Medication errors occur more often than people realize. Medication errors are part of the inadvertent misadventures that occur, on a small scale and large scale, in the best of healthcare facilities with trained professionals as staff and day-to-day operations. Unfortunately, medication errors range from mere inconveniences to actually harming patients, and far too many people fall victim to their consequences, with the cause being something as simple as medication storage.
The numbers don’t lie. Between 7 and 20% of all hospital admissions/year are associated with medication errors. According to the World Health Organization, millions of patients around the world are impacted by medication errors that stem from hospital stays and admissions every year. Drugs that are inappropriately stored contribute to the 73% of all medication errors that occur because of improper use. However, 100% of these incidents are preventable when adequate systems are in place.
Why Storage Is More Complicated Than You Think
There should be no complication when it comes to storing medications. Open a cupboard, open a cabinet, and voila, medications are stored. However, it’s not that easy, nor is it so difficult, but so many dynamics complicate medication storage.
For starters, there are different medications. There is different storage needs. There are medications that need to be refrigerated. There are those that need to be left in a dark environment. There are those whose packaging look the same and therefore must not be stored next to each other. If systems of storage do not support these adjustments, then staff members are put into positions where they must make judgement calls, increasing the likelihood of an error occurring.
Temperature can cause immediate issues. An antihypertensive med can cease to exist completely once stored in an unreasonably warm environment when it should have remained cool. An insulin dose can become unstable once left on a counter instead of in a refrigerator designated for meds only. These aren’t mere hypotheticals. They exist in real facilities where systems fail to accommodate proper storage needs.
Now place nurses on top of this busy environment. Nurses must provide medications during specific times throughout the day, and they only have so much time to do so. If they take the improper medication because similar-looking ones are stored next to each other, it doesn’t mean they’re solely at fault. It means that adequate systems fail to put them in a position to be successful. A good medicine cabinet with compartments organized appropriately does not make these mistakes happen.
Where Storage Errors Occur
Step into a healthcare facility today and within minutes one will be able to assess storage practices that are awry. Some problems are obvious; some are more insipid.
One issue is overcrowding. When multiple medications are stored in various locations within one small compartment, it’s impossible for staff to see what they need clearly enough. Therefore, words on labels become illegible; packages become crumpled; items get pushed to the back and forgotten leading to expired medications intermixed with current ones. This isn’t an organizational error; it’s a safety risk.
Poor lighting creates another negative vibe surrounding storage locations, wherever those are. If staff have to squint at medication names, they’re likely going to misread dosages or accidently select the wrong drug altogether. Adequate systems strive for adequate lighting, this shouldn’t be a perk.
Next comes security. Security levels for certain medications need to be locked up; others do not. Sometimes medications that require locks are housed in open spaces. This is a regulatory issue and a safety issue; when staff cannot easily distinguish between what needs special treatment and what does not, then systems have failed.
Temperature reading occurs sometimes but not always; a refrigerator may exist but without temperature tracking data, there’s no way of knowing that the refrigerator stayed cool enough after hours or if it imploded on itself at some point overnight causing all meds inside to spoil.
Financial Impact of Poor Storage
It’s one thing for facility administrators to be concerned about patient safety; however, when finances come into play for healthcare employers, poor storage practices hit harder.
Wasted medication from improper storage is costly. When medications expire or temperature-sensitive medications spoil because they’ve been improperly stored, facilities become responsible for these costs, not insurers.
Additionally, the metric of time matters here as well. If there is more time spent looking for medication in disorganized spaces, that’s more time that could have otherwise been dedicated to patient care with active patients. Count those minutes up over multiple shifts per day and it becomes quite significant.
Vicarious liability for legal ramifications exists, inspections occur to assess storage requirements; if policies are inadequate then citations and fines ensue. For pharmacies and clinics, violations impact licensure and accreditation opportunities as well as reputational considerations.
Improving Systems
Systems of medication storage do not require overhauls, but in some situations they do, and sometimes they just need minor adjustments by finding flaws first and then fixing them over time.
Compartmentalized Separation is first and foremost. Similar sounding or looking medications need physical space between them at different shelves or different compartments, or even different locations altogether. Colour-coding systems can help, but this shouldn’t be relied on alone.
Strong labelling goes beyond simply indicating what’s in an area; it should indicate how it needs to be stored (for how long), how it’s supposed to be treated (not always) with expiration dates clearly visible on front-facing areas with instructions on what people should be looking out for even while they’re taking the drug (if applicable). Some facilities utilize large lettering and high contrast differences so reading doesn’t become an error.
Access control is vital via security measures for sensitive materials as well as safety precautions that not all staff need access to every medication at all times. This tiered approach exists so controlled substances remain behind lock and key but still accessible to personnel who need them when properly trained. An excellent system will have lock mechanisms that can be opened differently for different access needs.
Best practices are now better into consideration. Factors that assess temperature and humidity levels for appropriate spaces created, for light-sensitive components or ventilated areas so moisture doesn’t develop, are essential to appropriate design compared to an add-on afterthought.
Inventory consideration should happen regularly with a systemized approach where ‘first-in, first-out’ naturally occurs because newly sealed medications become placed at the back while older stock comes toward the front with clear indicators as numbers go down so facilities know when to order again.
Staff Training/Design Consideration
A good system is only as good as it’s utilized with appropriate staff training that shouldn’t occur just during orientation but regularly when new systems adjust or medications change, for updates that condition include refresher training on what’s acceptable.
But ultimately, good design creates ease of use and staff don’t need extensive reminders about basic organized principles, if systems require constant references about protocols written down easily accessible somewhere else, then they’re probably not designed well enough in their own locations.
Human factors play into accessibility concerns. Staff shouldn’t have to bend over backwards or strain their backs reaching awkwardly to access common medications frequently used or infrequently used due to desired locations, they must stand fairly eye level just below waist high. When systems are inaccessible, workaround ideas develop that open up new avenues for error; if settings are designed well enough for accessibility purposes then this shouldn’t happen.
The Competing Priorities Imperative
Healthcare facilities have a million competing priorities going on every time staff show up, they’re no better than any other workplace, equipment upgrades, staff training updates through HR policies, potential patient care needs (always on this list), budgetary considerations, but proper storage is often last on this list if no incident has occurred recently.
This myopic view hampers future progress. It’s not just about compliance or avoiding errors, which it is, but it’s about creating an environment where safe medication practices occur automatically instead of staff needing to bend over backwards outside of proper safety protocols with good intentions alone.
Providing good systems empowers staff to do their jobs, the cognitive load is reduced with less opportunity for error but instead, creating effective workflows where staff don’t have to waste time wondering where they put the last lidocaine gel or whether they grabbed the right dosage of pravastatin for one patient instead of another.
It’s clear, the more facilities invest in proper systems for medication storage, the better subsequent outcomes for fewer errors or inventory waste through compliance safety options (and improved staff satisfaction). The investment payoff per dollar goes through easy access for years down the road under critical conditions putting everyone involved, from staffers down to patients, at risk.
Medication errors will never be eliminated but they will far too often occur without proper systems in place as a best prevention strategy available today throughout healthcare systems serious about patient safety where this ideal component will benefit from adequate time and resources implemented successfully instead of foregoing storage from decimated systems while hoping for the best, or doing nothing at all while patient well-being is collateral damage.
