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

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

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

4. 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)

5. What is the bottom line?

6. 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

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

8. Heparin 10,000 unit vials

9. Unsafe Storage: Insulin Jumble

10. 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

11. 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

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

13. 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.

14. Too many LASAs!

15. 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

16. The Swiss Cheese Model

17. 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.

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

19. Fentanyl IV PCA

20. Morphine IV PCA

21. Dilaudid IV PCA

22. Epidural

23. 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.

24. CADD Cassette

25. CADD Cassette Epidural

26. Heparin Bag

27. Patient take home meds from the ER Department

28. Any Questions?