Jon and Kate: I think I'll medicate!

Call me silly, but I'm always surprised when highly predictable events happen. Take the high-profile dissolution of Jon and Kate Gosselin's marriage.

Under circumstances that can best be described as childbearing Yahtzee, a young couple in rural Pennsylvania manage to add six-of-a-kind to the deuce they rolled in the first round of play. Shortly thereafter, they score a reality TV series, adding producers, cameramen, photographers, hired help, speaking engagements, investment portfolios, and book tours to the primary task of raising eight humans, six of whom--unfortunately and largely without precedent--share the same developmental stage.

She thrives, leaving the stay-at-home-mom-who-happens-to-drive-a-church-bus image behind and morphing into someone who might be credibly cast on "Real Housewives of Punxsutawney." He begins to resemble Jim Carey in "The Truman Show." The marriage crumbles. Who knew?

Marriage in the U.S. doesn't have great odds to begin with, and marriages with high-order multiples have higher failure rates than others. But like Captain Renault in Casablanca, we're shocked, shocked to find that gambling is going on in here!

The denouement of Jon and Kate has left me thinking about medication use, a topic that could reasonably be expected to arise in an upcoming episode. So, in the short window of clarity that followed the "ah-ha" moment when I learned Jon and Kate ain't great, I jotted down eight things about medication safety that you, too, probably knew all along. (Apparently, we should be shocked, shocked to find that gambling has been going on here!)

1. If you routinely identify patients using 2 distinct identifiers and engage them in the care that's about to occur, you're less likely to give a patient the wrong medicine, conduct the wrong test, or perform the wrong surgery.

2. If you make drug information available to clinicians on the front line (preferably in a mode that's as easy-to-use as an iPhone, not a dogged-eared text from an earlier century), the clinician administering drugs will be able to become familiar with, and actually double check, unfamiliar drugs and doses before administering them.

3. If you say "fifty" (without saying "five-zero") over the telephone, you're likely to be heard to say "fifteen." "I'll be there in 15 (or 50?) minutes" is not as much of a problem as, "Give her 15 (or 50?) units of insulin." Break multiple digit numbers into their simplest form, say and spell drug names, and read back and verify high-stakes information that's transmitted verbally.

4. 1400 commonly used drugs look like or sound like another one. These similarities regularly cause competent people to select an unintended drug from a computerized pick-list or mis-hear a drug as its sound-alike cousin. If you include the purpose for the drug on all orders or written prescriptions, this information allows another knowledgeable professional (like a pharmacist or nurse) to detect and derail a look-alike, sound-alike (LASA) error since few members of LASA drug name pairs are used for the same purpose.

5. If balsamic vinegar and olive oil come in similar containers, it's easy to kill a quesadilla. How drugs are stored at work matters, too.

6. If something can be attached to something else, someone will attach it. Good for tinker toys, Legos, and jigsaw puzzles. Bad for oral medications in parenteral syringes and pressurized B/P tubing connections that are compatible with IV lines. If you can't put diesel fuel into your gas tank by mistake, why don't we have similar safeguards in place at work?

7. If the lighting is bad in a restaurant, you have trouble reading the menu. If the lighting is bad over automated drug dispensing cabinets, your front line is going to have trouble reading the labels of the drugs they remove from them.

8. The average age of a nurse is around 50 years old. Most drugs that are given today were boiling in a cauldron somewhere when we took our boards. If you define how risks associated with high alert medications and LASA drugs are managed in individual care settings within your organization and teach these strategies to nurses (and others who handle drugs), you will prevent mistakes that have been made elsewhere from occurring where you work.

I hope you find these 8 to celebrate, agitate, and advocate, eight things that will help you take care when you medicate!

Fishing in a well-stocked pond

Florence has a sister, a new blog on the Medscape site called, "On Your Meds: Straight Talk about Medication Safety." I hope you'll take a look, and bookmark the site because On Your Meds is going to host a running commentary on specific strategies for reducing medication errors.

The current post is about high-alert medications, those with a heightened risk for causing harm if used in error. Insulin, chemotherapy, narcotics, drugs with weird dosing schedules, drugs with impossibly narrow therapeutic indices, drugs that result in closure of life-sustaining orifices if halted by mistake..... Let's just say that the drugs on ISMP's High-Alert list have earned their place.

I spent a year studying medication error prevention with ISMP, the nation's foremost experts on the subject. So I know more than the average bird, and often more than I wish I did, about medication errors. But you probably do, too: A medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer.

People often wonder where I get the stories I use to illustrate key facts about med safety. Med errors can arise anywhere in the medication use process, a complex system (run by human beings) that includes: prescribing; dispensing; administering; and monitoring the effects of drugs.

Now consider that in a given week, an average of 82% of adults in the U.S. are taking at least one medication (prescription or nonprescription drug, vitamin/mineral, herbal/natural supplement); 29% are taking five or more. (These stats provide a snapshot of adults in community settings and exclude medications administered to people in hospitals and extended care facilities.) At this point, the stories find me. Or as Larry the Cable Guy might say, "You're fishin' in a well-stocked pond, sister."

Last week, I'm in the locker room at the YMCA, sharing a little more personal space than I'd rather. I've just finished cycling, and it looks like the Y member closest to me is preparing for "Twinges," the water class for people with joint disorders. She's chatting with a friend, and putting her clothes in a locker. The next thing I know, a bunch of pills, maybe 12, have spewed from the pocket of her balled-up Khaki pants. Some hit the bench, some the floor, and a few land in my gym bag. I help her retrieve them, phrases like "drug storage" and "mindfulness" flashing in my brain. She scoops up the last visible ones, examines her catch, re-pockets them, and says to her friend, "Good, I got the yellow one. We can still go to lunch."

I'm working on a project about insulin pens, visiting the manufacturers' Internet homepages and checking out the patient education materials available there. I notice images on a manufacturer's site where hip-looking teens are depicted using their insulin pens as hair accessories. Phrases like "drug storage" and "mindfulness" flash in my brain.

ISMP shares an error analysis in which a patient being treated for angina in a busy Emergency Department receives IV saline instead of IV nitroglycerin. The commonly used nitroglycerin is seated next to a similarly-appearing, but obsolete, glass bottle of 0.9% sodium chloride. The key elements? "Drug storage" and "mindfulness."

Across the continuum, themes repeat. I'll be reflecting more about them here at Florence dot com and at On Your Meds. In the meantime, it may be worth thinking about the utility of high-level risk-reduction tools. Should professionals use the same strategies to manage medication risks that senior citizens at the YMCA do?