safety in the pharmacy what is 6th leading cause of death? 7000 fatalities/year from adverse drug reactions. The FDA, in a compilation of reports from 1998 to 2005, found that dangerous side effects and deaths from prescription and over-the-counter medications almost tripled to nearly 90,000 incidents 100000(in 1999) fatalities/year from medical errors(400,000?now) celebrities who have been killed by pharmaceutical mistakes, overdoses, etc? most common?---insulin, narcotics, opiates, methotrexate, warfarin, kcl injection drug use kills more people than MVA now. ADE=adverse drug event ADR=adverse drug reaction

Medication errors handwriting, wrong patient, language, wrong strength, wrong calculation, wrong sig,overworked, sound alike, look alike names, pt noncompliance, ect errors have categories--show chart tell pharm stories--- medication reconciliation---process to find the most current meds of a patient--show form pg 354

Categories of Medication Error Classification Category Description Example A No error, capacity to cause error NA B Error that did not reach the patient C Error that reached patient but unlikely to cause harm (omissions considered to reach patient) Multivitamin was not ordered on admission D Error that reached the patient and could have necessitated monitoring and/or intervention to preclude harm Regular release metoprolol was ordered for patient instead of extended-release E Error that could have caused temporary harm Blood pressure medication was inadvertently omitted from the orders F Error that could have caused temporary harm requiring initial or prolonged hospitalization Anticoagulant, such as warfarin, was ordered daily when the patient takes it every other day G Error that could have resulted in permanent harm Immunosuppressant medication was unintentionally ordered at one-fourth the dose H Error that could have necessitated intervention to sustain life Anticonvulsant therapy was inadvertently omitted I Error that could have resulted in death Beta-blocker was not reordered post-operatively

safety in the pharmacy A. Personal safety 1. Safety from physical harm a. substances b. supplies (chemicals, poisons, etc.) c. equipment d. improper body mechanics 2. Employee responsibilities a. maintain a safe work place b. apply principles of proper body mechanics c. wear appropriate PPE (Personal Protection Equipment) d. follow proper procedures in handling pharmaceutical agents that may pose a hazard to the practitioner e. know where to locate the material safety data sheets (MSDS) f. know and apply policies and procedures in case of emergency

i. fire safety ii. chemical spills and other hazardous materials iii. body fluids iv. standard precautions v. equipment maintenance and failure vi. internal disasters (fire, robbery, bomb threat, etc.) vii. external disaster (weather related, traffic disaster, etc.) Environmental Safety 1. Clean work place 2. Proper ventilation 3. Proper lighting 4. Adequate set-up and layout of work place 5. Properly functioning equipment 6. Well trained employees aware of potential hazards

Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Occupational Safety and Health Administration (OSHA) 1. Workplaces may be inspected by OSHA officers without prior announcement in order to accomplish intent to decrease hazards in the workplace and maintain a reporting system for monitoring job-related injuries and illness 2. They develop mandatory job safety and health standards Joint Commission on Accreditation of Healthcare Organizations (JCAHO) 1. Pharmacy standards of JCAHO provide quasi-legal standard of practice for the profession 2. In court of law practice standards define accepted professional practice and assume quasi-legal status 3. Pharmacies must meet strict standards in order to be accredited by JCAHO 4. Accreditation is voluntary but important if business is interested in dealing with third party payers who require certification through accreditation process, e.g. Medicaid, etc.

Pharmacy must ensure 1. Right drug – always double check the label on bulk bottle for strength and correctness 2. Right patient 3. Right dosage 4. Right route 5. Right time 6. Right technique

manufacturing label has a bar code somewhere----bottle comes to pharmacy with many pills inside. label gives generic and brand name, how many, strength,NDC code, lot#, expiration, instructions. prescription label has bar code somewhere---bottle to patient. has pt name, dr name, drug name, refills,sig, pharmacy name accuracy scanner--- a quick scan tells if the rx label and manufacture label have same drug. medication counter---quickly counts pills that are not see through. not to be used for sulfa drugs and amoxicllin due to residue. or use spatula and counting tray. count 3 or 5 at a time. put into bottle…child safety cap? pharmacist does verification of the drug.

Practitioner must be familiar with 1. Common side effects 2. Contraindications 3. Drug or food reactions with medications 4. Generic drugs that may be substituted D. Practitioner should know at minimum the following information for the drugs most used in individual practice setting or geographical location 1. Adverse drug reactions 2. Side effects 3. Contraindications 4. Drug/food interactions 5. Safe/effective dosage range 6. Common dosage regimens 7. Dosage forms 8. Route of administration E. Reviewing Refills 1. Number of refills 2. Correct drug selection 3. Significantly early or late requests for refills may indicate medication misuse

Beware of dispensing errors . Proper storage of pharmaceuticals 1. Store in original container until dispensed 2. Follow manufacturer’s directions for proper storage 3. Follow proper disposal of expired drugs a. deteriorated drugs are ineffective b. deteriorated drugs may be a hazard if a condition not treated appropriately c. deterioration may cause chemical changes leading to dangerous reactions All schedule II drugs must be kept under lock and key. With schedule III, IV, and V drugs, lock and key storage is optional but suggested