The University of Pittsburgh Medical Center is a leader in the development of quality improvement projects to protect its patients. UPMC takes a collaborative approach to medication safety. Across the health system, UPMC physicians, pharmacists, nurses, and other staff work together to eliminate the potential for medication errors. UPMC is recognized as a national leader for its ability and commitment to refine processes and develop strategies that ensure optimal use of medications. Some of these activities are:
Learn more about other patient and medication safety initiatives, including:
UPMC is taking innovative approaches to address the legibility of physician handwriting. One strategy is the development of computerized physician order entry (CPOE). CPOE eliminates the need to compile handwritten notes in a paper chart. Instead, physicians can type their orders using computer technology that is being brought to their patients' bedside.
Legibility also is stressed in regular communication with UPMC physicians. For example, a monthly physician newsletter regularly publishes examples of poor legibility taken from order sheets. Physicians are then asked if they can interpret the handwritten order of their colleague.
Consistent Prescribing Practices
Consistent use of abbreviations and prescribing practices in writing medication orders is being stressed at all UPMC hospitals and facilities. In fact, UPMC now forbids the use of specific abbreviations in all handwritten medication orders. For example:
- The use of trailing zeroes has been banned (an order for 1 milligram of a medication must be written as “1 mg” not “1.0 mg”).
- The use of “QD” is no longer accepted. Instead, physicians should write out “daily.”
- “QOD” is forbidden, and the phrase “every other day” must be written in its place.
- Writing the letter “U” for units of insulin could be interpreted as a zero, resulting in a patient receiving too much insulin. Physicians now must write out the word “unit.”
The importance of following these rules is being reinforced. Pharmacists at UPMC contact physicians who do not follow the standards. To ensure that their messages are received, some pharmacists are using an automated text page/e-mail system to reach these physicians.
Expanding the Role of the Pharmacist
UPMC is redefining the role of the pharmacist at its hospitals. UPMC’s innovative approach involves taking a growing number of pharmacists out of the pharmacy and onto patient floors and units, where they work directly with physicians, nurses, and even patients.
The concept of a decentralized pharmacy has many benefits. Pharmacists can fill orders right on the patient floor, reducing turnaround times for medication delivery and ensuring that missed dosages are replaced quickly. Additionally, the pharmacist works with other members of the patient care team to suggest effective medications, preferred routes of administration, or alternative drug therapies that may pose fewer side effects.
The decentralized approach also permits the pharmacists to work directly with patients. As part of an anticoagulation program, UPMC pharmacists are meeting with patients who have suffered strokes and are preparing to go home to continue their recovery. Pharmacists meet with patients prior to discharge and discuss such issues as proper self-administration of enoxaparin sodium (Lovenox) injections and postdischarge use and diet restrictions for warfarin (Coumadin).
Working With National Organizations
Pharmacists assigned to UPMC’s Drug Use and Disease State Management Program work closely with several national organizations to receive timely alerts and recommendations regarding safe medication practices. UPMC even shares its best practices with others through these forums.
UPMC reviews all information it receives from such organizations as the Institute for Safe Medication Practices (ISMP). UPMC Presbyterian has done an internal review of roughly the last 70 safe practice recommendations published by ISMP. The hospital found that it already had the majority of these recommendations in place. However, UPMC determined that it could further strengthen its standards for medication safety by incorporating some of the ISMP’s recommendations into the health system’s practices.
For instance, ISMP urges clinicians to use a technique called “tall-man lettering” to reduce confusion about look-alike and sound-alike drugs. ISMP recommends using a combination of upper- and lower-case letters (for example, chlorproMAZINE and chlorproPAMIDE) to help distinguish drugs with look-alike names. UPMC pharmacists are incorporating the use of tall-man lettering into PharmNet and other applications of eRecord (UPMC’s electronic health record) and its online formulary.