PharmPrac7e-Chapter14-WLpresentation

[Audio] Welcome to the Pharmacy Practice for Technicians Seventh Edition presentation..

[Audio] Chapter Fourteen: Medication Safety. Chapter Fourteen Medication Safety.

[Audio] At the end of this chapter, you will be able to: Describe patient medication rights, the extent of preventable medication errors, and the effects of errors on patient safety and healthcare costs. Identify specific categories of medication errors, their causes, and how to avoid them. Describe the various potential errors per each step of the dispensing process. Define FDA safety strategies to prevent adverse effects in high-risk drugs, including Medication Guide and REMS programs..

[Audio] Section fourteen point one: Medication "Rights" and Preventable Errors.

[Audio] Working in health care means making a commitment to "first do no harm." This means that healthcare workers must put safety first. As a result, no acceptable medication error rate exists, and each step in the task of filling medication orders should be reviewed with a 100% error-free goal in mind. Prescribers and pharmacy personnel are responsible for ensuring the "seven Rs," or seven rights for the patients. Technicians must work as part of a team to ensure that the medication each patient receives is for the right drug, at the right strength, in the right route formulation, for the right dosage time and supply, with the right documentation, for the right person, and accompanied by the right patient education..

[Audio] Medication errors are one of the most common types of medical errors. The National Coordinating Council for Medication Error Reporting and Prevention defines a medication error as "any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer." A medication error often results in an adverse drug reaction (ADR), which is an appreciably harmful or negative consequence to a patient from taking a particular drug. It may be a short-term acute reaction, long-term injury, or even death..

[Audio] Medication errors are difficult to track because there are no national laws requiring the reporting of pharmacy personnel errors. A 2009 observational study of 50 community pharmacies found that 1.7% of prescriptions filled, or 4 out of 250, had an error, and an estimated 65% of these errors resulted in negative impacts on the patients' health..

[Audio] Section fourteen point two: Root-Cause Analysis of Medication Errors.

[Audio] To prevent medication errors, one has to identify clearly what the error was, where it took place, and, through closer examination, what specifically caused it. Root-cause analysis is a systematic approach to identifying the deep causes of why something happened to prevent a recurrence. Numerous failures can occur at once, contributing to each other and magnifying the possibilities and quantity of errors, so prevention strategies have to address all three levels of systems and processes. An organizational failure occurs because of a deficiency in organizational rules, leadership, culture, policies, or procedures. Examples include inadequate staffing or training. A technical failure results from equipment problems. Examples include software viruses or calibration error in equipment. A human failure occurs at an individual action level. Examples include technicians misreading a label or not scanning National Drug Code bar codes..

[Audio] The level of errors where technicians and pharmacists have a great deal of influence is that of individual human errors. Despite being taught correct procedures, these errors still occur because of seven social and psychological reasons..

[Audio] An incomplete information error occurs when a full medication profile is not available because the patient was not asked sufficient or proper questions about their medications, the answers were somehow not recorded in the profile;, or the patient withheld information deliberately or by accident of memory..

[Audio] An incorrect assumption error occurs when an essential piece of information is assumed to be true without verification; therefore, a wrong decision is made..

[Audio] A selection error occurs when two or more options seem to exist and the wrong option is chosen..

[Audio] A capture error is an error of inattentiveness and habit..

[Audio] A rushed error is an error made because of the pressure to meet corporate or self-imposed time constraints, resulting in cut corners and unnoticed danger alerts..

[Audio] A distraction error occurs when a technician or pharmacist is interrupted in the middle of a filling process and forgets a portion of key information or train of thought..

[Audio] A fear error occurs when a technician fears the consequences of speaking up and asking a technician colleague, a pharmacist, or a prescriber to assist or double-check a prescription element..

[Audio] Human errors with medications occur most frequently at two crucial points in the process: prescription filling and administration. It's important to check each prescription against the original prescription and medication information sheet at least four times: during the computer order entry and printing of the label when the medication is taken from the shelf when the NDC number/bar code scan is verified during the counting of the dosage to fill the prescription.

