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Medical error is clearly the Number One problem in healthcare, contributing to more deaths in the USA than motor vehicle accidents, falls, drowning and plane crashes combined—see Figure 1 below. Most medical errors are related to system problems, not individual negligence or misconduct, and are preventable (see our other Summary Statistic on the preventability of adverse events).
Zegers M, Bruijne MC de, Wagner C, Hoonhout LHF, Waaijman R, Smits M, Hout FAG, Zwaan L, Christiaans-Dingelhoff I, Timmermans DRM, Groenewegen PP, Wal G van der.
Matthew Grissinger, RPH, FISMP, FASCPManager, Medication Safety AnalysisPennsylvania Patient Safety AuthorityABSTRACTPennsylvania facilities submitted 879 medication error reports from July 1, 2004, through January 31, 2011, to the Pennsylvania Patient Safety Authority involving patients taking their own medications while in a hospital.
Statistics show that each year, in the United States, approximately 195,000 people die due to preventable medical errors. Medical malpractice claims are when treatment provided by a doctor falls below the accepted standard of practice in the medical community and causes an injury or death to the patient. The Congressional Budget Office found medical malpractice amounted to less than 2 percent of health care spending despite the propaganda claiming heightened healthcare cost from lawsuits. It is free to call and ask an attorney at Martin & Grayson to review the situation that caused you or your loved one’s injury.
ABSTRACTPatient death or disability associated with incompatible blood is one of the Centers for Medicare and Medicaid Services Hospital-Acquired Conditions and is listed as one of the National Quality Forum’s Serious Reportable Events. Analysis on working at home for the healthcare industry, covering qualifications and salaries. If you have been trained in health care and are planning to work from home, you might consider medical billing and coding.
According to the US Bureau of Labor Statistics, there has been a tremendous growth in the medical billing and coding sector, and it will continue to be among the fastest growing opportunities in health-related work-at-home jobs.
Since it is also the sector susceptible to frauds, malpractices and medical necessity issues, insurance companies and the government are investing more time and money in researching to stop such activities. With the help of a standard coding system used by various health care professionals, insurance companies and federal agencies, a coder assigns certain alphanumeric codes to specific diseases, injuries and other medical procedures.
These assigned codes most often are used by various international organizations to track the pattern of specific diseases and the health care costs.
Patience and determination are two important skills needed to be a successful medical billing and coding professional.
Apart from this, you have to be extremely careful while translating medical language to coding, as any error in the coding would mean inconvenience to medical staff and delayed payments to health care providers. Your earning potential as a medical billing and coding professional can depend on few factors like your geographical location and your experience. Going by this standard, a medical billing and coding professional working from home can demand $10-$12 on hourly basis. Apart from this, you can contact the health insurance companies, physicians, or hospitals in your locality for job opportunities. Armed with the above provided information, you can choose your occupational title and your fees, and then start your career as a work-at-home mom in the healthcare sector. For the sake of simplicity, I have summarised the study results to one figure—10% (or one in every ten hospital admissions). Medical errors cause more accidental deaths in the USA than motor vehicle accidents, falls, drowning and plane crashes combined.
The Canadian adverse events study: the incidence of adverse events among hospital patients in Canada. The incidence of adverse events in Swedish hospitals: a retrospective medical record review study.
Adverse events and potentially preventable deaths in Dutch hospitals: results of a retrospective patient record review study. If the Center for Disease Control made preventable medical errors a cause of death category, it would rank 6th as a cause of death in America. The Government Accountability Office found malpractice cases have not widely affected access to healthcare. Many states have imposed substantial limits on damage awards in medical malpractice claims. The lawyers at Martin & Grayson will answer your questions and give you advice on resolving all your concerns. As we increase the number of prescriptions and medication times the patient may find herself or himself in a situation that is overwhelming."I am very happy with the pill dispenser. What this means is that there is a steady hiring by the professionals like doctors, pharmacies and insurance companies. While hospitals and doctors use these codes for internal data records, insurance companies need the codes to reimburse health care providers. In addition, you should have a problem solving ability and should be authoritative - you can't take no for an answer.
