1. Dangerous Prescriptions and Abbreviations

2. State Standard
16) Outline in a written or digital presentation industry standards surrounding medication safety. Cite information obtained from textbooks, online and print pharmacy journals, and related websites. Include at minimum the following: a. Error prevention strategies for data entry (e.g., prescription or medication order to correct patient) b. Patient package insert and medication guide requirements (e.g., special directions and precautions) c. Issues that require pharmacist intervention (e.g., DUR, ADE, OTC recommendation, therapeutic substitution, misuse, missed dose) d. Common safety strategies (e.g., tall man lettering, separating inventory, leading and trailing zeroes, limited use of error-prone abbreviations)
17) Identify strategies for preventing medication errors by distinguishing medications that either look alike or sound alike, such as Ceftin, Cefotan, Cefzil, Rocephin and Cipro. Include strategies related to recognizing high-alert/high-risk medications such as Sporanox for patients who have ventricular dysfunction.

3. Objectives Students will be able to…
Identify dangerous prescription errors
Identify dangerous abbreviations that should not be used in prescriptions

4. Contents of the Prescription
Name of the drug - CAUTION:
Look Alike/Sound Alike drug names
Massive number of new drug releases
Massive number of reformulations
Drug marketing strategy
Build on established names
New combination drugs – Use converged names

5. Contents of the Prescription
Name of the drug
AVOID THE USE OF:
Abbreviations
Many drugs identified with abbreviations
EX: HCT for hydrochlorothiazide, MSO4 for morphine sulfate
Attempts to standardize abbreviations have been unsuccessful

6. Contents of the Prescription
Strength of the drug
Decimal points
Avoid trailing zeros.
EX. 5 mg vs. 5.0 mg; can be mistaken for 50 mg
Always use leading zeros.
EX. 0.8 ml vs. .8 ml; can be mistaken for 8 ml

7. Rules for writing quantity of drug:
Quantities of 1 gram or more should be written in grams.
Ex - write 2 g.
Quantities less than 1 gram but more than 1 milligram should be written in Milligrams For eg, write 100 mg, not 0.1 g

8. Drug Quantities
Quantities less than 1 milligram should be written in micro / nano gram as appropriate.
DO NOT abbreviate micro/ nanograms; since that can lead to Prescribing errors. For ex. write 100 micrograms, not 0.1 mg, nor 100 mcg, nor 100 μg
Use ml or mL for milliliters

9. For some drugs, a maximum dose may need to be stated ( for eg
For some drugs, a maximum dose may need to be stated ( for eg. ergotamine in migraine & colchicine in gout).
Eg: Ergotamine 1 mg at onset of attack & repeat every 30 min if necessary . Do not take more than 6 mg in one day or more than 12mg in one week

10. CASE #1
Poor handwriting contributed to a medication dispensing error that resulted in a patient with depression receiving the antianxiety agent Buspar 10 mg instead of Prozac 10 mg

11. CASE #2
A hypertensive patient accidentally received Vantin 200 mg instead of Vasotec 20 mg when a pharmacist misread this prescription

12. MAXIMIZE PATIENT SAFETY
ALWAYS write legibly.
ALWAYS space out words and numbers to avoid confusion.
ALWAYS complete medication orders.
AVOID abbreviations.
When in doubt, ask to verify.
***It is your responsibility to always check if it can not be read or does not make sense

13. Dangerous Abbreviations
The Joint Commission has listed dangerous abbreviations, acronyms, and symbols on its “Do Not Use” list.
Some abbreviations could have more than one meaning.
Poorly written abbreviations are open to misinterpretation.

14. Dangerous Abbreviations
Items affected by the Joint Commission “Do Not Use” list include:
Medication orders
Clinical documentation
Progress notes
Consultation reports

15. Dangerous Abbreviations
Items affected by the Joint Commission “Do Not Use” list include:
Operative reports
Educational materials
Protocols
Other related material

16. Dangerous Abbreviations
January 1, 2004
Joint Commission issues minimum list of dangerous abbreviations, acronyms, and symbols (see Table 5.9)

17. Table 5-9 The Joint Commission’s “Minimum” Do Not Use List.

18. Dangerous Abbreviations
As of April 1, 2004
Each organization required to identify at least three more “do not use” abbreviations, acronyms, or symbols to go on its “do not use” list. Suggestions are given in Table 5.10

19. Table 5-10 The Joint Commission’s “Recommended” Do Not Use List.

20. Dangerous Abbreviations
The Institute for Safe Medical Practices (ISMP) suggested other abbreviations, acronyms, and symbols to be considered suspect.
The ISMP “Recommended” Do Not Use list is found on Table 5.11.

21. Table 5-11 ISMP’s “Recommended” Do Not Use List.

22. Table 5-11 (continued) ISMP’s “Recommended” Do Not Use List.

23. Table 5-11 (continued) ISMP’s “Recommended” Do Not Use List.

24. Table 5-11 (continued) ISMP’s “Recommended” Do Not Use List.

25. Table 5-11 (continued) ISMP’s “Recommended” Do Not Use List.

26. Table 5-11 (continued) ISMP’s “Recommended” Do Not Use List.

27. Commonly Used Symbols
Table 5.12 provides a list of symbols that are commonly used in pharmacy and medical practice.

28. Table Common Symbols.

29. Common Terminology
Terminology means the set of technical or special terms used in a business, art, science, or specific profession.
Pharmacy and medical professionals use a unique language and terminology. This adds to prescribing safety
The following slides contain a list of some of the terms found in Pharmaceutical Terminology.

30. Activity Complete a drug card for the following…
Prednisone (Deltasone)
Doxycycline (Vibramycin)
Alendronate (Fosamax)
Complete the Pharmacology Vocabulary activity and add to your “drug book”
Once complete, work with a partner to create a incorrect prescription order. Switch with another group and make corrections.