1. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 1 Chapter 14 Medication Safety and Error Prevention

2. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 2 1. List the most common types of errors made by technicians and patients. 2. Describe the guidelines that have been established and are monitored to prevent errors. 3. Explain the necessity of reporting drug errors. Medication Safety and Error Prevention Lesson 14.1

3. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 3 3a. List the organizations or groups where drug errors can be reported. 4. List and describe four automated systems and explain how they prevent errors. 5. Explore new ways that health care personnel can decrease drug errors Medication Safety and Error Prevention (cont’d) Lesson 14.1

4. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 4 Introduction  Not all __________ are harmful and not all are caused by pharmacy.  As many as ____________ people per year die from medical errors.

5. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 5 What Constitutes an Error  Any type of preventable mistake, whether intentional or not:  Wrong ________  Continued doses after physician discontinues order  Wrong _______ or combination  Table 14-1 lists types of errors in a hospital setting.

6. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 6 How Errors Occur  Ambiguous ____________labeled on drug container or label  Excessive workload  Failure to transcribe orders properly  Illegible______________

7. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 7 How Errors Occur (cont’d)  Inaccurate dosage__________  Inadequately trained personnel  Labeling errors  _______-a-like, ________-a-like drug names

8. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 8 Where Errors are Made  Most often reported in __________ and institutional pharmacies such as hospitals.  Medication Error Reporting and Prevention (MERP) organization tracks ________ and their causes.

9. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 9 Why Errors Occur  Errors are part of human nature.  Can be brought on by focusing on more than __________task at a time.  Stress  ______  Similar labels  Hard-to-read labels

10. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 10 Look-Alike, Sound-Alike Drugs  ________ reviews drug names.  Rejects approximately 33% of proposed names.  Examples of errors: Mellaril/Elavil, Paxil/ Taxol, Prilosec/Prozac, and Celebrex/Celexa.  USP has listed ______ LASA drugs.

11. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 11 Drug Interactions as a Source of Error  Probability of drug interactions increased in ____________or severely ill patients.  Taking similar drugs that have the same side effects may increase the risk and/or the severity of _______________- effects.  See Table 14-4.

12. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 12 Warfarin (Coumadin) Interactions  Warfarin given to prevent clots that can cause strokes or heart attacks.  Avoid____________, phenytoin, quinolones, sulfa drugs, cimetidine, heparin, amiodarone, NSAIDs.

13. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 13 Errors in the Pharmacy  Open error reporting without fear of retaliation is essential.  Identify the causes of the error and set _____________ in place that will not allow the error to happen again.

14. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 14 Medication Errors That Involve Allergies  Many allergic reactions ___________be avoided before drug administration.  Primary reasons for allergy-related prescribing errors are:  _______  Forgetting to review the patient’s drug history and profile

15. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 15 Parenteral Errors  These errors take effect ___________ and may not be easily reversed.  It is common to flush ____ lines with ___-lock solutions, which may get confused with the similarly sized and labeled vials of much more concentrated heparin solutions.

16. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 16 Parenteral Errors (cont’d)  Pharmacy technicians need to know what _________ dosages are.  If an ordered dose is suspect, bring it to the attention of the pharmacist immediately.

17. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 17 Sustained Released (SR) Dosage Form Errors  If an SR medication is given in place of a regular dose, adverse effects can occur, which could include _________.  Many of the errors occur due to suffixes on drug products that are not clearly understood.  See LA, CR, CD, ER, XL and SR.

18. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 18 Nosocomial Infections  About __ million patients suffer from these infections annually, with _________ deaths.  infection control specialists are responsible for the training of staff and patients as well as investigation of all cases of ____________ acquired infections.  Universal precautions.

19. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 19 Home Health Care Errors  Many elderly and disabled patients do not have __________ coverage for infusion sets and supplies.  Patients may try to use medical supplies intended for single use more than once to try to save costs.  Have poor ________ technique.

20. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 20 Medical Errors and the Elderly  Many older adults may forget to take their medication or they ________ ____ on the doses.  There is increased risk of drug-drug interactions.

21. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 21 Medical Errors and Pediatric Patients  Overdoses are due to medications not being kept in a secure area out of reach of ______.  There is difficulty reading and understanding dosing instructions for children.  In hospital setting: computation errors of dosage and dosing intervals.

22. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 22 How to Stop Errors from Occurring  Computerized prescription order entry solves problem of poor handwriting.  Errors from selecting from a ______-______ menu can be made.  Use bar code method.

23. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 23 Reporting Errors  Blame is unproductive.  Tracking systems do not focus on blame but are more interested in how the _______ occurred.  See Box 14-2.  IMSP list of abbreviations to avoid.

24. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 24 Reporting Errors (cont’d)  Joint Commission __ areas for patient safety  Leadership Process and Accountability  Competent and Capable Workforce  Safe Environment for Staff and Patients  Clinical Care of Patients  Improving Quality and Safety

25. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 25 Verbal Ordering Error Prevention  Verbal orders should be limited to __________ situations where immediate written or electronic communication is not feasible.

26. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 26 Parenteral Medication Error Prevention  Strategies for safe IV practices:  Standardize product concentrations, patient care procedures, and __________.  Develop toolkits and other resource materials to enhance the adoption of the recommendations.  Improve mechanisms for ____________ in a timely manner.

27. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 27 Bar Coding  When a nurse is about to give a dose, he or she scans the ___________ of the patient’s wristband against the bar code of the medication.  Alarm goes off if there is a discrepancy.

28. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 28 Robot Rx Machines  Medication records are read by the machine by ________ _________.  Appropriate medication’s bar code is read from the package and matched to the e-MAR.  Machine will pull from a rack of pre-packed ________ _________ medications.

29. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 29 Automated Dispensing Systems  Hold unit-dosed medications and nursing supplies to be accessed by ________ on the patient floors.  Works effectively if the medication within the drawer is correct.  If the _______ medication is loaded into the drawer and the nurse fails to catch the mistake, then an error can occur.

30. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 30 Community Pharmacy ADS Machines  Three types of robotics:  Table-top automatic pill counters: model KL20 by Kirby Lester  Large wall units that use cassettes: _______ ______ Systems  Robot technology: SP 200 System by Script Pro

31. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 31 Patient Dose-Specific Orders  Joint Commission requires hospitals and institutions to prepack all liquid doses in _______ syringes.  Each dose is prepared by the technician and is labeled with the patient’s name, medical record. and room number.  The name of the drug, dose, strength and time of administration is indicated on each dose.

32. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 32 USP REGULATIONS  Addresses the problem of contamination of any type of _________ product.  Many pharmacies are contracting their sterile preparations out to companies that _____________ and have met all guidelines of USP.

33. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 33 Drug Labeling  _______-coding  Tall-man lettering  Name Alert stickers for _________ drugs

34. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 34 Boxed Warnings  Medications that have been known to cause severe reactions have an additional _______ to highlight the information on the package insert.  Black box warnings

35. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 35 Training and Education  Certification and continuing education are important.  Technicians should always check each prescription _____ times throughout the filling process.  ASHP curriculum for pharmacy technician training.

36. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 36 Medication Reconciliation  This is the process of identifying the most up-to-date list of all the medications a patient is currently taking.  Verification, clarification, reconciliation  Goal is to make sure the _________ is being given the proper medications at all times.