Expanding paramedics’ scope has serious implications for medication safety: ISMP Canada

Paramedics have seen their scope expand and are working in new patient care models. One example is Ontario’s recent move to allow them to treat patients and discharge them, with recommendations for follow-up if needed. However, that means there is also a higher risk of medication errors.In a recent bulletin, ISMP Canada (ISMPC) examined medication safety in Canadian Paramedicine Practice. It analyzed data collected from paramedics who completed Medication Safety Self-Assessments. The Medication Safety Self-Assessment collects ratings from 0 to 4 on eight elements of medication safety. It was completed by 196 paramedics in 2023. More than two-thirds worked in communities of 100,000 people or more, and 94% were first responders to emergency calls. Most were primary care paramedics, and the rest were advanced care paramedics. The paramedics gave high scores (above 3 out of 4) to patient engagement and partnership, interdisciplinary care team, medication management, medication administration and quality assurance and incident management. They gave lower scores to education and training (2.8) and equipment and technology (2.6). Read: What are these ‘emergency medical responders’ Nova Scotia wants to pair with paramedics?Scores were generally higher for day-to-day activities and medication safety practices and lower for things that were more administrative. The categories were further subdivided into assessment items, some of which showed specific areas for improvement. Within medication management, paramedics gave high scores (above 3) to being aware of look-alike, sound-alike names and packaging, and the proper storage of controlled medications. But when it came to labelling prepared medications with the name and dose or concentration, the score was 2.8. In medication administration, a near-perfect score was given to following standard protocols, medical directives or clinical guidelines, while using machine-readable coding at the point of care only got 0.3. Read: Despite 20 years of issues, Peel paramedics are still being dispatched using a flawed systemThe ISMPC recommends that organizations consider adding machine-reading technology, such as barcoding, to the point of care. This technology is available in hospitals and community pharmacies and helps reduce medication selection errors. Regarding quality assurance and incident management, paramedics gave high scores for reporting medication incidents, and lower scores (2.7) for having a just culture. In a just culture, errors and near misses are used as a chance to improve the system and make things safer, and paramedics and patients would feel safe reporting errors without being unfairly blamed for them. It’s important, the ISMPC says, and can be established by sharing aggregate data around medication incidents, using lessons from them for continuous quality improvement, and including just culture information in training programs. Read: Nova Scotia expands immigration program in bid to fill pharmacy, paramedic jobsIn Education and Training, a lower-scoring category, receiving information about medication incidents was highlighted as an issue. The answer to this is logical: the ISMPC says paramedic organizations should share what they learn from medication incident analysis throughout their organizations. When it came to equipment and technology, medication device training and checking for competence before use, having access to prescription safety glasses, and labelling distal end tubing for patients receiving multiple solutions were all low. The report said organizations should improve their training and ongoing competence assessment for the use of medication devices and examine them around tubing labelling, the report said. They should also ensure access to prescription safety glasses. Even though it was a higher score, at 3.2, ISMPC said that disclosing medicine incidents that happen during care could be improved. Paramedics need more mentoring, training, and resources around this so they feel comfortable telling patients and caregivers about incidents in the moment. Read: Tears and fond memories shared by paramedic who unknowingly treated daughter in crash

Expanding paramedics’ scope has serious implications for medication safety: ISMP Canada

Register for free access or login.

Related Topics