Basics of Medication Safety This is a sample PowerPoint from “Learn to be Safe – Medication Safety. A Guide for Pharmacists”. It is for conducting a presentation on medication safety to the public – your patients and families. To prepare for presentations, review the purpose of the guide, how to use the guide, key topics and messages, and supporting documents, available at www.mips.ca. The guide includes background information and options for presentation content, patient stories, slides, handouts and resources including those referenced in these slides, a presenter’s planning checklist, tips on conducting effective presentations, and information on supplemental topics. Presentation and PowerPoint Tips Choose a name for your presentation e.g. Basics of Medication Safety. Use this sample PowerPoint as a base – add/delete and move slides to meet your audience needs, goals and timeframe. Add speaking notes from your own experiences, Core Content, and the Appendices. Develop additional slides as needed for presenting supplemental topics (Appendix D – Supplemental Topics). Note: sample slides are included for supplemental section Cancer Medications in the Home. Choose activities and handouts considering your audience and timeframe. Add or handout references so people have additional places to go for information. Use plain language principles when developing your slides (Appendix A – Points for Presenters). Customize your presentation to your audience.

Welcome and Introductions Suggested Content Thank people for attending. Inform participants of location of washrooms and fire escape route. Ask participants to introduce themselves and why they are attending the session (depending on number of people attending).

Presentation Goals To raise your awareness of: how you can help improve patient safety safe medication use practices the value of working with your pharmacist Suggested Content Review goals (on slide). Confirm time available for presentation. Encourage that questions be asked throughout.

Topics Overview of medication safety Engage in patient safety! Keep a current medication list Know your medications Store and dispose of medications safely Report and learn from medication incidents Suggested Content Modify this slide to include what will be covered in the presentation. Add supplemental topics as needed. Resources Core Content and Supporting Documents Appendix D – Supplemental Topics

Get warmed up!! Activities Use warm-up exercise (individual or in a group) to assess knowledge. Pose questions for people to think about and answer verbally or to themselves. Examples: See Appendix E – Presentation Aids Aid 3: Medication Safety Quiz Chose some questions to assess participant’s knowledge and actions related to medication safety. Aid 5: Learn to Read your Prescription What is A? What is E? What is G? Why is it important? Aid 6: Learn to Read Your Prescription Label What is A? What is E? What is G? Why is it important? Aid 7: What are Auxiliary Labels? Review the additional information provided on auxiliary labels and ask participants why this would be important extra information about their prescription medication. Show Videos from Agency for Healthcare Research and Quality on asking questions and medication safety -http://www.youtube.com/watch?v=BmQwfh-VkUM&list=SPFA873DC3884769D8&index=5 Resources Appendix C – Patient/Family Engagement Tools Appendix E – Presentation Aids

Overview of Medication Safety

Why is Medication Safety Important? Medication incidents can happen Everyone has a role to play in preventing harm from medication incidents Suggested Content Depending on the audience, illustrate your points with an example: Harm from medication incidents can result in a longer hospital stay, readmission to the hospital, more time for providers to sort through problems and lower success of the treatment plan. Up to 50% of Canadians don’t take their prescription medications how their doctor asked them to. Communication plays a large role in patient safety incidents and patient harm. People with low literacy skills have difficulty understanding what is on their prescription and the directions from the doctor or pharmacist. Six in 10 Manitoba/Canadian adults have low health literacy, and don’t have the skills needed to find, understand, evaluate and use information to adequately manage their health and healthcare needs. 46% of medication incidents are from leaving out a regularly used medication. In a study, one in 10 adult Canadians with health problems reported being given the wrong medication or wrong dose while filling a prescription or when hospitalized (within the last two years). Resources Core Content – Facts

Examples of medication incidents Your medication container from the pharmacy contains the wrong medication You take the same medication twice in the same day by accident Suggested Content Define medication incident depending on the audience. E.g. an event that occurs with a medication that can lead to wrong medication use and/or patient harm. Provide examples (on slides). Expand on examples from personal experience and patient stories. See Appendix B – Patient Stories: Medication incidents can happen. Activity Ask - Do you have examples of medication incidents from your own experience? Resources Core Content Appendix B – Patient Stories

