Medication Safety/Quality Assurance

Medication

Safety

/Quality
Assurance

Medication Errors

🎃

Every pharmacy has its own set of standards

🎃

Community pharmacy “traps”

🎃

Professional practice

🎃

Health care products

🎃

Procedures

🎃

Systems

Reducing Errors

🎃

Automation has significantly reduced errors

🎃

Automated dispensing machine (ADM) and floor stock

Word Cloud

Name 2 community pharmacy "traps"

Medication Errors Best Practices

🎃

Continually ask pt. for updates

🎃

Clarify prescriptions w/ pharmacist

🎃

Select medication based on hard copy

🎃

Notify pharmacist of electronic notifications

🎃

Use verifications (NDC #)

🎃

Verify stock

🎃

Use barcodes w/ total parenteral nutrition (TPN)

Medication Errors Best Practices (cont.)

🎃

Count twice

🎃

2 pt. Identifiers (Pick up AND managing meds)

🎃

Offer counseling (OBRA ‘90)

🎃

Order floorstock on preprinted order forms

🎃

Draw up long-acting insulin in pt. Specific syringes

🎃

When using ADM verify before putting in pocket

🎃

Nursing unit monthly checks

Medication Errors Best Practices (cont.)

🎃

Pharmacist double check w/ chemo meds

🎃

Pt. weight in kg

🎃

Annual skill demonstrations (written/skill)

🎃

Pharmacy and therapeutics (P&T) committees

🎃

Check pt. INR prior to dispensing warfarin

🎃

Check hematocrit levels prior to dispensing epoetin alfa

Fill in the Blank

Select medication based on the

Multiple Choice

What is true about total parenteral nutrition (TPN)?

• Use barcodes

• Confirm w/ pharmacist

• It is delivered orally

• Orders must confirmed via hard copy

Match

Match the error prevention with it's fact

• OBRA '90

• Floor stock

• Long acting insulin

• Chemo. Meds

• Pt. INH

Guarantee counseling by pharmacist

Ordered on preprinted forms

Drawn up in pt. specific syringes

Must have pharmacist check

Checked prior to admin. warfarin

• Guarantee counseling by pharmacist

• Ordered on preprinted forms

• Drawn up in pt. specific syringes

• Must have pharmacist check

• Checked prior to admin. warfarin

Medication Adherence

Day’s
Supply

🎃

Provider
changed dose

🎃

Pt. is taking to
much

🎃

Pt.
misunderstands
instructions

🎃

Pt. is diverting
or abusing
medication

“Refill
to soon”

Database to
research
trends in
controlled
substance use

Prescriptio n
Monitoring

Program
(PMP)

Number dispensed

number of doses per
day

Fill in the Blank

What is the daily supply of the sig below? (type number only)

po bid dispense #60

🎃

Right Medication

🎃

Right route

🎃

Right time

🎃

Right pt.

🎃

Right dose

🎃

Right documentation

🎃

Right response

5 Rights

Patient Information

🎃

Verify spelling of pt. name

🎃

Pt. address

🎃

Make sure you can read physician
name

🎃

Verify/document address on script

🎃

Double check for suspicious activity

🎃

Liquid meds verify pt. weight
(especially peds)

Prescription Delivery

Potential Errors

🎃

Report near misses and errors
IMMEDIATELY

🎃

Root Cause analysis

🎃

Continuous quality improvement
🎃

(CQI)

🎃

Be discrete

🎃

Document
🎃

ISMP Medication/Vaccine
Error Reporting Program
🎃

(MERP)

🎃

(VERP)

🎃

MedMARx

🎃

FDA Adverse/Vaccine Event
Reporting System (FAERS)
🎃

MedWatch

Reorder

Place the prescription delivery steps in the correct order.

• Verify number of prescriptions being picked up and deographics

• Check prescription

• Check recipt for 3rd party info.

• Inform pt. they can speak w/ pharmacist and answer their questions

• Complete the sale

1

2

3

4

5

• 1
• 2
• 3
• 4
• 5