mid Flashcards
The role of_______has greatly evolved over time. It is not only about providing consumers and patients their medications, but it has already expanded to active participation in helping them achieve the maximum therapeutic benefits of their medications through pharmaceutical care. With this bigger responsibility, it has become more crucial for pharmacists however, does not ensure that there is no room for errors to take place, thus it is imperative to to ensure that they carry out their tasks with utmost caution and vigilance.This scenario, know the probable causes of errors in their field of practice.
pharmacists
The most commonly encountered
errors in the community and hospital pharmacy settings are
dispensing errors
are inconsistencies between the prescription order and the medication prepared by the pharmacists given or the pharmacy technicians/assistants.
Dispensing errors
There are different types of dispensing errors;_____________1]. Such errors may pose great harm to consumers or patients leading to increased morbidity and mortality rates, especially if they go unnoticed. In addition, it may also increase unwanted health care costs which will pose another burden not only to the consumers and patients but also to the pharmacy management itself.
Error by Omission, Error by Commission, Mistakes, and Slips
Recently in the Philippines, ___________were charged with dispensing the wrong drug to a consumer. Instead of filling the consumer’s prescription of Cefalexin for her urinary tract infection, she was given Levothyroxine (Eltroxin®). The medication that was contained a high dose of hormones, eventually leading for the consumer to be diagnosed with iatrogenic hyperthyroidism. Scenarios like this serve as a reminder to all pharmacists and pharmacy technicians that such errors can greatly impact another person’s life [2].
three pharmacy assistants
Statistically, dispensing errors account for _______of all medication errors [3].
21%
There are a lot of underlying causes for dispensing errors, it may be caused by
Sound-alike and Look-alike Drugs (SALADs), Confirmation Bias, Communication Barriers, Commonly Misinterpreted Prescription Abbreviations, or Commonly Misinterpreted Dose Designations.
Certain environmental factors can also contribute to dispensing errors, such as_________ These errors are not inevitable, but there are proven strategies that could be done to prevent its occurrence [1-3].
disorganized dispensing areas,
unsuitable spaces,
the long shifts that pharmacists and pharmacy technicians have to deal with, especially in drugstore chains that are open for 24 hours.
In the healthcare industry, an_________happens when a healthcare professional fails to do the right thing which leads to an undesirable outcome or raises significant potential for such an outcome. For community and hospital pharmacists, failure to counsel the consumer about their medication and failure to check for drug interactions as well as contraindications fall under this category of error.
error by omission
plays a significant role in ensuring medication safety and medication adherence among consumers. Studies have shown that when consumers and patients thoroughly understand their medication it is more likely for them to be motivated to take their medications religiously, thus failure to do such counseling could lead to unsafe medication use and decreases adherence to medication. This defeats helping them achieve the maximum therapeutic benefits from their medications [4].
Patient counseling
On the other hand, _________is also a crucial mistake for pharmacists and all healthcare professionals.
failing to screen for drug interactions and contraindications
are situations wherein another drug, food, or herb could potentially alter the effects of another drug, these interactions could greatly put the health and safety of the consumer at risk [5]. Drug interactions could range from mild to even severe fatal interactions [6].
Drug interactions
DDIs prevalence range from_____ in different studies due to variability in the study population, design, setting etc., especially geriatric and patients in polypharmacy [7-10].
16-91%
are instances the make a particular medication inadvisable to consumers with certain conditions. For example, Isotretinoin is absolutely contraindicated to women who may become pregnant, because of it high risk of causing severe birth defects.
Contraindications
Miscalculation of dose, dispensing an incorrect medication, dosage strength, or dosage form, fall under this type of dispensing error. Certain factors can influence this kind of error such as the presence of sound-alike and look-alike drugs (SALADs) in the pharmacy formulary, which increase the chance of confusion during dispensing. Ineligible written prescriptions as well a verbal medication orders also contribute to the chances of errors by commission. More studies have been focused on errors by commission as opposed to errors by omission.
