Facebook
Twitter
LinkedIn
Email
 |
Checking for direct PDF access through Ovid | |
Excerpt
Physician orders are not always carried out in a timely and accurate manner. Medication orders are subject to the 5 w’s; wrong drug, wrong dose, wrong patient, wrong time, and wrong route. The potential for medication error is magnified by verbal orders and illegibility. Speaking orders to a nurse without looking face to face, speaking with an accent, speaking amidst noisy surroundings and interruptions are potential communication pitfalls. Sound-alike drugs such as carboplatin and cisplatin (chemotherapy isomers for ovarian cancer), or sound-alike numbers such as 15 mg and 50 mg can be confused. To avoid misunderstanding, the speaker should ask the listener to repeat specific orders, including numbers such as “one five” instead of 15. Verbal orders should be allowed only when the physician is not present or the chart is unavailable. Illegibility occurs, as often among physicians as other professionals, yet consequences may be more serious. Correcting the entire word and not just letters, using the same word(s) consistently, not using abbreviations, and not crowding words at the end of an order sheet or progress note may prevent errors.
Checklists, protocols, and “care pathways” are useful to efficiently communicate patient care orders. These serve to protect against forgetfulness or interruptions during order writing. Alternatively, certain preexisting orders should be stricken through and verbally communicated to the nurse, e.g., consider striking the standing order for “Motrin,” for postpartum pain in women with platelet disorders. Otherwise, the unsuspecting nurse may be so habituated to routine order sets that she may not be attentive to order changes.
When patients with similar names receive care, clerical errors in x-ray, laboratory, and charting can occur. Wrong patients have gone to the operating room, wrong drugs have been administered, and wrong x-ray and laboratory data have been placed in the chart. Even when names are dissimilar, clerical errors result in wrong x-ray and laboratory reports found in the chart.
Human factors, emotions, and disrespect influence care. Slips of the tongue, or forgetfulness by the overworked or distracted physician, occur frequently. The fatigued or overly busy physician who is short, sharp, and “chews out” a resident, nurse, or ward clerk, unwittingly sets up the patient for a “failure-to-communicate syndrome.” Consequently, physicians are not updated on a patient’s condition in a timely manner. When the clinician is overcome by illness, fatigue, or undue stress, assistance should be requested to prevent errors.
Effective communication procedures are needed to bridge anticipated gaps in patient care. Pertinent information is not always transmitted when responsibility shifts for patient care, such as during change-of-shift nursing reports and physician sign-outs. Standardized sign-outs limit miscommunications. Omissions are magnified when a patient’s location shifts, e.g., between hospitals, and between outpatient and inpatient status. Here, timely transfer of pertinent medical record information is essential.
Whenever clinician responsibility (shift-change or cross coverage) and/or patient location shifts, would-be hazards and “what if” responses should be anticipated and communicated appropriately. Rather than through an intermediary practitioner, physicians should communicate directly with each other.
