Scrutiny of the process intensifies when a mistake is made, especially if that error involves someone famous being given a so-called high-alert medication - those that, when given in the wrong dose or used incorrectly, have the highest risk of seriously harming or even killing a patient.

Both Scott & White and King’s Daughters hospitals have, for a number of years, had systems to protect against such errors.

A recent mistake to receive national attention came in November at a Los Angeles hospital and involved the newborn twins of actor Dennis Quaid. The mistake involved accidental overdoses of heparin, an anti-clotting drug.

King’s Daughters Hospital switched from look-alike heparin vials to distinct syringes more than a year ago, said Scott Wood, director of King’s Daughters Hospital pharmacy.

Many of the high-alert medications are the most essential to hospitals. Among them are drugs to prevent blood clots, sedate patients, relieve pain and stabilize diabetics. But incorrect use of these drugs can lead to disasters.

Look-alike medications at King’s Daughters are separated in the Pyxis system, an advanced automated medication system designed to improve patient safety, Wood said.

In the system high-alert stickers and “tall man lettering” are used on look-alike, sound-alike medications.

Tall man lettering is when part of the drug name is written in upper case letters to help distinguish one drug from another.

Also King’s Daughters uses two patient identifiers - name and birth date - when medications are administered, said Connie Madsen, director of patient affairs at King’s Daughters.

“Medication management,” she said, “is a complex system involving physicians, nurses and pharmacy.”

Ongoing education is provided to all King’s Daughters staff and the medication process is continuously monitored, Mrs. Madsen said.

The Joint Commission, she said, has had medication management standards in place for years and King’s Daughters adheres to those practices.

Scott & White also stays compliant with the commission’s annual national patient safety guidelines, said Tricia Meyer, director of Scott & White Hospital pharmacy.

“Even over and beyond that, we have medication safety meetings, we have teams that are always looking at improving processes and safety,” she said.

The Joint Commission, an independent, not-for-profit organization, is the nation’s predominant standards-setting and accrediting body in health care.

The number of medications administered to a hospital patient in a given day can easily reach well into the double digits.

Scott and White uses a point-of-care bar code system, Medication Administration Check (MAK), to administer drugs in the medical surgical, intensive care and pediatric units, said Kendra Sutton, a registered nurse who works as hospital liaison between Siemens and Scott & White.

The hospital has had the system for three years.

When using MAK, the nurse’s name badge is scanned along with the medication and the patient’s arm band.

If a wrong medication or the wrong patient is scanned, the system shows a red X. A green check mark is indicated if the correct patient and medication are scanned.

Scott & White has numerous strategies to administer patients’ medication safely, Ms. Meyer said.

In addition to the thousands of drugs already available to patients, 40 more drugs are considered each year for addition to the hospital pharmacy inventory, Ms. Meyer said.

When a drug not currently available at the hospital is being considered for use, a checklist of safety issues is examined, which includes the effectiveness of the drug and documented errors involving the drug, Ms. Meyer said.

Also examined is the packaging of the product, whether it looks similar to another drug, and whether its name sounds like another agent. Toxicity and special preparations required when administering the drug are considered.

“Some drugs require extra training for technicians,” she said.

Also, new procedures and policies may be needed in order for it to be used appropriately.

Scott & White has pharmacy satellites in areas that have high-risk patient populations - neonatal intensive care, pediatrics, intensive care, oncology and the operating room, she said.

Satellite pharmacists have special training and possess a greater understanding of therapies used by their patient population, Ms. Meyer said.

“The oncology pharmacy is a dedicated pharmacy,” she said. “Only the pharmacists who have gone through training can mix chemotherapy drugs. They’re on call 24 hours a day, seven day a week.”

Scott & White has an anticoagulation clinic made up of pharmacists and nurses whose job it is to monitor patients on anticoagulants. There is an anticoagulation safety team that looks at the different anticoagulation drugs that are in the system and to make sure all safety practices are being followed.

The hospital has a heparin protocol drafted and developed by a medication safety team, Ms. Meyer said.

“The teams are always looking at processes and drugs that relate to patient safety,” she said.