You are given too much of a medication while in hospital You receive a medication that you know you are allergic to …Continued

Where can medication incidents occur? At your doctor’s office when a medication is prescribed At your pharmacy When a prescription is filled When you select an over the counter medication In your home, when you take or use the medication Suggested Content Medication incidents can happen at any place on your journey in the healthcare system. Resources Core Content

Where can medication incidents occur? In the hospital, when medications are ordered or prepared by the pharmacy At your bedside, when medications are given/taken …Continued

Engage in Patient Safety!

You can help improve medication safety Patients are the best source of information on the medications they are taking Be involved in medication safety - there are lots of ways to do this! Ask questions! Suggested Content Key Point – You can help improve medication safety. Review points on slide. Activities: Ask: Give me examples of how you feel you are involved in your healthcare Do you feel comfortable asking questions? What is your relationship like with your pharmacist? Doctor? Do you have or need a patient advocate to help you be involved? Ask for verbal or written responses or people can think to themselves depending on time available. Handouts or direct people to websites (see next slide) See Appendix C – Patient/Family Engagement Tools MIPS Declaration MIPS Partnerships Document MIPS Values Document MIPS S.A.F.E. Patient Blog MIPS It’s Safe To Ask brochures (15 languages) MIPS S.A.F.E. Toolkit Summary Sheet MIPS Patient Advocate Form Tools at Safemedicationuse.ca Videos: MIPS Learn to be Safe – Patient Safety Videos (E/F) Resources Core Content – Be Engaged in Patient Safety! Appendix C – Patient/Family Engagement Tools

Be involved in patient safety! It’s Safe to Ask! S.A.F.E. Toolkit S.A.F.E. Patients Blog Patient Advocate Form Patient Values and Partnerships Suggested Content Patient and family engagement helps: reduce the risk of unplanned harm related to care (such as the examples provided earlier about medication incidents), improve your safety as patients, and helps you get the best possible health result. Be a partner in your healthcare! Activities Tell a patient story (See Appendix B – Patient Stories: Be engaged in patient safety!) See Appendix C – Patient/Family Engagement Tools. Modify slide to include resources you will be reviewing or suggesting: MIPS Declaration MIPS Partnerships Document MIPS Values Document MIPS S.A.F.E. Patient Blog MIPS It’s Safe To Ask brochures/posters (15 languages) MIPS S.A.F.E. Toolkit Summary Sheet MIPS Patient Advocate Form Tools at Safemedicationuse.ca Videos: MIPS Learn to be Safe – Patient Safety Videos (E/F) Resources Core Content Appendix B – Patient Stories Appendix C – Patient/Family Engagement Tools www.safetoask.ca

Keep a Medication List

Keep a Current Medication List what you are actually taking how you are taking it why you are taking it Suggested Content Key Point – Keep a current medication list. Patients and families are vital partners in giving correct information about the medications they are taking and how they are being taken. Key Point – Review what to list (see slide). Remind people to keep the list with them at all times, and show the list to their doctor, nurse, pharmacist or other healthcare provider any time they receive healthcare i.e. KNOW and SHOW. Activities Tell a patient story (See Appendix B – Patient Stories: Keep a Current Medication List). Resources Core Content – Keep a Current Medication List Appendix B – Patient Stories As a patient, YOU are the best source of information on the medications you are taking!

Keep a Current Medication List regularly used and “as needed” prescription medications pills, ointments, creams, liquids non-prescription medications vitamins, herbal, natural products dosages and strength (eg: 1 x 500 mg tablet) how and when you take the medication Suggested Content Key Point – Keep a current medication list. Key Point – Review what to list (see slide). Resources Core Content – Keep a Current Medication List

