safety in the pharmacy

1. safety in the pharmacy what is 6th leading cause of death? 7000 fatalities/year from adverse drug reactions. The FDA, in a compilation of reports from 1998 to 2005, found that dangerous side effects and deaths from prescription and over-the-counter medications almost tripled to nearly 90,000 incidents 100000(in 1999) fatalities/year from medical errors(400,000?now) celebrities who have been killed by pharmaceutical mistakes, overdoses, etc? most common?---insulin, narcotics, opiates, methotrexate, warfarin, kcl injection drug use kills more people than MVA now. ADE=adverse drug event ADR=adverse drug reaction

2. Medication errors handwriting, wrong patient, language, wrong strength, wrong calculation, wrong sig,overworked, sound alike, look alike names, pt noncompliance, ect errors have categories--show chart tell pharm stories--- medication reconciliation---process to find the most current meds of a patient--show form pg 354

3. Categories of Medication Error Classification

5. safety in the pharmacy • A. Personal safety • 1. Safety from physical harm • a. substances • b. supplies (chemicals, poisons, etc.) • c. equipment • d. improper body mechanics • 2. Employee responsibilities • a. maintain a safe work place • b. apply principles of proper body mechanics • c. wear appropriate PPE (Personal Protection Equipment) • d. follow proper procedures in handling pharmaceutical agents that may pose a hazard to the practitioner • e. know where to locate the material safety data sheets (MSDS) • f. know and apply policies and procedures in case of • emergency

6. i. fire safety • ii. chemical spills and other hazardous materials • iii. body fluids • iv. standard precautions • v. equipment maintenance and failure • vi. internal disasters (fire, robbery, bomb threat, etc.) • vii. external disaster (weather related, traffic disaster, etc.) • Environmental Safety • 1. Clean work place • 2. Proper ventilation • 3. Proper lighting • 4. Adequate set-up and layout of work place • 5. Properly functioning equipment • 6. Well trained employees aware of potential hazards

7. Occupational Safety and Health Administration (OSHA) • 1. Workplaces may be inspected by OSHA officers without prior • announcement in order to accomplish intent to decrease hazards • in the workplace and maintain a reporting system for monitoring • job-related injuries and illness • 2. They develop mandatory job safety and health standards • Joint Commission on Accreditation of Healthcare Organizations • (JCAHO) • 1. Pharmacy standards of JCAHO provide quasi-legal standard of practice for the profession • 2. In court of law practice standards define accepted professional practice and assume quasi-legal status • 3. Pharmacies must meet strict standards in order to be accredited by JCAHO • 4. Accreditation is voluntary but important if business is interested in dealing with third party payers who require certification through accreditation process, e.g. Medicaid, etc.

8. Pharmacy must ensure • 1. Right drug – always double check the label on bulk bottle for • strength and correctness • 2. Right patient • 3. Right dosage • 4. Right route • 5. Right time • 6. Right technique

9. manufacturing label has a bar code somewhere----bottle comes to pharmacy with many pills inside. label gives generic and brand name, how many, strength,NDC code, lot#, expiration, instructions. prescription label has bar code somewhere---bottle to patient. has pt name, dr name, drug name, refills,sig, pharmacy name accuracy scanner--- a quick scan tells if the rx label and manufacture label have same drug. medication counter---quickly counts pills that are not see through. not to be used for sulfa drugs and amoxicllin due to residue. or use spatula and counting tray. count 3 or 5 at a time. put into bottle…child safety cap? pharmacist does verification of the drug.

10. Practitioner must be familiar with • 1. Common side effects • 2. Contraindications • 3. Drug or food reactions with medications • 4. Generic drugs that may be substituted • D. Practitioner should know at minimum the following information for the drugs most used in individual practice setting or geographical location • 1. Adverse drug reactions • 2. Side effects • 3. Contraindications • 4. Drug/food interactions • 5. Safe/effective dosage range • 6. Common dosage regimens • 7. Dosage forms • 8. Route of administration • E. Reviewing Refills • 1. Number of refills • 2. Correct drug selection • 3. Significantly early or late requests for refills may indicate • medication misuse

11. Beware of dispensing errors . Proper storage of pharmaceuticals • 1. Store in original container until dispensed • 2. Follow manufacturer’s directions for proper storage • 3. Follow proper disposal of expired drugs • a. deteriorated drugs are ineffective • b. deteriorated drugs may be a hazard if a condition not treated appropriately • c. deterioration may cause chemical changes leading to dangerous reactions • All schedule II drugs must be kept under lock and key. With schedule III, IV, and V drugs, lock and key storage is optional but suggested