You have to have the acumen to judge which part of the medical report is important for coding.
However, on an average, an entry level medical billing and coding professional can earn $25,000 and up to $50,000. Almost 300 different medications were mentioned in the reports, and 18.7% of the reports revealed that patients took multiple medications. Surprisingly, in healthcare ranking by country, United States ranks 37th out of 191 participating countries in overall healthcare efficiency, quality, and performance. These mistakes can cause catastrophic injuries and a lifetime of future medical needs and cost. Martin & Grayson seeks to keep focus on the real issue – improving healthcare and patient safety. Additionally, doctors have the finances to higher expensive lawyers and well-practiced experts. For best results contact us as soon as possible so we can begin our investigation and protecting you from tricky insurance adjusters, investigators, and defense lawyers.
Blood component transfusions to nondesignated recipients occur in about 1 of 10,000 transfused units. One or more controlled substances were involved in 40.3% of the events, and more than 25% of the reports mentioned a medication considered to be a high-alert medication. Martin & Grayson is located in Jefferson City and represents clients throughout Missouri including St.
Two-thirds of these errors are associated with incorrect blood recipient identification occurring at the patient’s bedside. Employing strategies to prevent harm from patients taking their own medications can be prioritized by proactively assessing the risk associated with patients bringing in their own medications, developing a screening process for patients admitted to the facility who have a previous history of bringing in their own medications, and providing patient and family education upon admission to the facility about the facility’s policies in regard to patients’ use of their own medications.IntroductionThe medications prescribed for and administered to patients while they are hospitalized are typically provided by the hospital’s pharmacy department. There were 535 reports of blood transfusion-related events submitted to the Pennsylvania Patient Safety Authority during the 13-month period from July 2008 through July 2009. However, there are times when it may be necessary for a patient to bring his or her own medications into the hospital. Martin & Grayson helps people in counties all over Missouri including Cole, Callaway, Boone, Camden, Cass, Clay, Crawford, Dent, Franklin, Gasconade, Jasper, Jackson, St.
For example, patients are often asked to bring their medications with them so that an accurate medication list can be generated for medication reconciliation. Recipient identification at blood collection and administration are essential to the safety of the total blood transfusion process.
If the drug the patient needs is not on the hospital’s formulary and the hospital has no alternative therapy, the patients’ personal medications may be used to avoid an interruption in therapy.1 Some patients also may bring their medications from home to the hospital in hopes of saving money. The safe transfusion of blood components is a complex process involving many departments, multiple staff, and several steps. Many patients desire to self-medicate with their own medicines while in the hospital to ease anxiety over the loss of self-control of their care.2 Hospitals of all sizes face challenges in managing patients’ personal medications.
You must select STANDARD SHIPPING at check-out to take advantage of this limited time free shipping offer. Larger institutions and government hospitals generally maintain larger inventories of medications and have closed formularies. Smaller community and rural hospitals may not have the space or funds to maintain a large inventory of medications and, therefore, may be more likely to allow patients to use their own medications.
Analysts queried the database for events associated with blood transfusions, errors related to procedure, and complications of procedures, treatments, and tests.
A survey of directors of pharmacy at small hospitals (300 beds or less) found that a majority (90.9%) of the hospitals allowed patients to use their own medications while in the hospital.
The death occurred in the operating room, and additional patient identification was identified as a recommendation to prevent future blood transfusion errors.
Before use or administration of a medication brought into the hospital by a patient, his or her family, or a licensed independent practitioner, the hospital identifies the medication and visually evaluates the medication’s integrity.
