The Institute for Safe Medication Practices has published the 2020-2021 Targeted Medication Safety Best Practices for Hospitals (TMSBP). The updated list includes new best practices on opioid prescribing and on the risks related to the ‘override’ feature with Automated Dispensing Cabinets (ADCs). In addition, five best practices were revised or incorporated into other items.
While targeted for the hospital-based setting, some best practices are applicable to other healthcare settings. Facilities can focus their medication safety efforts on these best practices, which are realistic and have been successfully adopted by numerous organizations. These best practices were developed to identify, inspire and mobilize widespread, national adoption of consensus-based best practices for specific medication safety issues that continue to cause fatal and harmful errors in patients, despite repeated warnings in ISMP publications.
The Best Practice recommendations presented are based on error reports received through the ISMP National Medication Errors Reporting Program (ISMP MERP) and have been reviewed by an external expert advisory panel and approved by the ISMP Board of Trustees. This initiative was first launched in 2014 and is updated with additional Best Practices, as needed, every two years.
The two best practices that have been added are:
Opioid Best Practice:
- Verify and document patient’s opioid status and type of pain before prescribing and dispensing extended-release and long-acting opioids
- Alert practitioners when ER and long-acting opioid dose adjustments are required
- Eliminate the prescribing of fentanyl patches for opioid-naïve patients
- Eliminate the storage of fentanyl patches in ADCs or as unit stock in clinical locations where acute pain is primarily treated
ADC Best Practice:
- Limit the variety of medications that can be removed from an ADC using the override function
- Require a medication order prior to removing medication from an ADC
- Monitor automated dispensing cabinet overrides to verify appropriateness, transcription of orders and documentation
- Periodically review for appropriateness the list of medications available using the override function
- Restrict medications available using override to those that would be needed emergently (as defined by the organizations)
For a copy of the 2020-2021 ISMP Targeted Medication Safety Best Practices for Hospitals, click here. Please note that sign-in and/or creation of a free user account may be required for access.