The face of the moon was in shadow
Policies live on intranets; bundles live on shift. The safest private units standardise a few non-negotiable behaviours: name-band checks, high-risk double-checks, LASA read-backs, paediatric weight accuracy, and early escalation. Do the same way, every time.
The core bundle (copy/paste to your unit board)
ID match: two identifiers + allergy status before every dose.
High-risk double-check (two clinicians): anticoagulants, insulin, electrolytes, opioids/PCA, chemo, paeds concentrates.
LASA read-back: say drug, dose, route, time aloud; verify label vs MAR/prescription.
Paediatric weights: metric only, date-stamped; dose per kg with independent calc.
Infusions: standard concentrations; smart-pump libraries locked; calculation printed on the chart.
Escalation: if dose or route feels wrong, pause and call; document the conversation.
Documentation: administer → document → sign with time; exceptions explained, never left blank.
Storage & chain of custody (quiet reliability)
Segregate: high-risk shelves; look-alikes far apart; tall-man lettering on bins (label stock, not clinical notes).
Temperature: log fridges daily; excursion = quarantine + pharmacist review.
Controlled drugs: opening/closing counts, witnessed; discrepancies escalated immediately.
Kits & trolleys: sealed after restock; seal numbers logged.
Handovers that protect patients
Protected SBAR with a high-risk meds line (“heparin, insulin sliding scale, PCA in situ”).
Flag new starts, titrations, and any near-miss from the shift.
Keep one live list of pending therapeutic drug monitoring (e.g., vancomycin).
Role-specific anchors
Doctors
Avoid verbal orders; if unavoidable, repeat back and sign within the timeframe.
Default to weight/renal adjusted dosing when indicated; write the indication on the order.
Nurses
Standardise the two-person check and announce LASA aloud.
Refuse unclear labels or hand-written decants; request pharmacy relabel.
Physiotherapists
Before mobilising: confirm analgesia timing, anticoagulant status, and post-dose monitoring requirements (e.g., fall risk).
Five-minute micro-audits (daily)
Fridge temp within range; log signed.
High-risk shelf tidy; bins labelled; expiries checked.
CD register matches stock; last discrepancy closed.
MAR vs reality: pick two patients; one omission error = fix the process.
Pump library in use; no free-text concentrations.
Common pitfalls—and calm fixes
Look-alike packaging → reorder layout; add shelf cues; brief the team today.
Missing weight for paeds → stop, weigh, record; re-calculate doses.
Verbal orders left unsigned → escalation to prescriber or duty lead within policy time.
Infusion maths done from memory → post the unit standard; require cross-check.
Manager’s implementation checklist
High-risk list published & audited weekly.
Double-check policy demonstrated in induction; spot-checks logged.
Pharmacy partners review LASA risks quarterly.
Incident → learning huddle within 72 h; change adopted and re-audited.
New staff complete med-safety competency before independent shifts.