The hospital informs the prescriber and patient if the medication brought into the hospital by patients, their families, or licensed independent practitioners is not permitted. Pennsylvania facilities have submitted a number of reports to the Pennsylvania Patient Safety Authority mentioning errors with the use of patients’ own medications, many indicating staff have found medications in a patient’s room that were brought from home without the hospital staff’s knowledge. There is scarce literature that addresses situations in which patients bring in their own medications, and a comprehensive search found no literature that discussed patients taking their own medications unbeknownst to the healthcare staff. Pre-analysis errors during blood specimen collection may include delays in collection, wrong blood in tube collected, or incorrect or no label applied to the specimen. Analysis of events reported to the Authority in which patients used their own medications has determined the most common types of events, patient populations involved, medications involved, and reasons why patients bring their medications to the hospital, as reported in Pennsylvania.Aggregate Analysis of Patients Bringing Their Own Medications into the Hospital While reviewing reports submitted to the Authority, analysts have the opportunity to further classify reports, using a “monitor code,” for future querying opportunities. Of the 344 errors identified in the pre-analysis area, 141 (41%) events involved the wrong patient because the specimens did not match historical records or failed the Delta checks (comparing prior test results from a patient to determine if a newly obtained test result is likely to be in error) or because the wrong labels were placed on the tubes.

Analysts queried the Authority’s database for reports assigned the monitor code “PE1,” representing reports identified as errors involving patients using their own medications. Tamper Proof Automatic Medication Dispenser Complete System includes Battery Back-Up System, 2 Keys, 2 Medication Cassettes, Manual.
Other pre-analysis area errors included those with incorrect patient information (19%), missing independent double checks (7%), missing computer transcription (6%), miscommunications (6%), blood bank armband issues (5%), missing consents (1%), and others (15%) (see Table 2).   Table 2. In addition, the event descriptions were queried for phrases such as “own meds” to identify reports that may involve patients taking their own mediations that were not assigned the “PE1” monitor code.
Errors in the Pre-Analysis Stage of Blood Transfusion,   July 2008 through July 2009   Examples reported to the Authority include the following: There was an outstanding, [unlabeled blood] specimen from the morning collection.
The query yielded 879 medication error reports that had been submitted to the Authority from July 1, 2004, through January 31, 2011. The [phlebotomist] found the missing labels in a [patient] room, remembered drawing the blood from a patient [with the missing specimen labels], and [realized] she must have placed these labels on a [blood] specimen from another patient.
Medication Chart for home (laminated) complete with Magnet, dual Markers with Velcro fastener. Two Weekly pillboxes (once a day or twice a day) Morning and Evening, Instruction sheet in plastic bag. When the lab [completed testing, the result] did not match [the patient’s] previous blood type. The [original] blood had been drawn from another patient, and the wrong label [had been] applied.A lab phlebotomist collected a specimen for a type and cross match on a patient. Predominant Medication Error Event Types Associated with  Patients Taking Their Own Medications (n=746, 84.9% of total reports),  July 1, 2004, to January 31, 2011Events took place in 68 different care areas, as selected by facilities.
This does not include reports where no medications were mentioned (n = 114, 13%).Patient found unresponsive. The phlebotomist drew the original specimen on the wrong patient [and mislabeled the specimen at the time of collection].Type and cross match specimens were received in the blood bank. No phlebotomist’s initials were on the labels.Laboratory ErrorsLaboratory errors are those that occur in the blood bank and may include errors in computer transcription, patient identifier mismatches, testing errors, or incorrect blood component released from the blood bank. Of the 101 errors identified in the laboratory areas, 15 (15%) involved the wrong blood component dispensed. Other laboratory area errors included those with delays (13%), blood components that were dispensed before all testing was completed (12%), computer entry errors (11%), missing or incorrect unit tags (11%), incorrect antibody screening (9%), expired blood components (7%), missing patient identifier information (5%), mislabeled blood specimen tubes (3%), special orders not followed (2%), inability to open blood storage cabinet (1%), and others (12%) (see Table 3).  Table 3. Errors in the Laboratory Stage of Blood Transfusion,   July 2008 through July 2009 Examples of laboratory errors reported to the Authority include the following:When the lab staff was signing out a unit of blood [to dispense to the nurse], it was noted [that] the unit number on the blood bank slip was incorrect. In 2010, two million people reported using prescription painkillers for nonmedical purposes for the first time within the last year—this equates to nearly 5,500 people per day.6 The unprecedented rise in overdose deaths in the United States parallels a 300% increase since 1999 in the sale of opioid painkillers.
