Core processes for ordering medications have become enormously complex, and the risk of errors and process failures has grown in turn. Either an error or a process failure can start a chain of events leading to an adverse drug event. Several practices have been shown to improve the overall safety of ordering processes. Tools such as Failure Modes Effects Analysis (FMEA) can identify potential failures in your own ordering processes and show you which practices to test first to reduce the risk in your organization.

Changes for Improvement

• Eliminate or Reduce Availability of Multiple Strengths
• Implement Pharmacy-Based Dosing
• Ensure That Allergy Information Accompanies Patients
• Include Renal Function Data on CPOE Screens
• Use Pre-Typed Medication Records, Orders, and Flow Sheets
• Use Standard Scales for Dosing High-Alert Medications
• Use Drug Interaction Software
• Ensure Pharmacist Review of All Medication Orders
• Carry Reference Materials in Handheld Electronic Devices
• Provide Patient Information and Drug Profiles to Prescribers
• Limit Over-Ride Options on Computer and Medical Device Safety Features
• Provide Reference Materials at Point of Care
• Check Multiple Variables When Ordering Medications
• Share Patient Information among Clinical Disciplines
• Make Allergy Information Available in Multiple Locations
• Provide Medication and Food Interaction Information
• Assign Pharmacists to Patient Care Units
• Provide Allergy Alerts with a Computerized Prescriber Order Entry System
• Collect Allergy Information on Admission
• Have Pharmacists Determine All Doses for Renal Patients
• Provide the Pharmacy with Renal Function Data
• Connect Medication Orders to Lab Results
• Use Protocols and Order Sets for at Least 75 Percent of Medications