Error by commission
are usually caused by a lack of problem-solving skills.
Mistakes
There are two main types of mistakes, it is either .
knowledge-based or rule-based
are related to the deficit of any type of knowledge, it could be general, specific, or expert. An example of this is when a pharmacist dispenses a drug to a patient without even establishing whether the patient is allergic to it or not. It is general knowledge for pharmacists to always ask their patients if they are allergic to some medications, so proper caution can be initiated.
Knowledge-based mistakes
take place in situations where there is a disregard of particular rules, resulting in an unwanted outcome [12].
Rule-based mistakes
is a standard operating procedure in pharmacies, but there are times when this rule is not followed, thus resulting in unwanted outcomes. The negligence of double-checks is an explicit example of a rule-based error.
Double-checking during preparation and dispensing
are considered to be action-based errors. The presence of interruptions and disturbances in the community and hospital pharmacy leads to these errors.
Slips
is a routine task of the pharmacists and pharmacy technician in the community or hospital pharmacy. That being said, it is already an automatic skill-based activity for these professionals.
Dispensing a medication
such as telephone rings, noisy environment, and using mobile phones during work hours could cause a break in this routine task, diverting the attention of the pharmacist or pharmacy technician during dispensing. These unintended acts may lead to dispensing errors
Interruptions and disturbances
At present, there are thousands of drugs in the market, so it is not unlikely that they may be mistaken for each other. , ________or more commonly known as SALADS, greatly contribute to the confusion of pharmacists and pharmacy technicians during the dispensing process. These drugs may have visual similarities in packaging with the other drugs, or it may be drug names that sound or spell like other common drug names. For example, Hydralazine, a vasodilator, is commonly confused with Hydroxyzine which is an antihistamine (see Figure 11.1), and interchanging such medications can greatly affect a patient.
Sound-alike and look-alike drugs
There are risk factors that may increase the likelihood of confusion when handling these medications. These include
illegible handwriting of physicians in the prescription order, improper shelving in the pharmacy, or new drugs that have just been out in the market [14-16].
In the community pharmacy setting, approximately ____ of handwritten prescriptions contain at least one prescription-writing error [12-13]. It promotes poor and inefficient communication putting the life of the consumers in danger.
21%
As an example of this error, in _____, it caused a patient’s life when a pharmacist misread the prescription order of a cardiologist. Instead of Isosorbide dinitrate 20 mg, an anti-anginal drug, the patient was given Felodipine, an anti- hypertensive drug. The jury rewarded the patient’s family with a compensation fee both paid in half by the pharmacist and the physician [13].
1999
was initiated by the Institute for Safe Medication Practices (ISMP) as a technique to differentiate the letter characters of different medication names that are mostly confused with other medications (See Table 11.1) [15-16].
Tall man lettering
in the pharmacy can also lead to confusion of one drug for the other.
Improper shelving
that are commonly confused or mistaken with one another must be stored in different locations to avoid picking the wrong drug during dispensing, especially during busy hours in the pharmacy.
Drugs
that are most likely to bring confusion is also a good way to alert the staff personnel to be more cautious when dispensing these drugs. This should not only apply to SALADS, but to all the drugs in the pharmacy.
Identifying drugs
in the pharmacy should be done in an organized way-by the drugs’ indications or by their use, or it can also be in an alphabetical order. It doesn’t only lessen the ocurence of dispensing errors, but it also increases the efficiency of work in the pharmacy [15-16].
Displaying drugs
is very important to community or hospital pharmacists and all allied healthcare professionals.
Familiarity with new drugs
in providing drugs to the community, it is a pharmacist’s key responsibility to know the new drugs being released and/or recalled in the market.
Being a frontliner
can increase dispensing errors in a way. When there is a lack of familiarity with these new drugs, there is a possibility that confusion may arise when these new drugs have an existing sound-alike or look-alike drugs in the pharmacy formulary. Therefore, great care must be given in knowing the medications for patient safety.
