Patient Safety and Quality Assurance
Core concepts
Patient safety focuses on systems that prevent harm: accurate patient identification, complete allergy and medication reconciliation, barcode scanning, independent double checks, and clean, organized workflow. Know high-alert medications (insulin, heparin, opioids, concentrated electrolytes, neuromuscular blockers, chemotherapy), LASA names, tall-man lettering, and error-reporting systems. Understand root cause analysis (RCA) for sentinel events and failure mode and effects analysis (FMEA) for proactive risk reduction. Sterile compounding requires USP <797> environmental controls, garb, disinfection, and beyond-use dates (BUDs); hazardous drugs require USP <800> containment and closed-system transfer devices where indicated.
Traps
High-alert does not mean high error frequency; it means high risk of significant harm when an error occurs. Questions confuse BUD with expiration date, or quarantine with recall. Do not skip the independent double check because two people “already looked.” Also distinguish adverse drug reaction reporting (MedWatch) from internal error reporting; both are important but serve different purposes.
Worked example
A technician prepares an insulin dose. Because insulin is high-alert, the correct process includes a second qualified person independently verifying the drug, concentration, dose, and pump/syringe setup-not merely confirming that the first person read the label.
Rule of thumb
Ask: “What system catches this error before it reaches the patient?” If the answer is only “being careful,” the process is not robust.