[Audio] Many errors occur at the point of administration. Technicians and pharmacists must provide adequate education in the forms of medication label, information sheets, and pharmacist counseling about proper administration. Without this education, the following errors are common. A wrong time error occurs when a drug is given 30 minutes or more before or after it was ordered to be administered An extra dose error occurs when a patient receives more doses than were prescribed. An omission error occurs when a prescribed dose is due but not administered..

[Audio] Section fourteen point three: Step-by-Step Overview of Filling and Administration Education.

[Audio] The only way to stop medication errors is to review the steps in the filling process and key points where errors can be prevented. These steps include: Step 1: Receive and Review the Prescription. In receiving a prescription or medical order, an initial check of all key pieces of information is vital. Inspect for legibility, valid prescriber information including name, address, and phone number as well as DEA number for controlled substances, Patient information, and medication information..

[Audio] In the community pharmacy setting, the pharmacy technician often enters the prescriptions into the computer database, whereas in the hospital it is the pharmacist or the prescriber who usually enters the medication order. As each piece of information is entered, check the brand and generic drug options, making sure to enter the brand name if the prescription is written as D-A-W. Special attention should be paid to dosages, formulations, concentrations, and the increments of measure..

[Audio] While working through DUR and insurance processes, multiple prompts and alerts will pop up on the screen about repetitive drug therapies, dosing ranges, existing allergies, contraindications in pregnancy or in women of childbearing potential, and problematic interactions with other medications . Beware of alert fatigue. This is when the technician and/or the pharmacist start to have a relaxed attitude toward the screen alerts. Find ways to stay alert, engaged, and focused with each new prescription and screen prompt..

[Audio] After generating the label, cross-check it with the original prescription to make sure that a typing error or inherent program malfunction did not alter the information and that it is for the proper patient. See that the patient information has been cross-checked. Be sure the label and original prescription are identical. Review to be sure leading or trailing zeros and unapproved abbreviations are correct. And verify that all the data elements match those of the original prescription such as prescriber information, patient information, and medication information..

[Audio] The most common error is a selection error. Look-alike labels, brand or generic names, and medication shapes or colors can all contribute to medication errors. To avoid an incorrect selection from the storage shelf, match the NDC numbers, drug names, and other information available on manufacturers' labels or patient information handouts, scanning the bar codes to make the right choice. It's also important to verify: Has the available information on the manufacturer's label been used to verify the medication selection? Does the brand or generic name on the label match the product container? Do the dose strength and form on the label match those indicated on the product container? Do the NDC numbers and manufacturers' names match those listed on the label?.

[Audio] Calculation and substitution errors are frequent sources of pharmacy-related medication errors in all practice settings. Always write out your calculations and have a second person check the answers. In compounding or filling a prescription, be sure to check: Have the amount to be dispensed and the increment of measure been reviewed? Does the prescription require a calculation or measurement conversion? If you are using equipment, has it been calibrated recently? Does the medication dispensed require warning or caution labels?.

[Audio] Though the pharmacist is legally responsible for every prescription or medication order filled, it is not practical for pharmacists to verify each step. Instead, the pharmacist verifies the initial computer entry and the original prescription/medication order, and the quality and integrity of the end product. Technicians are responsible for laying out all the information in a logical order for the pharmacist to check. In obtaining approval, be sure to check: Did the pharmacist review the prepared medication? Can the pharmacist verify the validity of the prescription using the finished product and the information you provide? Can the pharmacist verify the patient information using the finished product and the information you provide? Can the pharmacist verify the correctness of the prepared prescription based on the medication information provided?.

[Audio] Simple measures—such as establishing well-organized and clearly labeled storage, backup database, and temperature-controlled systems—can help keep a patient's medications together and separate from those of other patients while being properly stored. Prior to storing, be sure that any drugs requiring medication guides have the guides included with the meds. Examples of such drugs include Isotretinoin, amiodarone, Fentanyl, warfarin, zolpidem and Nonsteroidal anti-inflammatory drugs..

