References
Should known allergy status be included as a medication administration ‘right’?
Abstract
This article employs a paediatric case study, involving a 3-year-old child who had an anaphylactic reaction that occurred as a result of the multidisciplinary team's failure to identify and acknowledge the patient's documented ‘known allergy’ status. It examines and reconsiders the ongoing healthcare dilemma of medication errors and recommends that known allergy status should be considered the second medication administration ‘right’ before the prescribing, transcribing, dispensing and administration of any drug. Identifying and documenting drug allergy status is particularly important when caring for paediatric patients, because they cannot speak for themselves and must rely on their parents, guardians or health professionals as patient advocates. The literature states that medication errors can be prevented by employing a ‘rights of medication administration’ format, whether that be the familiar ‘5 rights’ or a more detailed list. However, none of these formats specify known allergy status as a distinct ‘right’. The medication safety literature is also found wanting in respect of the known allergy status of the patient. When health professionals employ a medication administration rights format prior to prescribing, transcribing, dispensing or administering a medication, the ‘known allergy status’ of the patient should be a transparent inclusion.
The issue of medication errors (ME) is not a new concern. More than 50 years ago Barker et al's (1962) study acknowledged that ME were a much bigger problem than anyone realised and that on a daily basis patients were harmed by providers of health care. As a potentially high-risk therapy, medication administration and the associated ME remain a significant contributor to patient harm (Leape et al, 2005; Kelly et al, 2006; Aspden et al, 2007; World Health Organization (WHO), 2017a; 2017b). The Institute of Medicine (IOM) report, ‘To Err Is Human: Building a Safer Health System’ (Kohn et al, 2000), stated that ME were a significant cause of morbidity and mortality, with nearly 100 000 deaths, 1 million injuries, and 17 billion dollars annually attributable to ME. In addition, the IOM identified that hospitalised patients were potentially subjected to at least one ME a day, taking into account near misses, and that not all detected errors were reported (Aspden et al, 2007). Other studies have also indicated that up to 30% of patients will experience a harmful event such as ME or wrong procedures due to incorrect patient identification during their hospitalisation (Fowler et al, 2008; Griffin and Classen, 2008). A seminal study by Wilson et al (1999) observed that human error was a significant factor, with 81% of harmful events associated with human factors, such as non-caring attitudes and behaviour, and a lack of knowledge. Vincent et al (2001) categorised 48% of these harmful occurrences as preventable, which has been supported by other studies (Rex et al, 2000; Regenbogen et al, 2007). In the classic Harvard medical practice study, Leape and colleagues (1991) found that 1 in 4 of these harmful events was the result of negligence and 58% were deemed preventable.
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