Release of new drugs
is a psychological phenomenon wherein humans tend to process new proven to cloud the judgment and decision-making of individuals doing cognitive work
Confirmation bias
According to the_________humans are more likely to view information as th I have always seen it, rather than the new information given to them. In pharmacy practice pharmacists tend to have repetitive work, making them vulnerable to bias. Although it is unintentional, getting used to dispensing the same drugs repeatedly over a long time predisposes pharmacists to have their own beliefs when it comes to medications. This can lead to a potential risk for dispensing errors.
Social Cognitive Theory
One example is the report of a pharmacist to the Institute of Safe Medication Practices, wherein a number of prescriptions for Sinequan”, an antidepressant drug have been misread by the pharmacist as Singulair”, a drug treatment for asthma and allerg rhinitis. It was reported that in his pharmacy it was rare for the staff to see prescription orders for the brand Sinequan”, resulting in the confirmational bias as they dispensed Singulair because it was more familiar to them [18].
It is important that________eliminate these biases as this can pose a serious threat to the health and safety of consumers.
pharmacists
Encouraging_______ by staff members in the pharmacy is one of the strategies to overcome confirmational bias [19] This strategy is a common way of preventing errors from occurring.
double checks
Studies have shown an error detection rate of_____through double-checking [20]. Having a checklist and a formalized process in doing this approach is also recommended [19]. Figure 11.2 shows the suggested dispensing process flow chart to avoid any dispensing errors.
93-97%
Having someone____your work during the busy hours in the community or hospital pharmacy is an effective way to reduce dispensing errors.
check
is much needed from the staff personnel, and they must be able to see the idea to help them reduce their mistakes and not something that emphasizes it.
Positive perspective
Although_______is a team effort, this must be done independently, without prompts from the personnel who did the initial work. Prompts from the personnel who did the initial work might influence the judgment of the checker and could probably lead to missing the error from the previous work [21].
double-checking
that are included in the high alert list, such as sound-alike or look-alike drugs must be given more attention during counter checking, since these medications, when interchanged, can greatly pose harm to the
consumer.
Medications
Patients with ________should be given great attention. These patients have numerous and perplexing medications. This counter-checking strategy has shown a reduction in dispensing errors but some studies have suggested that having too many check points in dispensing can also stress out the staff personnel, leading to errors as well.
multiple prescriptions
must therefore be limited to those high-alert and perplexed medications, polypharmacy, and to patients who are highly vulnerable such as pediatrics, geriatrics, and patients with co-morbidities [21].
Double-checks
is important in any profession, and for healthcare professionals it is even more essential to establish good communication when dealing with patients [22].
Communication
are the frontliners when it comes to medications. They are the first choice of most people for their medication needs. As frontliners, it is crucial for them to ensure safe medication.
To be able to achieve that, there must be effective communication between the pharmacist and the consumer or patients.
Community or hospital pharmacists and pharmacy technicians
starts with active listening. It is not only by focusing on the content of the message itself but by paying attention during the entire process [23]. Through this effective communication, dispensing errors may be avoided.
Effective communication
has been known to increase dispensing errors, defeating the goal of giving the best pharmaceutical care to consumers and more likely predisposing them to have unsafe medication use [1]. This, in particular, has been one of the foremost contributors to errors in the healthcare industry [24].
Poor communication
One example of a communication barrier is a ________ (see Figure 11.3). Most community pharmacies are purposefully situated in crowded areas. This strategy is understandable because good human traffic is suitable for business. However, this could pose a problem when it already affects the communication between the pharmacist and the patient. With a noisy environment it would be hard for the patient and pharmacist to understand each other.
noisy environment
suggested having a private counseling area to discuss. pertinent issues to the patient’s medication. In this conducive space, barriers are eliminated and the pharmacists will focus on understanding the patient’s needs.
Drugstores or hospital pharmacists
in such a short period is common in community pharmacies. This enables the pharmacist to get the correct information that is needed from the consumer. With the presence of barriers, proper relaying of the message is disrupted leading to incorrect dispensing of medications, dosage strengths, and dosage forms. Not only will it disrupt the proper relaying of information, it may also cause consumers to be more irritable, making them more reluctant to have a conversation with the pharmacist.