[Audio] At the point of delivery to a patient or administering nurse, opportunities for mix-ups arise. On delivery, be sure to check: Will the appearance of any of the medications be new to the patient, caregiver, or nurse? Is the patient receiving medications intended for them? Does the patient or caregiver understand the instructions for use? Does the patient, caregiver, or nurse know what to expect? Are all of the medications prescribed for the patient included?.

[Audio] Section fourteen point four: Manufacturers' Innovations to Promote Safety.

[Audio] Drug manufacturers and retail packagers also have a role in improving medication safety in the ways they design and package their drug products. Many companies manufacture formulations and packaging with unique colors, shapes, or markings to assist in distinguishing between different types and dosages or competitor products. They are also including more patient educational materials. Technology is being used to improve patient safety and medication adherence. AdhereTech's Smart Pill Bottle system can send reminder text messages or phone calls for missed doses. Technicians and pharmacists can take advantage of these safety innovations and offer them to their patients, especially to those who are vulnerable..

[Audio] Section fourteen point five: Medication Error Reporting Systems.

[Audio] The Institute for Safe Medication Practices or I-S-M-P is a nonprofit healthcare agency whose membership is primarily composed of physicians, pharmacists, and nurses. The I-S-M-P does not set standards but analyzes the causes of medication errors to communicate critical error-reduction strategies to the healthcare community. The I-S-M-P provides the national error-tracking programs called the Medication Errors Reporting Program (MERP) and the Vaccine Errors Reporting Program (VERP). These programs are designed to encourage healthcare professionals to voluntarily and anonymously report medication and vaccine errors (or near errors) directly..

[Audio] Section fourteen point six: FDA Adverse Reaction Reporting Systems.

[Audio] The F-D-A established a nationwide post-marketing surveillance system to serve as a conduit for reporting serious adverse effects of certain medications. This F-D-A Adverse Event Reporting System or F-A-E-R-S is a centralized database that stores information from two separate federally sponsored reporting programs: MedWatch, a voluntary program that offers healthcare professionals and consumers a way to anonymously report a serious adverse event associated with any specific Drug And the Vaccine Adverse Event Reporting System or V-A-E-R-S, which is run by the F-D-A and the Centers for Disease Control and Prevention to collect and analyze information on adverse events that occur after immunizations.

[Audio] Section fourteen point seven: Safety and Controlled Substances.

[Audio] Prescription and illegal drug abuse are growing national problems that need to be addressed by the pharmacy field. The abuse of prescription pain medication is the fastest-growing drug problem in the United States. Drug dependence can give pharmacy personnel a healthy caution in dispensing drugs. It is a complex and difficult mental health and biological problem. Prescription drug and controlled substance dependence often begins with drug tolerance which is when the body adapts to a drug so that higher doses are needed to produce the same pharmacological effect. The next stage is Psychological dependence, when the patient takes a drug on a regular basis because it produces a sense of well-being that the patient does not want to consider being without. The next stage is Physical dependence, which is defined as taking a drug continuously so that when the medication is stopped, physical withdrawal symptoms occur. And finally, Addiction which is defined as a chronic disease marked by compulsive and uncontrollable use of a drug substance..

[Audio] Section fourteen point eight: Pharmaceutical Temptations for Abuse and Theft.

[Audio] Health professionals, like physicians, nurses, pharmacists, and others, often fall victim to drug abuse and controlled substances diversion. It is not uncommon for a pharmacy technician to succumb to the temptation to pilfer prescription drugs. It is estimated that more than 10% of healthcare profess abuse problem. Access to controlled drugs offers a temptation to healthcare workers who are drug seekers. Some will divert and abuse these drugs for reasons such as self-medication to relieve stress or pain, improve work performance and alertness, or to sell and make money. When the prescriber, pharmacist, or technician is caught, it can mean loss of job, license, and registration, and embarrassment to the family and profession. In addition, a drug-impaired pharmacist or technician is more likely to make medication errors and be subject to criminal prosecution..

[Audio] This concludes the Pharmacy Practice for Technicians Seventh Edition presentation for Chapter Fourteen..