Rural hospitals aim to cut medication mistakes

Posted: Monday, August 04, 2003

JUNEAU (AP) Mistakes in prescribing or giving medications are a concern in rural Alaska, according to the Alaska State Hospital and Nursing Home Association.

Hospitals and clinics in small towns and villages don't always have a pharmacist. Nurses often must locate medications in a ''drug room,'' figure out the right dosage, mix intravenous solutions and give the drugs, experts said at the association's conference Thursday and Friday in Juneau.

About 20 health care providers, many of them rural nurses, attended the association's conference, which focused on how to avoid medication errors.

''There's a national movement on quality of patient care and patient safety,'' said Randall Burns, director of the association's small hospital performance improvement network. ''Certainly the quality of care, given the resources we have, is an issue that all of us face.''

The Institute of Medicine estimated in 1999 that medication-related errors cause 7,000 deaths a year in the United States.

Experts said errors can occur because pharmacists or nurses confuse similar-sounding drug names or similar-looking packages of medications.

But rural areas have characteristics that may contribute to medication errors.

The Bristol Bay Area Health Corp., based in Dillingham, serves about 8,000 people in 33 villages spread over 44,000 square miles, said Sue Mulkeit of the Native health corporation. Some elders in those villages don't speak English, she said. Some children don't speak English until they get to school.

Cordova gets a summer influx of Filipino and Japanese cannery workers, many of whom don't speak English, added Gretchen Zolldan of the Cordova Community Medical Center.

''We may not understand what their allergies are, or what their specific medical complaint is,'' she told the Juneau Empire.

Some errors happen in rural areas because health care workers don't see a particular type of treatment very often, and they don't know what the typical doses of medication are.

Institutions are looking for systematic ways to dispense drugs.

The six Pioneers' Homes in Alaska moved to a centralized way of dispensing medications in 1997, rather than having them bought in each community, said Robert Albertson, the chief pharmacist for the homes.

The new system gives patients drugs on cards with each pill individually wrapped in a bubble, so it's easy to see if the daily dose is taken. The cards contain an explanation of what the drug is for, so the person giving it to the patient can check that it applies.

The Alaska Native Medical Center is testing a telepharmacy program in rural villages. A pharmacy at the medical center in Anchorage would accept prescriptions by phone, fax or secure computer lines. The orders would be reviewed by a pharmacist for their appropriateness and safety.

The drugs would be dispensed from bins in the village clinics in an automated system, based on a bar-coded label.

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