LEC10 Safe use of medications in the hospital part 1 PDF

Safe Use of Medication in the hospital PharmD Pharmacy Practice-IVA (Hospital Pharmacy) Dr. Syed Saad Hussain  Content Medication error and its types Factors contributing to medication error and corrective mea...

Safe Use of Medication in the hospital PharmD Pharmacy Practice-IVA (Hospital Pharmacy) Dr. Syed Saad Hussain  Content Medication error and its types Factors contributing to medication error and corrective measures Unit dose dispensing ASHP guidelines related to safe use of medications  Medication Error Why inpatient dispensing Medication errors are errors or mistakes in the medication use process (prescribing, dispensing, administering of drugs) that may result in negative outcomes. Difference between drug related problems and Medication Error DRPs are medication errors because problems in medication use can occur even when best medication practices are applied. For example, side effects are DRPs that occur through no one’s mistake—indeed, they are expected, unavoidable reactions of the appropriate use of many drugs (e.g., potential upset stomach associated with non steroidal anti-inflammatory drugs).  Medication Error Why inpatient Classification dispensing of Medication Errors  Prescribing errors occur when prescriptions have an incorrect drug selection, dose, dosage form, quantity, route, concentration, rate of administration, or instructions for use of a drug product. These include illegible prescriptions or medication orders that lead to errors that reach the patient.  Dispensing errors are mistakes made during the dispensing process where a patient receives the wrong drug, the correct drug for the wrong patient or wrong dose.  Administration errors occur when patients are administered something other than that prescribed for the patient—the wrong dose, omitted dose, additional dose, wrong administration time, incorrect handling of drugs during administration, or wrong infusion rate.  Medication Error Why inpatient Classification dispensing of Medication Errors  Monitoring errors result from the failure to review a prescribed regimen for appropriateness or the failure to use appropriate clinical or laboratory data for adequate assessment of patient response to prescribed therapy.  Transcription and/or interpretation errors are made during the transcribing or interpreting of prescriptions due to causes including misinterpretation of abbreviations, illegible handwritten prescriptions, misinterpretation of spoken prescriptions.  Omission Error The failure to administer an ordered dose to a patient before the next scheduled dose or failure to prescribe a drug product that is indicated for the patient. The failure to administer an ordered dose excludes patient’s ref usal and clinical decision or other valid reason not to administer.  Medication Error Why inpatient Classification dispensing of Medication Errors  Wrong Time Error Administration of medication outside a predefined time interval from its scheduled administration time (this interval should be established by each individual healthcare facility).  Unauthorized Drug Error Dispensing or administration to the patient of medication not authorized by a legitimate prescriber.  Dose Error Dispensing or administration to the patient of a dose that is greater than or less than the amount ordered by the prescriber or administration of multiple doses to the patient, i.e. one or more dosage units in addition to those that were ordered.  Dosage Form Error Dispensing or administration to the patient of a drug product in a different dosage form than that ordered by the prescriber.  Medication Error Why inpatient Classification dispensing of Medication Errors  Drug Preparation Error Drug product incorrectly formulated or manipulated before dispensing or administration.  Route of Administration Error Wrong route of administration of the correct drug.  Administration Technique Error Inappropriate procedure or improper technique in the administration of a drug other than wrong route.  Deteriorated Drug Error Dispensing or administration of a drug that has expired or for which the physical or chemical dosage-form integrity has been compromised  Monitoring Error Failure to review a prescribed regimen for appropriateness and detection of problems, or failure to use appropriate clinical or laboratory data for adequate assessment of patient response to prescribed therapy.  Factors contributing medication errors Why inpatient dispensing HOSPITAL ADMINISTRATION RELATED FACTORS:  Inadequate policies regarding safe use of medication  Inadequate policies governing reporting of incidents in institution  Inadequate policies concerning performance of task for supportive personnel PERSONNEL RELATED FACTORS:  Lack of hospital pharmacist  Lack of administration nurse  Overburdened personnel  Factors contributing medication errors Why inpatient dispensing TECHNIQUE RELATED FACTORS:  Use of non-professional personnel in areas requiring professional judgment  Inadequate labeling of drugs and allied items for nursing station. FACILITY RELATED FACTORS:  Inadequate storage and equipment facilities  Inadequate drug station on patient care areas.  