A current medication list helps: you learn about your medications you take your medications correctly your doctors, nurses and pharmacists know about your medications in an emergency Get a list of current medications when you move from one setting of care to another Suggested Content Keeping a medication list helps: you learn about your medications you take your medications correctly your healthcare providers know about your medications provide important information in an emergency It is especially important that patients be given a list of their current medications when they move from one care setting to another. In Manitoba, suggest that people have an Emergency Response Information Kit (E.R.I.K). See Appendix C – Patient/Family Engagement Tools. Activities Handouts It’s Safe to Ask Medication Card - Hand out a medication card and review the sections. Knowledge is the best medicine medication record Video: Show a video. Know and Show Your Medication Card tells people why it is important to know your medications and show your medication card. How to Fill out the Medication Card demonstrates how to fill out the medication card. (see next slide. Show online or get a copy from MIPS). And/Or Show the 30 second medication safety video from the series Learn to be Safe – Patient Safety Videos http://www.safetoask.ca/?page_id=261 Resources Core Content – Keep a Current Medication List Appendix C – Patient/Family Engagement Tools

Intro to Know and Show Your Medication Card Videos: Intro to Know and Show Your Medication Card Activities Overview – intro to “Know and Show Your Medication Card”. 4 minutes 16 sec In “normal” view, right click on “Know and Show Your Medication Card”, then select open hyperlink. During slide show, use mouse to hover over hyperlink and click How to fill in and use the Medication Card - 5 min 43 sec In “normal” view, right click on How to fill in and use the Medication Card, then select open hyperlink During slideshow, use mouse to hover over hyperlink and click Resources Core Content – Keep a Current Medication List Appendix C – Patient/Family Engagement Tools How to fill in and use the Medication Card

Know Your Medications

Your community pharmacist can help you! Know Your Medications Check name and purpose of medications when you: get a prescription fill a prescription are given medications Your community pharmacist can help you! Suggested Content Tell a patient Story – See Appendix B – Know your Medications: Check Name and Purpose of Medication. Key point - Know your medications. Check name and purpose of medications when you: get a prescription, fill a prescription, and are given a medication. Ask questions. Ask about your medications when you 1) are at an appointment with your doctor or nurse 2) are in hospital, 3) when you leave the hospital, and at your community pharmacy. Your community pharmacist is available to answer questions and will take the time to review your medications. Activities Agency for Healthcare Research and Quality video on asking questions and medication safety - http://www.youtube.com/watch?v=BmQwfh-VkUM&list=SPFA873DC3884769D8&index=5 Resources Core Content – Know Your Medications Appendix B – Patient Stories Appendix C – Patient/Family Engagement Tools

How to Read a Prescription Activities Handout or on PowerPoint Provide overview of reading a prescription. See Appendix E – Aid 5: Learn to Read to a Prescription. Ask people to name/describe sections and describe why each is important. Answers A. Doctor's information B: My information C: Date prescription was written D: Symbol used for prescription E: Medication name and strength F: The amount of the medication the pharmacist is to dispense G: Sig, instructions on how to take the medication H: Indication, what the medication will be used for I: Number of refills Resources Appendix E – Presentation Aids

At appointments, ask your doctor or nurse: 1. What is my health problem? 2. What do I need to do? 3. Why do I need to do this? Suggested Content If time, review questions that can be asked at a) doctor/nurse appointments, b) while in hospital, c) at discharge from hospital, and at the community pharmacy. a) At appointments, ask your doctor or nurse three important questions: 1. What is my health problem? Examples of good related questions Are there pictures or pamphlets to more clearly explain my health problem? How will this health problem affect my daily activities? Where can I find more information on my health problem? 2. What do I need to do? What are the brand and generic drug names of the medication? How long do I have to be on the medication? What tests do I need and when? When should I return to see you? When should I get a refill? How long will I need to take the medication? Are additional tests (e.g. blood work) required, and if so, when? Is it necessary to return to a doctor/nurse to re-evaluate the effect of the medication, and if so, when? What should I expect from the medication (i.e. side effects or improvement in symptoms)? 3. Why do I need to do this? Examples of good related questions: What is the reason for taking the medication? Please write it on my prescription. How will it help my health condition? What good will the medication do for me – how will it help my health problem? I have the following concerns about the medications (list them). Activities Handout – See Appendix C – Patient/Family Engagement Tools. MIPS It’s Safe To Ask brochures (15 languages). Resources Core Content – Know Your Medications Appendix C – Patient/Family Engagement Tools