When the nurse went to transfuse [the blood], the bracelet and the medical record number on the bracelet were checked but did not match. Patient took the Soma and Valium by crushing the medications and self-administering via her gastrointestinal tube. The medications were discovered in the patient’s personal belongings along with a syringe and pill crusher. The patient had a blood redraw, and the lab [staff] stated that blood bank [staff] had made an [incorrect] computer entry.Clinical ErrorsBlood transfusion errors that occurred or were reported in clinical areas that excluded pre-analysis errors consist of events that involve bedside testing or equipment used at the bedside, mix-up of transfusion units, and actual transfusion of the blood to the incorrect patient.
Of the 115 errors identified in the clinical stage of the blood transfusion process, 40 (35%) involved patient reactions to the blood components. Other clinical area errors included intravenous line issues (17%), incorrect blood components administered (12%), expired or wasted blood component (8%), no type and cross laboratory testing before blood component administered (7%), incomplete documentation (6%), identification band issues (5%), incorrect patient received blood component (4%), inadvertent transfusion of type and hold component (1%), and others (5%) (see Table 4).   Table 4. In addition, empty bottles for [containing] Zanaflex®, Vicodin, and Darvocet® were found in the patient’s drawer. Errors in the Clinical Stage of Blood Transfusion,   July 2008 through July 2009    Examples of clinical errors reported to the Authority include the following:The blood product was released from the blood bank according to the patient identification on the form, and [the blood] was administered without confirming the product label to the patient’s [identification].
The patient received an incorrect unit of packed red blood cells, resulting in an intravascular hemolytic reaction that required fresh frozen plasma and platelets to correct the coagulopathy.A patient was ordered to have a transfusion of fresh frozen plasma.
The patient’s parent brought in the patient’s home supply, and the nurse said the child could take that because the fever needed to be treated. The nurse went out to get an oral syringe, and when he came back to the room, the mother said she gave the child what “seemed like a lot of Tylenol.” The nurse asked how much, and the parent said 20 mL, which would be 640 mg.
The doctor was notified and labs were obtained, which showed an acetaminophen level of 30 and liver functions tests [serum glutamic oxaloacetic transaminase and serum glutamate pyruvate transaminase] increased significantly. More than 25% (n = 220) of the reports mentioned a medication that would be considered to be a high-alert medication in either the acute or ambulatory care settings.9,10 Of the 25 most commonly mentioned medications (see Table 2), 10 (40%) were high-alert medications. Most of these high-alert medications were opioids, but two medications, insulin and warfarin, were not. Department of Health and Human Services, and representation from government and nongovernment organizations formed the U.S. Forty percent (n = 28) of the 70 events involving high-alert medications resulted in patients being transferred to a higher level of care.  Table 2. Top 25 Medications Involved in Medication Errors  in Events in which Patients Took Their Own Medications  (n = 526, 59.8% of total reports) Reasons Patients Bring Their Own MedicationsAnalysts also reviewed event descriptions to determine if reporting facilities mentioned the reasons why patients felt the need to bring in and self-administer their own medications. Reporting recommendations from this group included using the Centers for Disease Control and Prevention’s National Healthcare Safety Network as the national surveillance system for recipient outcomes of blood and blood products.7 The College of American Pathologists (CAP) offers accreditation that focuses on the quality of laboratory testing and transfusion services that meets national and local standards.
Most of the reports submitted to the Authority involved situations in which the patients brought in their medications without informing facility staff and self-administered them.
However, at least 45 reports (5.1%) described errors that occurred in which organizations were intentionally using patients’ own medications.
A nurse gave an extra dose of fenofibrate [which was the patient’s own medication] instead of the thalidomide that was scheduled.
The patient’s thalidomide [also her home medication] was later found in another patient’s drawer. The next dose of fenofibrate was held and thalidomide was administered.Vytorin® [a combination tablet of ezetimibe 10 mg and simvastatin 20 mg] was ordered for the patient.
The pharmacy substituted Zetia® [ezetimibe] 10 mg and Zocor® [simvastatin] 20 mg to use for Vytorin, and that was printed on medication administration record. A decision to transfuse is based on clinical presentation and supported by laboratory results.11 If the laboratory results and the patient’s clinical presentation do not match, a decision to transfuse may occur based on incorrect results or analytical errors.
