Letter to the Editor

Imagine a sign on your cath lab that says, We meet minimum standards and allow unlicensed personnel to administer emergency medications. What questions would that generate among your patients? Teamwork is essential to a well-run cath lab. However, clear lines of responsibilities must be established to prevent an environment for errors. The National Academy of Sciences reports that medical errors kill 44,000 people in U.S. hospitals each year; other reports place the number much higher, at 98,000. Medication errors in and out of hospitals kill more than 7,000 patients annually. These significant statistics prompted the Clinton administration to instruct federal health care agencies throughout the nation to adopt the latest techniques for reducing medical errors (Kohn, Corrigan & Donaldson, 2000). Errors and resulting complications do happen in cath labs and important steps must be taken to ensure patient safety. Managers across the country need to evaluate their procedural practices to insure the highest standards of care. Unfortunately, as contributors to this publication have pointed out, a barrier to reducing medical errors in cath labs is the confusion with regulatory requirements, as requirements vary from state to state as well as between healthcare institutions. State Medical and Nursing Boards provide guidance for unlicensed personnel to administer medication under certain circumstances. However, these circumstances apply mostly to hospital, nursing home or private practice settings and may not help cath lab managers establish protocols for medication administration. As a result, cath lab managers have some discretion in how and who performs medication preparation and administration tasks. The choice appears to be either take advantage of confusing regulations and allow unlicensed personnel to give medications for cost-efficiency reasons, or raise the bar and ensure appropriately licensed personnel perform tasks they are licensed to perform. Licensed personnel means RNs should be administering medications (narcotics, emergency medications, intravenous medications, or conscious sedation). In the home construction industry where safety is also a primary concern, you have a clear separation of specialty employees. You won’t find carpenters working on electrical equipment and plumbers won’t be framing walls. Consumers expect homes to be built with quality materials and assembled with skilled and certified craftsmen. In this country, construction is highly regulated, with licensed craftsmen performing specific tasks and compliance confirmed by inspection. Companies that don’t measure up will not stay in business long. Should the health care consumer expect less than the home purchaser? Cardiac cath lab standards must be as rigid. Blending specialty roles and duties for efficiency and cost is not an option. Our patients expect safe and quality care. Beyea (2002) reports it is critical to standardize policies and procedures for handling of medications as well as solutions to prevent medication errors in the operating room (OR). She recommends standardized procedures in every OR. Cath labs everywhere must likewise standardize and improve protocols to reflect the highest possible safety standards. Patients expect procedures and protocols that prevent any opportunity for error. The right person doing the right job at the right time is the direction needed to ensure the highest standards of care. Barry R. Brown, BSN, RN, BC Graduate Nursing Student University of the Incarnate Word