In the United States, great advances have been made in medication safety where strategies have been put in place for preventing errors, like not using dangerous abbreviations and identifying high alert drugs that are most likely to injure someone when they are used in error.

More than 90 per cent of hospitals are barcoded and are using computerized prescribing and bedside barcode scanning, where the doctor's orders are computerized. When the pharmacy dispenses the drug, it is labelled with a barcode. If the incorrect drug is scanned, there is an alert. The nurse or pharmacist on dispensing, and the nurse when administering get notified that there is something wrong, specifically, it is the wrong drug or dose for that patient. The use of bedside barcode scanning ensures that the right drug is being given to the right patient, at the right time.

"We have had very positive outcomes with manufacturers and regulators in terms of understanding that drug naming, labelling, and packaging is important," says Michael Cohen, President, Institute for Safe Medication Practices (ISMP). "Going forward we need to improve upon the availability of ready-to-use pharmaceuticals, like syringes or pre-mixed IV solutions, for institutional use in acute care hospitals. That in itself would address a lot of the errors we are seeing in our reporting programs in the United States, Canada and other places as well."

Technology is at the forefront across the United States, where infusion pumps are smart pumps used by and large in almost all hospitals. The smart pumps contain a library of drugs and the concentrations that are available for use in the hospital. When a patient needs an infusion, the nurse will look at the label to confirm it is the right drug, then put the IV tubing into it, hang it on an IV pole, attach the IV to a pump and push a button to start the infusion; the rate of the infusion is selected. Based on the concentration of the solution, the library knows how much drug is in each ml of solution. If a tenfold increase or decrease is accidentally ordered as an example, an alert is generated. In some cases it is a hard stop and you can't undo, or infuse anything without checking it out.

ISMP has been funded by the US Food Drug Administration (FDA) to develop a self-assessment tool for high alert drugs. The tool includes prevention strategies for each pharmaceutical that will allow hospitals to assess where they are in implementing each of the strategies. They will be able to compare themselves to each of the participating hospitals in a variety of demographic categories across the country.

"There are a lot of different things that can go wrong with medications, but we have done a good job with identifying them and applying prevention strategies," says Michael Cohen. "We are not perfect. Sometimes the system fails and they get through."

Michael Cohen, along with David U and Dr. Michael Hamilton from ISMP Canada, are members of the World Health Organization (WHO) Global Patient Safety Challenge on Medication Safety, Medicines Working Group. They are proposing solutions that address many of the obstacles the world faces today to ensure the safety of medication practices. The work will be launched in the first quarter of 2017.