Such errors may result in the mislabeling of blood samples and inadvertent administration of the wrong blood to the wrong patient. Patients were unaware that the directions for a particular medication were different in the hospital compared with at home. In June 2009, nine facilities in the northeast region of Pennsylvania began working collaboratively with the Authority to identify and eliminate phlebotomy specimen mislabeling—one of the most common pre-analysis errors. Patients were simply unaware that they should not take their own medications while in the hospital.The patient used the call bell and asked to speak to the med nurse. These facilities committed to a year-long process of monitoring, investigating, and redesigning systems across many disciplines and units.
Identified best practices from this collaborative will be shared in future updates in the Advisory. To learn more about this collaborative, visit the Authority’s Web. Issue Blood Components from the Blood BankAs previously noted, the laboratory discovery of the wrong blood in a tube specimen when comparing the results of two or more specimens from the same patient that have been collected at different times is known as a Delta check.
These manual techniques are inherently unsafe and have the potential for errors in interpretation and documentation.11Transfuse the PatientThe bedside check verifies the identity of the intended recipient and matches it to the identity of the person about to receive the blood transfusion.
The medications administered included Zanaflex® 8 mg, Coumadin 5 mg, and docusate sodium 100 mg.
Bar-coded systems are not subject to distraction and can help organizations improve the labeling of blood samples, dispensing of blood components, and identifying the patient at the bedside.13 Studies indicate that many facilities use bar-coded labels, but there continue to be issues of the incorrect bar-coded label from one patient to another, wrong blood in tube, or blood being administered to a nondesignated blood recipient with blood that appears correctly labeled. She stated that her husband brought them in and that she took “everything, Dilantin®, phenobarbital, Colace®, all of them.” The doctor was notified and order was given to hold the medications. The lab alerted the staff that the patient had open bottles of medication on her bed with some of them spilled on the floor. Routine monitoring includes documentation that a patient is tolerating the transfusion without adverse events.
When the patient was asked what she was doing, she stated she didn’t get enough medicine so she was taking her own.
If the patient exhibits any signs of a transfusion reaction, the transfusion is stopped immediately, vital signs are obtained, and a comparison of the patient’s armband with the blood component tag and label are performed.12 Patient monitoring is a crucial part of the safe transfusion process so transfusion reactions can be promptly recognized and safely managed. When asked what she took, she stated that she took baby aspirin, heart pills, and Synthroid®. The patient should be very closely monitored in the first half hour of an elective transfusion, according to the organization’s transfusion policy, and when adequate staffing in the patient care area is ensured to provide adequate monitoring for a transfusion reaction. Over 12.6% (n = 111) of the reports indicated that patients self-administered their own medications because they were not completely satisfied with the care they were receiving. For example, patients stated that their pain was poorly controlled, that they were “tired of waiting” for their medication, or that their disease was not being adequately treated while in the hospital.The nurse discovered that the patient had medicated himself with insulin, indicating that he was concerned that staff did not medicate him in a timely manner. All blood components should be refrigerated or frozen and stored according to FDA and AABB requirements and transfused before the expiration date indicated on the blood component label. The patient had Humalog® insulin along with insulin syringes in his room, apparently from home. Any component that was previously frozen must have an expiration time assigned when the unit is thawed.6,7,12 Review prescriber ordering procedure of blood components. The medication and syringes were removed from the patient’s room.A five-year-old patient was seizing for about six to seven minutes, with the doctor in the room. The use of computerized prescriber order entry (CPOE) provides a structured, legible, and traceable communication between the prescriber and the blood transfusion service.

CPOE combined with computer-assisted decision support provides readily available information intended to assist the clinician in making proper transfusion decisions using the alerts built into the system. The mother took the medication Diastat® [diazepam] out of a bag and gave [the patient] the medication, saying there was no time for a third party to retrieve [the medication].
The patient’s father was upset with the delay of medications reaching the nursing unit for his daughter.
