Medication Safety On the Wards Patient Safety

Know your Pharmacist

C-foam will commence a series of posts around medication safety. Medication safety is not something that doctors are actually very good at. Doctors are also not the best at managing the health of their families, friends, and especially themselves. We will look at the issues associated with prescribing for yourself or for friends and family.

Firstly, though, we need to acknowledge our pharmacists who work within our hospital system. A medical director of a large unit in my hospital said to me ‘”our ward pharmicist is our single most important factor in preventing adverse outcomes for our patients.”

I can’t argue with this view. When I was a young trainee, hospital pharmacists were few and far between. Now we become upset when a ward loses a pharmacist because of funding or staffing issues.

I am lucky enough to sit on a committee that looks at medication prescribing and administration errors on a monthly basis. We always have plenty to discuss. Prescribing errors are certainly under-reported, but clear patterns persist and doctors still need to recognise the role they play in adverse patient outcomes, or at least in potential adverse outcomes. Nursing staff are much more likely to admit or report error than medical staff.

The ward pharmacist, if you are lucky enough to have one, is an important patient safety officer. They keep doctors honest and provide valuable education to keep us from repeating mistakes. They can’t be there 24 hours a day, but we need to imagine that they are going to check our medication prescribing when next they are on duty. It has been proven that doctors tend to comply less with good practice at times when we think we are not being observed (we practise hand hygeine reasonably well when someone is observing us, but quite poorly when we think no one is observing us).

So, your ward pharmacist is your patient’s friend first, your friend second. If you or a member of your family were a patient, you wouldn’t want it any different. My experience of ward pharmacists is that they are amongst the least judgemental and the most approachable of clinical staff. They will tell you when you have made a mistake. They will also help you to understand how not to make that mistake again.

Please read this series of posts around medication safety. Please ask questions and post comments. We know there are a number of reasons why we sometimes take short cuts and make mistakes. We will explore these, but we must remember that we cannot fall back on issues such as high workload and stress to excuse our mistakes, because courts will not accept these excuses. We need to practice safely at all times.

We hope to post some profiles and comments by our Tropical North Queensland Pharmacists, so that we can get to know them better and discover what they like most and dislike most about our medical practice. And, yes, pharmicists do make mistakes as well. And they admit them and they deal with them and they learn from them. That is what we all must learn to do.

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