In the hospital – 5 “Rights” patient name medication name (generic and/or brand) dose (amount) time of day to be taken route (by mouth, onto skin, etc.) Suggested Content If time, review questions to ask while in hospital. When you are in the hospital remember the 5 “Rights” Activity Ask: Is my name listed for receiving this medication? Is the medication name correct? Am I getting the correct dosage of the medication? Is this the right time of day for me to take this medication?” Is this the correct way for me to take the medication? Resources Core Content – Know Your Medications

At hospital discharge, ask: What medications have changed since I came into hospital? Ask: What medications are: continued as before? stopped? changed? new? Did my dose change? Suggested Content Tell a patient story – See Appendix B – Patient Stories: Know your Medications. Key point – At Hospital discharge, what medications have changed since I came into hospital? Review points on slide/add or delete based on audience. Resources Core Content – Know Your Medications Appendix B – Patient Stories

At hospital discharge and at the pharmacy, ask: what is the medication name? (spell it) why do I need it? I have allergies – will I have a reaction to this medication? when and how should I take it? how should I measure a liquid? will it interact with other medications I am taking? Suggested Content If time, review points on slide/add or delete based on audience. Resources Core Content – Know Your Medications

At hospital discharge and at the pharmacy, ask: what will it do? what are the side effects? how long should I take it? what do I do if I miss a dose? does my refill look the same as before? are there “extra labels” on the container? how do I store it? Continued If time, review questions on slide. Activities Handout,/review/discuss MIPS S.A.F.E. (Self-Advocacy for Everyone) Toolkit  - information on working with your pharmacist – See Appendix C – Patient/Family Engagement Tools. Appendix E – Aid 3: Medication Safety Quiz - related questions. Appendix E – Aid 4: MIPS It’s Safe to Ask – Safe use of Medications.  Bring medication measuring devices to use for demonstration of what to use (dosing cup, oral syringe with coloured cap, medication dropper, dosing spoon, oral dosing syringe for infants) and what NOT to use (hypodermic syringe with clear cap, baking spoons, measuring cup with both TBSP (tablespoon) and TSP (teaspoon) markings, kitchen spoons). Video: MIPS Learn to be Safe - Patient Safety Video on medication safety (approx. 30 seconds). http://www.safetoask.ca/?page_id=261 Resources Core Content – Know Your Medications Appendix C – Patient/Family Engagement Tools Appendix E – Presentation Aids

How to Read a Prescription Label Activity Handout of sample and/or use PowerPoint See Appendix E – Aid 6: Learn to Read a Prescription Label. Ask people to name/describe sections and describe why each is important. Answers A: Pharmacy name and information B: Prescription Number (unique identifier specific only to that prescription). C: Patient name D: Number of refills remaining E: Name of prescriber F: Directions G: Brand name of medication H: Name of medication or main ingredient I: Amount dispensed J: Date dispensed K: Price L: Drug Identification Number (DIN) Resources Appendix E – Presentation Aids

Auxiliary Labels Activity Use handout of sample (download from website) http://www.knowledgeisthebestmedicine.org/index.php/en/know_your_healthcare_team/auxiliary_labelsand/) or use the slide. Ask people to name/describe sections and describe why each is important. Resources Appendix E – Presentation Aids

Auxiliary Labels ...Continued

Auxiliary Labels ...Continued

Know Your Medications – More TIPS Use the same pharmacy Ask your pharmacist how to take medications until you understand Ask before you cut, split, crush or open a pill or capsule Take with water, not juice; unless told other wise by your healthcare provider Suggested Content If time, review slide content. Add points from core content depending on audience, or if there are questions. Resources Core Content – Know Your Medications

Know Your Medications – More TIPS If dose is more than 3 pills at once, check Do not share your medications Give your contact information and an emergency contact Check when medications “expire” (best before date). ASK QUESTIONS ...Continued

