Buyers Taking an Active Role in Patient Safety Patrick Gallagher, CPhT Pharmacy Buyer Marian Medical Center

How Buyers can play a Key Role It’s not just about ordering drugs and processing invoices anymore!

As a Buyer, it is important for us to learn more

How Buyers can play a Key Role Past expectations of the Pharmacy Buyer How the position has evolved (Buyers are CPhT, full time person, 340B Accounts) Buyers role in patient safety Future expectations of Pharmacy Buyer (National Certification)

What is the bottom line?

High-Alert Drugs Identified by ISMP, Joint Commission, IHI and others High potential for causing errors in the medication use system – Selection – Storage – Ordering – Dispensing – Administering – Monitoring

High-Alert Core List Concentrated electrolytes – Potassium chloride – Potassium phosphate – Sodium chloride greater than 0.9% Insulin Anticoagulants Narcotics and opiates

Heparin 10,000 unit vials

Unsafe Storage: Insulin Jumble

CHW High Alert Medications 2010 Insulins Concentrated Potassium and Sodium Solutions (KCL, Kphos, NaCl > 0.9%) Chemotherapy Agents Therapeutic Heparin Neuromuscular Blocking Agents Epidurals & any opiate intrathecal or other analgesic drip administered into the central system Any Opiate administered by PCA, NCA or IV drip (Morphine, Hydromorphone, Meperidine, Fentanyl) Oxytocin (Pitocin) drip Magnesium Infusion > 4 Grams Neonatal or Pediatric medications in facilities with low volumes of these patients

Additional High-Alert Drugs Chemotherapy Drugs used in neonates and pediatrics TPN Sterile Water – Injection larger than 10 mL – Irrigation bags Others as determined by the hospital

It’s also not about saving money, it’s about saving lives!

Objective 1: Identifying a Problem Identifying a possible danger to patient safety. Verifying/ validating a potential problem to patient safety. Alert the person(s) of authority of the problem ( notify manufacturer, notify ISMP.) Alert others that may be affected of this potential problem.

Too many LASAs!

If it doesn’t look right, or you don’t feel right about it, it probably isn’t right Most Pharmacists will thank you if you question it You should feel good about bringing it to someone’s attention, especially a high alert drug It takes a series of little things to create one big error

The Swiss Cheese Model

Objective 2: Make Change Use your own resources. Talk to your co-workers. Consult your colleagues / buyers. Consult other buyers/ wholesalers that you have met through NPPA.

By speaking up you become a wing man, no…not Batman!

Fentanyl IV PCA

Morphine IV PCA

Dilaudid IV PCA

Epidural

Objective 3: Going Public with Change Getting the word out for change. Ask for feedback from people that may be involved in change. Always be willing to listen and expand on initial idea. Monitor / listen to new ideas.

CADD Cassette

CADD Cassette Epidural

Heparin Bag

Patient take home meds from the ER Department

Any Questions?