Particular care must be exercised when prescribing for infants, children, and small adults, during which failure to adjust the quantity can result in overtransfusions and can lead to serious morbidity or mortality.11 Review patient consent for blood components and ensure right for refusal clause appears on the consent. This medication was not approved by pharmacy.A patient was agitated about their elevated glucose readings for the past two checks.
The consent includes information about the infectious and noninfectious risks of transfusion, given in an appropriate reading level and in the patient’s native language.
Adjustments were made to NovoLog® scale during the day shift; however, following the last elevated glucose reading, the patient expressed concerns about inadequate treatment. The consent also includes the opportunity for the patient to ask questions about the transfusion and should be obtained as soon as it has been determined that there is a possibility that a transfusion may be needed.12 Monitor, track, and trend all blood samples for type and cross, type and hold, wrong blood in tube, mislabeled tubes, and issued blood components from blood bank.
Calls were made to the resident to explain the situation; patient was assured that a sliding scale order would be entered for the elevated reading, but no order was received. Blood bank hours of operation and staffing issues should be considered with the review or development of blood transfusion safety.
Risk Reduction Strategies Many institutions are confronted with managing the patient’s own medications that are brought in from home, and organizations can have procedures in place for the control and administration of these medications. Guidelines should be clear, unambiguous, and readily accessible.NotesAgency for Healthcare Research and Quality.
Consider the strategies described in this section, which are based on a review of events submitted to the Authority and observations at the Institute for Safe Medication Practices:Proactively assess the risk associated with the use of patients’ own medications. HCUP Facts and Figures Statistics on Hospital-Based Care in the United States, 2007 [online]. If patients are asked to bring in medications only for reconciliation purposes, explain to the family why the medications were needed and encourage them to take the medications home. If the facility does not need to use a patient’s medications, explain to the patient and family the policy on bringing in prescription, over-the-counter, and herbal or homeopathic medications into the facility.Review medication administration records (MARs) to determine how the directions for patients’ own medications are expressed. CMS improves patient safety for Medicare and Medicaid by addressing never events [fact sheet online].
Examples of circumstances allowing for personal medication use could include the following: The medication is not available on the hospital’s formulary, including those medications that are part of a restricted distribution system, compounded by an outside specialty pharmacy, investigational medications, and controlled substances. The patient is on a continuous parenteral infusion of such medications as Flolan®, Remodulin®, or an insulin pump.1Develop an alternative plan to provide the medication to the patient if the pharmacy is unable to supply it before the next dose is due. For example, stating that if a patient’s home medication must be used, it should be administered by a nurse. Address the pharmacy’s role in this process, including the following: If the medications are not to be allowed for use, return them to the patient’s family or caregivers. Ensure a process is in place to return the medications to the patient or family on discharge from the facility. Specify that the pharmacist is the health professional who will identify the medications, and include guidelines for another health professional to identify these medications if the pharmacist is unavailable.
In one published account of a hospital’s assessment of medications that patients brought to the hospital, pharmacists were able to identify 95% of the medications, with 1 in 15 containers of these medications being mislabeled or unlabeled.11 Develop a process to ensure the proper labeling of any patient’s personal medications that are allowed for use in accordance with state regulations, making sure that the medications are identifiable, in good condition, and not expired.
Specific challenges to be addressed include the following:Changes in the frequency of administration.
For example, if a patient was taking their medication from home once daily but the directions have changed in the hospital to two times a day.The use of bar codes. If the organization uses bar coding at the point of care, the pharmacy will need to apply a bar code to each medication brought in by the patient for use within the facility.Before medications are sent to the nursing unit, place stickers or some other means of notification on containers for the medications that have been reviewed by a pharmacist.
Use a documented tracking mechanism to communicate the use of patients’ personal medications, especially when patients bring in controlled substances or investigational medications. Department of Health and Human Services, Food and Drug Administration, Center for Biologics Evaluation and Research. Guidance for Industry: Biological product deviation reporting for blood and plasma establishments [online]. Develop a standardized approach in regard to the storage of patients’ own medications in the patient care area.
