patients share the same sex and have exam rooms near each other in the EMR dashboard layout. Other factors, such as patient name similarity, birthdate, and age, were not significantly associated with RaR events. By highlighting specific risk factors, this resource aids nurses in understanding the underlying causes of wrong-patient medication errors, particularly those related to EMR interface design and patient placement. Awareness of these factors enables nurses to implement targeted safety improvement initiatives, such as verifying patient identity more rigorously when patients of the same sex are in proximate exam rooms, thereby reducing the likelihood of such errors. Nurses can utilize this resource when developing or revising medication administration protocols, especially in ED settings, where the fast-paced environment increases the risk of errors. It is beneficial for training sessions focused on enhancing patient identification practices and informing the design of EMR interfaces to minimize the risk of wrong-patient orders. Regular reference to this study can help nurses stay informed about factors contributing to medication errors and the best practices to prevent them.

De Rezende, H., & Melleiro, M. (2022). Towards safe patient identification practices: The development of a conceptual framework from the findings of a ph.d. project. The Open Nursing Journal, 16(1). https://doi.org/10.2174/18744346-v16-e2209290

         This article presents a conceptual framework to enhance patient identification practices within hospital settings. Developed from a Ph.D. project, the framework emphasizes a collaborative approach involving managers, healthcare professionals, patients, and families. It integrates technological resources and educational strategies to raise awareness about the importance of accurate patient identification. The framework also highlights the role of interdisciplinary teamwork in promoting safe care and recommends areas for teaching and research to develop effective patient identification practices. This resource provides a structured approach to understanding and improving patient identification processes for nurses. By adopting the proposed framework, nurses can enhance their awareness and skills regarding accurate patient identification, reducing errors, and improving patient safety. The emphasis on interdisciplinary collaboration encourages nurses to work closely with other healthcare professionals, patients, and families to implement effective identification protocols. Nurses can utilize this resource when developing or updating patient identification policies and procedures within their healthcare institutions. It is beneficial during training sessions to educate staff about the significance of accurate patient identification and the strategies to achieve it. Nurse educators and researchers can reference this framework when designing studies or curricula on patient safety and identification practices.

Paterson, E. P., Manning, K. B., Schmidt, M. D., & Provine, A. D. (2022). Automated dispensing cabinet overrides—an evaluation of necessity in a pediatric emergency department. Journal of Emergency Nursing, 48(3), 319–327. https://doi.org/10.1016/j.jen.2022.01.007

         This retrospective observational study examines automated dispensing cabinet (ADC) overrides in a pediatric emergency department (ED) to assess their necessity and impact on patient safety. The research analyzed 445 override instances over ten weeks, focusing on the timing of medication orders, pharmacist verification, and administration. Findings revealed that the median time from prescription entry to override was approximately four minutes, matching the median time for pharmacist verification. However, medication administration occurred a median of eight minutes after prescription entry, indicating that pharmacist verification was completed before administration in many cases. This suggests overrides were often unnecessary, as waiting for pharmacist review did not delay medication delivery. For nurses, this study highlights the importance of evaluating the necessity of ADC overrides to enhance medication safety. Understanding that many overrides may not expedite patient care encourages nurses to rely on standard verification processes, thereby reducing potential risks associated with bypassing pharmacist review. Nurses can apply insights from this research by critically assessing the need for ADC overrides, particularly in high-pressure environments like pediatric EDs. Incorporating this knowledge into training programs and protocol development can promote adherence to safety procedures, ensuring overrides are reserved for emergencies where immediate medication access is crucial.