Factors contributing medication errors Why inpatient dispensing TECHNIQUE RELATED FACTORS:  Use of non-professional personnel in areas requiring professional judgment  Inadequate labeling of drugs and allied items for nursing station. FACILITY RELATED FACTORS:  Inadequate storage and equipment facilities  Inadequate drug station on patient care areas.  Preventing medication errors Why inpatient dispensing The Institute of Medicine made a series of general recommendations relating to the prevention of medication errors.  Involve the patient in the medication use process. This includes formalizing the rights of patients, educating them, and consulting with them.  Consumer-oriented medication resources should be made available to support patient self-management of their medication use.  Health care providers should have access to patient information and decision - support tools and technologies to enable them to be more active in monitoring and intervening.  Medication labelling needs to be improved along with methods for communicating medication information to consumers.  Health care payers and oversight organizations should be more active in promoting good medication use practices.  Corrective measures Why inpatient ADMINISTRATION dispensing RELATED MEASURES The administration of a hospital is mainly responsible for formulating policies regarding all operations in an institution. An institution must have adequate and clear cut polices as for the drug use in the institute. A comprehensive policy on incident detection and subsequent reporting system for each drug accident in hospital is to be formulated. LACK OF PERSONNEL The medical care without a pharmacist may eventuate into serious medication errors. Some hospitals have not deployed pharmacist to carryout pharmaceutical services. A pharmacist can prove his work. For this it is advisable that on receipt of a prescription to place signature, it must be checked for its correctness and any potential drug-drug interactions  Corrective measures LACK OF PERSONNEL Can also be solved by:  Sharing of pharmacist by two or more small hospitals  Combining responsibilities such as procurement, administration  Purchase of pharmaceutical services from community pharmacy  Use of consultant pharmacist  Use of supportive personnel for the following activities Taking telephone orders for new prescription or for prescription refills. Weighing or measuring ingredients for compounding of prescriptions. Mixing of already weighed or measured ingredient. Calculation of percentages in prescription compounding. Affixing of prescription labels to medication containers.  Corrective measures INADEQUATE LABELLING OF DRUG ISSUED TO NURSING STATIONS Affixing labels is an institutional policy matter and for this appropriate guidelines must be provided. The containers which are dispensed to nursing stations should must properly labelled and should be look like commercial labels have information for strength, identification, route of administration, warnings and caution if any present Use of colour coding (white for poison, blue ink are oral preparations) Use of label position indicator Use of auxiliary labels  Corrective measures Why INADEQUATE inpatient DRUG STATIONSdispensing ON PATIENT CARE AREA  Due to lacking of facilities such as inadequate place, poor lights, less storage for necessary materials, storage for equipment and persons passing due to which interference occur and nurse may distract and medication errors occur and can also be solved by: Medication Cabinet This concept is implemented effectively in small hospitals where separate room for medication is not possible. So for solving the problem ready- made stainless steel cabinets are available commercially with working top counter, sink, medicine cup dispenser, shelves for medicine, rack for medicine cards narcotic lockable cabinet, for biological products refrigerator, syringe drawer, light, and a basket for waste. These cabinets easily installed at corner  Corrective measures Why INADEQUATE inpatient DRUG STATIONSdispensing ON PATIENT CARE AREA Provision of medication room This room is built for preparation and storage of medications. It is clear for observation from in and out, enclosed for quite, more than one person can work. pharmacists can advise about requirements for such facility. The requirements for medication room are Division of shelves for individual patients. Safe, lockable (Double lock), and secure safe used for narcotics. For storage of syringes etc drawer underneath work top counter. For preparation bulletin board at eye level. For hand washing a sink. A refrigerator above the counter is convenient for different medications. Thank you