In accordance with hospital policy, report any adverse events associated with the use of patients’ personal medications. Ensure procedures are in place to return patients’ personal medications before discharge, and note the final disposition of the medications in the pharmacy records.ConclusionIn Pennsylvania, almost 900 medication errors have been reported from July 1, 2004, through January 31, 2011, involving patients taking their own medications while in healthcare facilities, many times unbeknownst to healthcare practitioners.
One or more controlled substances were involved in over 40% of these events reported to the Authority, and more than 25% of these reports mentioned high-alert medications. Employing proactive strategies to address situations in which patients may bring in their own medications and implementing a screening method for patients admitted to the facility with a previous history of bringing in their own medications can be steps that are prioritized to prevent potential harm to patients.NotesNorstrom PE, Brown CM.
Results from the 2010 national survey on drug use and health: summary of national findings [online]. Failure of bedside ABO testing is still the most common cause of incorrect blood transfusion in the barcode era.
Drug Abuse Warning Network: selected tables of national estimates of drug-related emergency department visits. Changes in practice and organization surrounding blood transfusion in NHS trusts in England 1995-2005.
Patients do not realize that the directions for a particular medication are different in the hospital compared with at home.
Patients are not told that they should not take their own medications while in the hospital. End-to-end electronic control of the hospital transfusion process to increase the safety of blood transfusion: strengths and weaknesses. Which of the following statements reflect standards from the Joint Commission?The hospital defines when medications brought into the hospital by patients or their families cannot be administered. After the use or administration of a medication brought into the hospital by a patient, the hospital identifies the medication and visually evaluates the medication’s integrity.The hospital informs the prescriber and patient if the medication brought into the hospital by patients is permitted. Use identification technologies such as bar-coding systems or radiofrequency identification tags to improve proper specimen labeling. The hospital safely controls medications brought into the hospital by patients, their families, or licensed independent practitioners. Obtain positive donor-recipient identification and verification during blood collection and administration. Risk reduction strategies to ensure the safety of the blood transfusion process include all of the following EXCEPT: Guide prescribers to use algorithms and blood transfusion records to indicate the basis for transfusions when ordered. Implement a standardized checklist for the safe handling of blood components when transfusions are administered. Insulin and warfarin were the types of high-alert medications mentioned most often in the reports.While in the hospital, a patient self-administered atenolol 50 mg from her own supply. The patient brought in her medication from home because she thought that it was okay to take her high blood pressure medicine.
However, the patient’s attending physician had not ordered this medication for the patient. What proactive strategies may help to prevent these types of errors?Develop a screening method for patients admitted to the facility who have a previous history of bringing in their own medications. Inform the patient and family upon admission to the facility about the facility’s policies in regard to patients’ use of their own medications. The physician had considered that the risk of fluid overload was outweighed by the patient’s deteriorating condition and laboratory values. If the medication was brought in for reconciliation purposes, ask the patient’s family to take the medication home. Precautions were taken pretransfusion, including the administration of medication in an attempt to prevent any transfusion reaction. The patient was transfused with one unit of packed red blood cells and, two hours later, became acutely short of breath and hypoxic. Oxygen was administered to the patient, and the physician was summoned to the patient’s bedside. Repeated laboratory testing of the original blood specimen revealed that the results did not match the patient’s previous blood type. The original blood had been drawn from a different patient, and the wrong label had been applied.
The patient had received an incorrect unit of packed cells based on an incorrect blood type. In the case study described above, breakdowns or errors that led to wrong blood delivery associated with transfusions likely included all of the following EXCEPT: Verification took place in the presence of the patient. The laboratory stage, which begins when the blood specimen is delivered to the laboratory through the distribution of the blood or blood components The pre-analysis stage, which begins during collection of blood specimens and typically occurs at the bedside The clinical stage, which begins in the clinical area, excludes the pre-analysis stage, and includes additional bedside testing or equipment used at the bedside The monitoring stage, which begins in the clinical area after the blood or blood component has been transfused and includes monitoring the patient after the transfusion is complete Routine medication and solutions may be added to or infused through the same tubing with blood or blood components.

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