CH 4 Pharmacy Practice and Medication Safety Flashcards
Prescriptions are
Written, oral, or electronic transmission directions for dispensing
medication
Used in clinics or community pharmacies such as CVS, Walgreens
Prescription requirements… 7
patient’s…
drug’s…
‘sig’..
date…
prescribers…
DEA…
why…
Patient’s name and address
drug Name and quantity
Directions for use (also called the “sig”)
date prescription was written
prescriber’s name, telephone number, address, license classification, and signature
DEA number (for controlled substances)
purpose or condition for which the drug is being prescribed if requested by the patient
Additional info but not required…
Refills
Any additional instructions deemed necessary by the prescriber
If generic substitutions are permitted
Medication Orders are prescriptions…
issued and dispensed in an
institutional setting (hospitals or long-term care facilities)
Medication Orders include…
name of the drug, dose, route
Often submitted electronically into a patient’s electronic health record (EHR)
Stop orders
automatic stop time or date for certain drugs
Used for medications with a specific duration limit
Drug Administration Rights
6 Right… P.R.D.D.D.T
Right Patient
Right Route
Right Drug
Right Dose
Right Documentation
Right Time
Factors that Influence Drug Action
(7) maddaga
mental status
age
disease states
drug interactions
allergies
genetics
A.D.M.E.
Meds forPediatric(kids) Patients
Medication doses are often based on their weight (kg)
big difference between age and the development of the organs that can affect drug pharmacokinetics
Patient-Specific Factors on Drug and
Nondrug Therapy (4)…
cultural beliefs
disabilities
socioeconomic factors
language barriers
Antihistamine Drugs
H1 Antagonists used for
seasonal allergies and cough and cold
Diphenhydramine (Benadryl)
Loratadine (Claritin)
Fexofenadine (Allegra)
&
H2 Antagonists used for
dyspepsia or heartburn, gastroesophageal
disease (GERD) or to prevent stress ulcers
famotidine (Pepcid)
cimetidine (Tagamet)
Allergic Response
caused by med, env., food
mild to severe cases
Tall man lettering
Drug name pairs or larger groupings with bolded and uppercase letters to
help draw attention to the dissimilarities in LASA medications
DOXOrubicin – IDArubicin
hydrALAZINE – hydrOXYzine
diazePAM – diltiaZEM
DACTINomycin – DAPTOmycin
Dispensing Precautions
some drugs may be affected by…
light or moisture and should not be repackaged
Medication Safety is enhanced with tech such as…
Bar codes and scanning
computerized physician order entry (CPOE) _Used in hospitals whereprescriber enters the order which is then verified and dispensed by the
pharmacy
High Alert Medications are meds that have an increased…
risk of causing significant patient harm when
used in error
High Alert Medications Examples:
a.i.c.h.a.i.n.o.
Antithrombotic agents
Insulin
Chemotherapy
Hypertonic sodium chloride
Adrenergic agonists/antagonists
IV potassium chloride (KCl)
Neuromuscular blocking agents
Opioids
Medication errors
Occurs when any of the 6 “rights” of drug administration are incorrect
needs to be reported to help understand what caused the mistake and what can be
done to help prevent future errors
Example: the wrong drug or wrong dose is given to a patient
Near misses
Medication errors that are caught before they reach the patient
needs to be documented and reported to help prevent future near misses of similar
fashion
Example: a technician fills metoprolol tartrate instead of metoprolol succinate
which is caught by the pharmacist upon final verification
Reporting errors
needs to be documented and reported to help prevent future errors of similar fashion
The patient and the prescriber should be notified of the medication error
Errors should be documented in a database and should be reviewed using root cause analysis RCA
California Board of Pharmacy requires that every pharmacy must have a quality
assurance program to document medication errors to help prevent recurrence
RCA
root cause analysis
used to identify the main cause or problems of medication error and find solutions
does not seek to place blame or punish individuals for making a mistake
Example: RCA could identify that errors were occurring due to a lack of training on
a new policy or procedure
Automatic stop orders
specific date or time when a medication is to be discontinued
Medications can also be given a set number of doses, and then the order is stopped
Example: placing a medication order for an antibiotic to stop after 7 days of therapy
Conditional orders must meet
certain conditions before they can be activated
Example: placing hold parameters on a blood pressure medication to hold the dose
if the systolic blood pressure is < 90 mmHg
(REMS) Program
Risk Evaluation and Mitigation Strategy
for certain medications
Goal) benefits > risks
May involve special dispensing or prescribing requirements for
certain drugs
May require prescribers and/or pharmacists to complete special
training
Inventory reports
Keeps track of all inventory in the pharmacy
Helps to notify staff when to re-order medication or supplies
Diversion reports
Monitors the waste, access, administration, and return, of medications including controlled substances
Helps to identify theft, especially of controlled substances
Example: a partial vial of fentanyl is used in the OR but no waste was documented for the rest of it
Discrepancy reports
Ensures all products are accounted for
Helps to identify lost or stolen inventory
Override reports
Tracks which medications were accessed or used before being verified by the pharmacy
Example: RN pulls a medication to be given urgently to a patient
Usage reports
Tracks how often certain medications are being used
Ex) high volumes of Tamiflu prescriptions given during wintertime
Narcotic waste report
Used to document the waste of controlled substances
Requires signature of the person wasting the controlled substance and the signature of a witness
Example: RN pulls a morphine syringe (2 mg/mL) but only gives 1 mg to the patient and must waste the rest
Business summary reports provides…
-productivity reports, losses and profits, net sales, employee satisfaction surveys, quality assurance, distribution costs, etc.
Factors That Can Affect Compliance and Adherence
Side effects
Dosing frequency
Drug interactions
Cost
Patient counseling
Flavoring agents
Forgetfulness
Routes of administration
Dosage formulations
Pill boxes
Lack of awareness of disease
Polypharmacy
Routes of admin
oral
sublingual
buccal
paternal and Topical routes of admin (other deck of flashcards)
Institute for Safe Medication Practices (ISMP)
devoted to preventing medication errors
Publishes newsletters, guidelines, and educational tools for institutions to promote essential medication safety standards and practice
Medication Reconciliation
is a detailed list of the…
patient’s home medications
Improves medication compliance with patients and medication safety during transitions of care
