ส่วนที่ 1 ข้อมูลเอกสาร

ส่วนที่ 2 Five Rights (และ 5 เพิ่มเติม)

ส่วนที่ 3 High-Alert Medications

3.1 List (ISMP)

3.2 Safety Strategies

• Independent double-check (2 nurses, separate calculations)
• Limited access (locked cabinets)
• Pre-mixed solutions (avoid bedside preparation)
• Standardized concentrations
• Smart pumps with dose error reduction software (DERS)
• Auxiliary labels (warning labels)
• KCl: never IV push, must infuse, max 10 mEq/hr peripheral
• Heparin: double-check, use weight-based protocols
• Insulin: u-100 vs u-500 distinction, use insulin syringes only

ส่วนที่ 4 LASA (Look-Alike, Sound-Alike)

4.1 Examples

4.2 Prevention

• Tall Man Lettering (e.g., hydrOXYzine vs hydrALAzine)
• Separate storage
• Read labels 3 times
• Verify with generic AND brand name
• Barcode scanning at administration

ส่วนที่ 5 Medication Reconciliation

5.1 When to Perform

• Admission (within 24 hr)
• Transfer (between units)
• Discharge

5.2 Process

1. Obtain best possible medication history (BPMH) from: patient, family, pill bottles, pharmacy, previous records
2. Compare with ordered medications
3. Identify discrepancies
4. Resolve with prescriber
5. Document reconciled list
6. Communicate changes to patient + next care provider

ส่วนที่ 6 Drug Allergies

• Document: drug, reaction type, date, severity
• Differentiate true allergy vs side effect vs intolerance
• Red wristband for allergy
• Check before every medication administration
• Cross-reactivity awareness (e.g., penicillin ↔ cephalosporin 1-5%)

ส่วนที่ 7 Medication Administration Safety

7.1 Preparation

• Clean, uncluttered work area
• Minimize interruptions (medication vest, "do not disturb" sign)
• One patient at a time
• Don't prepare in advance for later

7.2 Administration

• Barcode medication administration (BCMA) preferred
• 2 patient identifiers
• Verify allergy
• Educate patient about each medication
• Stay with patient until medication taken (PO)
• Check IV patency before infusion
• Time strips, labels on IV bags

7.3 Special Considerations

• Pediatric: always double-check weight-based doses, use oral syringes (not teaspoons)
• Elderly: polypharmacy, altered pharmacokinetics, Beers criteria
• Renal/hepatic impairment: dose adjustment
• Pregnancy/lactation: FDA categories, risk-benefit

ส่วนที่ 8 Error Reporting & Learning

8.1 Types of Errors

8.2 Reporting

• Non-punitive culture — encourage reporting
• Near-misses reported (catches before harm)
• Sentinel events → root cause analysis
• System improvement focus (not blame individuals)
• Report to: internal (incident system), external (national reporting)

8.3 Root Cause Analysis

• Interdisciplinary team
• 5 Whys technique
• Fishbone (Ishikawa) diagram
• Identify system factors (not just human)
• Action plan with follow-up

ส่วนที่ 9 Adverse Drug Reaction (ADR)

9.1 Recognition

• New symptoms after medication initiation
• Temporal relationship
• Known side effect profile
• Resolution with discontinuation

9.2 Common Serious ADRs

9.3 Reporting

• Internal incident system
• สำนักงาน อย. (HPVC): Health Product Vigilance Center
• Document: drug, dose, timing, reaction, outcome

KPIs

References

• JCI. (2021). International Patient Safety Goal 3: Improve the Safety of High-Alert Medications.
• ISMP. (2024). List of High-Alert Medications in Acute Care Settings.
• WHO. (2017). Medication Without Harm: WHO Global Patient Safety Challenge.
• Institute for Safe Medication Practices. Targeted Medication Safety Best Practices.
• สำนักงานคณะกรรมการอาหารและยา. ศูนย์เฝ้าระวังความปลอดภัยด้านผลิตภัณฑ์สุขภาพ.

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