As the resident medication experts, pharmacists must play a pivotal role in preventing medication errors throughout the hospital. Accordingly, it is vital to thoroughly evaluate the medication-use process and identify areas where the potential for error exists. Studies suggest that half of all harmful medication errors occur during drug administration, and of these errors, two-thirds involve injectable medications.1,2 Because so many medication errors occur during drug administration, minimizing the opportunity for error during this critical process is necessary. ASHP recommends that pharmacists dispense medications in ready-to-administer (RTA) forms whenever possible to avoid having the nurse manipulate drugs prior to administration. Utilizing RTA prefilled injectable medications can reduce the possibility of medication error, increase standardization, help control costs, reduce waste, ensure that items are properly labeled and bar coded, and improve nursing satisfaction.
Norwalk Hospital is a 328-bed, not-for-profit, acute care, community teaching hospital that serves a population of 250,000 in lower Fairfield County, Connecticut. The pharmacy provides clinical pharmaceutical services and pharmacy supply chain distribution management, and is staffed 24/7 by 11 pharmacists, four clinical specialists, and 12 technicians. The inpatient pharmacy follows a centralized distribution model, utilizing robotic dispensing, a medication carousel, and bar code–ready inventory, which is about 98% CPOE- and 90% bedside bar code–compliant. We have utilized commercially available RTA products for many years, including controlled substances (eg, morphine and hydromorphone), rescue medications for code carts (eg, sodium chloride, lidocaine, epinephrine, dextrose, etc), and a few miscellaneous medications (eg, vitamin K and low–molecular weight heparin). As more products have become commercially available, we have been adding them to our inventory. Most recently we added ondansetron, metoclopramide, and diphenhydramine, which are typically ordered by prescribers on an as-needed basis.
Considerations for Increasing Use of RTA Products
To determine which products should be provided in prefilled RTA syringes, the pharmacy department must begin by evaluating the products that are commercially available, the safety profile of these medications, the volume of these items used by the facility, and the relative costs. Prior to incorporating use of RTA products, pharmacy must work closely with the quality improvement team, infection control team, regulatory team, and medication safety personnel to evaluate the hospital’s capacity to incorporate RTA injectables into existing workflow. A collaborative effort to increase use of these products can improve safety and mitigate risk during the medication administration process.
Benefits of RTA Prefilled Injectables
At Norwalk Hospital, we have realized multiple benefits by increasing use of RTA dosage forms, including:
The key benefits of utilizing these products—including increased nursing satisfaction and more time for nurses to spend on patient care, reduced number of steps required to administer medications, lower risk of medication errors/cross contamination, and increased standardization through proper labeling and bar coding—illustrate the value of incorporating RTA prefilled injectables into pharmacy practice. Looking forward, we anticipate incorporating additional RTA products into our inventory as they become commercially available, particularly in the anesthesiology arena.
Keith P. Shuster, RPh, MBA, the manager of acute care pharmacy services at Norwalk Hospital in Connecticut, has over 25 years of clinical and management experience. He received a BS in pharmacy from the University of Connecticut and an MBA from the University of New Haven. Keith’s professional interests include pharmacy management/operations, medication safety, regulatory/quality improvement, and emergency management.
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