Establishing rapport with consumers
A number of studies have shown that environmental factors such as ______interfere with the focus of people performing cognitive work [25].
background noise and interruptions
is needed when having conversations, hence it is important for a community pharmacy to have an adequate space that can promote active listening for effective communication between the pharmacist and the patient
Utmost concentration
are commonly seen in community pharmacies, particularly the counterspace that separates the pharmacist from the patients (See Figure 11.3 on Communication Barriers in Pharmacy). This barrier is inevitably present in the pharmacy but it is still possible to conduct good patient counseling while having this barrier.
Physical barriers
with the patient while talking could create that connection wherein the patient will feel the full attention of the pharmacist.
Leaning slightly forward and having proper eye contact
like crossing arms can come off as being guarded, arrogant, and intimidating. Therefore, it is advised that these gestures and mannerisms be avoided by the pharmacist during a conversation with a patient [30].
Gestures and mannerisms
Another physical barrier in the community pharmacy is the presence of a _______near the patient receiving area. This also serves as a distraction during the communication process.
telephone
must be situated away from the patient receiving area to avoid interrupting patient-pharmacist conversations.
Telephones
Using ______while communicating with a patient or consumer is also a distraction. This kind of behavior is unprofessional and should never be done in practice.
mobile phones
is one of the key elements in communication, it paves the way toward understanding.
Language
is a constant challenge for healthcare professionals Pharmacists are faced with this challenge more often than we know, global migration greatly contributes to the increasing number of patients with diverse languages [26].
Conquering language barriers
Inability to explain to a patient their medications in the best way they can comprehend can be______for pharmacists, knowing that the safe use of medication by their patient greatly relies on their skills as a professional.There are various ways of solving this problem and having a bilingual staff is a common strategy in the community or hospital setting. However, there are still tricky scenarios wherein you might need help from third-party translators, especially when dealing with foreign customer There are companies that offer translating services to help you in these situations. In a fast-paced environment like in a community pharmacy, this can be a bit of a burden since time also play a role in effective patient counseling.
stressful
It is important that the_____shows total control in these situations and not cause the patients to worry. There must be a prepared list of company translators that can easily be contacted to facilitate the communication process.
pharmacist
Some community pharmacies also use ________
These are standardized images that are made to help overcome problems concerning language barriers.
pharmaceutical pictograms.
Although, this_______only applies to basic information about the medication such as when to take it, how to take it properly, frequency of taking the medication, and things to avoid when you are on that medication [27]. For information that are highly sensitive, it is still a must to have a professional translator to help you with your patients.
pharmaceutical pictogram
The use of _______in written prescription orders has been a long-standing practice in the healthcare industry.
medical abbreviations
Although some studies have already shown the risk in using these abbreviations, it is still somehow being used until today. When handling medications, it is crucial not to ______ these abbreviations.
misinterpret
have been caused by misinterpreting medication abbreviations which can cause overdosage or underdosage, leading to the endpoint that the consumer is no longer able to get the maximum therapeutic benefit of their medications (See Table 11.2) [29].
Serious and fatal events
The ________of the Philippines has established an agency that can cater to these cases-the National Pharmacovigilance Center. This particular center focuses on Medication Errors, Adverse Drug Events, and Dispensing Errors, which will all be reported to them.
Food and Drug Administration
is the center’s motto, thus each healthcare professional is urged to report each error that they see in the practice. Specific forms are provided to establishments to report errors to the FDA Philippines. (See FDA website for the forms - wwwx fda.gov.ph).
“Saving Lives Through Vigilant Reporting”
are unfortunate events that could happen at any time in practice. Putting into practice the strategies that are mentioned above is highly recommended to lessen the occurrence of dispensing errors.
Dispensing errors
As early as now, _______must know the precautions they have to do when entering the pharmacy practice.
pharmacy students
