May 17, 2024

Welcome to this week’s UH EMS-I's Pharmacy Phriday. In this edition, we will once again focus on medication errors. Do you recall hearing of the “Six Rights” of medication administration in your training? They are common, but they are important. Medication administration is a high-risk event in EMS and deserves frequent review.  

Errors can occur and have the risk of causing great harm to the patient. Causes of errors vary and can include verification issues; the chaotic setting prehospital providers work in; poor lighting; dangerous environments; fatigue; the critical time-sensitive nature of emergency patient care; the rapidly changing status of ill or injured patients; medication storage issues; and appearance and labeling of medications just to name a few. Regardless of the cause, the provider must take responsibility to ensure medication errors are eliminated.  

The “Six Rights” are steps that providers can use to prevent errors. They include: 

• Right patient: This is not usually a problem in the prehospital setting, except for maybe multi-casualty incidents. More commonly, this might relate to whether the medication is right for the patient, i.e., allergy concerns, interactions with prescribed medications, or possible interaction with medications taken by the patient before EMS’s arrival on the scene. 

• Right medication: Packaging can often look similar on different medications. Be sure to read the label. It is often suggested that the label be read three times, including when removing the medication from the box, as the medication is drawn up, and just before the medication is administered. Do not be confused by similar-sounding medications! 

• Right dose: Efforts are often made to provide medications in single dose units, but this is not always the case. In cases when specific amounts must be drawn up (i.e., weight-based medications, administration for special population groups like pediatric or geriatric patients, etc.), ensure calculations are correct and drawn up correctly. Concentrations of the same medication can also cause errors.  

• Right route: Besides ensuring a medication is being given via the route intended, remember that some medications can be given via multiple routes with different dosing and concentrations depending on the route. Be sure the proper concentration is being used for the proper route! 

• Right time: In the prehospital setting, most medications are given “stat.” The provider must be sure to remember time as a critical element in cases of repeat doses or possible infusion rates.  

• Right documentation: Inform other providers and document any medications given to ensure proper transition of care. This may include other medications the patient had taken prior to EMS’s arrival or prescribed medications affecting the patient’s care. 

To avoid medication errors the provider should also be aware of various tools and resources available to assist in those efforts. These can include protocols and apps, as well as tools within those documents. Other tools should include printed reference materials in the squad and, of course, your partner or medical direction. Many articles and documents stress the importance of a team concept in treating our patients and medication administration!   

Next week (May 19-25, 2024) marks the 50th anniversary of EMS Week. We would like to take this time to recognize all our EMS providers and support personnel and thank you for your service! For more about this year’s EMS Week, click here. 

As always, stay safe!

Sincerely,



The UH EMS-I Team

University Hospitals