DOUBLE CHECK!! Get information on how to take the medication… THEN Tell your pharmacist your understanding of how to take the medication Suggested Content Describe the “Teach Back” technique – it helps clarify for everyone what the patient/family member understands. Resources Core Content – Know Your Medications

non-prescription medications Know your non-prescription medications Vitamins, herbs, natural health products, “over the counter” medications Tell your doctor and pharmacist what non-prescription medications you are taking. A bad interaction with prescription medication or a medical condition may cause harm Suggested Content Tell a patient story – See Appendix B – Patient Stories: Know your Medications - Understand the risks of non-prescription/over-the-counter medications. Key point – Tell your doctor and pharmacist what non-prescription medications you are taking. Review slide content. Resources Core Content – Know Your Medications: Understand the risks of non-prescription and over-the-counter medications Appendix B – Patient Stories

Storing and Disposing of Medications

Store Medications Safely securely (e.g. locked cabinet) in an area free of excess heat, cold and moisture (some exceptions) Leave medications in original labelled containers Do not mix medications in same container Suggested Content Tell a patient story – See Appendix B – Patient Stories: Store Medications Safely. Key points - Store Medications Safely. Review slide content and provide examples. Resources Core Content – Store Medications Safely Appendix B – Patient Stories

Dispose of Medications Safely Return unused or out of date medications to your pharmacy If using needles to inject medication, get a biohazard container from your pharmacy Suggested Content Tell a patient Story – See Appendix B – Patient Stories: Dispose of Medications Safely. Key Point – Dispose of Medications Safely. Return unused, unwanted, or expired medications. Describe Manitoba Medications Return Program and explain that patient will not get money back for returning their medications. Resources Core Content – Dispose of Medications Safely Appendix B – Patient Stories

Report and Learn from Medication Incidents

Report and Learn from Medication Incidents Inform healthcare providers if you feel a medication incident has occurred Reporting incidents helps get to the root of the problem Suggested Content Tell system story – See Appendix B – Patient Stories: Report and Learn from Medication Incidents Emphasize that most of the time, things go well but sometimes, incidents reach the patient Key Point – Patients and/or families must inform their healthcare provider if they believe an incident has occurred. Key Point – Reporting is not about punishing the people involved, it is about getting to the roots of the problem to prevent the same incident from occurring again. Resources Core Content – Report and Learn from Medication Incidents Appendix B – Patient Stories

Reporting Medication Incidents Medication incidents to your healthcare provider, and ISMP Canada online at www.SafeMedicationUse.ca or toll-free at 1-866-544-7672 Report critical incidents to your Regional Health Authority Suggested Content Describe what and how to report Activities Go to http://www.safemedicationuse.ca/report/ to show participants how to report an incident to ISMP Canada. In slide show, hover mouse over hyperlink and click to reach website Resources Core Content – Report and Learn from Medication Incidents

Reporting Adverse Drug Reactions Adverse drug reactions are not related to the healthcare provided Report adverse drug reactions to the Canada Vigilance Program Either by mail, fax, telephone or online For details see: http://www.hc- sc.gc.ca/dhp-mps/medeff/report- declaration/index-eng.php#a1 Suggested Content Adverse drug reactions are reactions that are not related to the healthcare provided, and are not medication incidents They should be reported to the Canada Vigilance Program Activities Go to website (http://www.hc-sc.gc.ca/dhp-mps/medeff/report-declaration/index-eng.php#a1) to show consumers how they can report adverse drug reactions. In slide show, hover mouse over hyperlink and click to reach website Resources Core Content – Report and Learn from Medication Incidents

Summary and Evaluation Suggested Content Thank people for coming Activity Review Appendix E – Aid 3: Medication Safety Quiz. See Appendix E – Aid 8: Participant Evaluation Form. Ask people to complete evaluation forms. Resources Appendix E – Presentation Aids

Children and Teens For content, refer to Appendix D – Supplemental Topics.

High Alert Medications For content, refer to Appendix D – Supplemental Topics.

Seniors For content, refer to Appendix D – Supplemental Topics.

Travelling with Medications For content, refer to Appendix D – Supplemental Topics.