💊Patient safety & Quality Assurance💊

When to wash hands

Before and after patient contact, after touching contaminated surfaces, before preparing any medication, after removing gloves

Proper Hand Washing Technique

Wet hands , soap, scrub 20 seconds, rinse, dry

Alcohol based hand rub (ABHR)

Acceptable alternative UNLESS hands are visibly soiled or after C.diff exposure (soap and water required for C.diff)

Gloves

Always when handling medications, hazardous drugs, or patient samples

Gown/Lab coat

Sterile compounding, hazardous drugs handling (chemo)

Mask/Respirator

Sterile compounding, hazardous drug preparation (N95 for some)

Eye protection/ Face shield

Hazardous drug compounding, splash risk

Hair covers/Shoe covers

Required in clean room/sterile compounding

Counting trays

Clean with 70% isopropyl alcohol (IPA) between patients; dedicated trays for penicillin based drugs (allergy risk from residue)

Countertops

Disinfect regularly with approved solutions

Laminar flow hood (sterile compounding)

Clean with 70% IPA before use, and every 30 min during use and after spills

Hazardous drug spills

Use a hazardous spill kit; double glove; seal waste in appropriate containers

ISO 5

Where actual drug preparation happens (inside hood)

ISO 5

Buffer area/cleanroom around the hood

ISO 8

Ante-area (where you gown up before entering)

Wrong Drug

Incorrect medication Dispensed

Wrong Dose

Incorrect strength given

Wrong Patient

Medication given to the wrong person

Wrong Route

Incorrect administration route

Wrong Quantity

Incorrect amount dispensed

Wrong Time

Medication given at wrong time

Omission Error

Dose not given/missed

Unauthorized Drug

Drug dispensed without valid order

QD/Daily

Once daily

BID

Twice daily

TID

Three times daily

QID

Four times daily

Q4H

Every 4 hours

Q6H

Every 6 hours

Q8H

Every 8 hours

Q12H

Every 12 hours

PRN

As needed

AC

Before meals

PC

After meals

HS

At bedtime

Drug Utilization Review (DUR)

Computer flags a drug interaction, allergy, or duplication → stop and alert pharmacist

Adverse Drug Event (ADE)

Patient calls saying they had a bad reaction to their medication

OTC Recommendation

Patient asks which OTC product to use for their symptoms → pharmacist only

Therapeutic substitution

• Prescriber asks for a different drug in same class (e.g., brand → generic, or switching statin) → pharmacist approval needed

Drug misuse/abuse concerns

Patient seems to be misusing medications, early refills on controlled substances, multiple prescribers

Adherence issues

Patient hasn't refilled a critical medication in months (e.g., blood pressure, insulin)

Post-immunization care

Patient has adverse reaction after vaccine given in pharmacy

Allergy concerns

Prescription written for drug the patient is allergic to

Unclear/ambiguous prescription

Illegible writing, missing dose or directions

Drug-disease concern

Prescribed drug appears contraindicated for a known condition in patient profile

Prospective DUR

BEFORE dispensing (most common)

Generic Substitution

Same drug, different manufacturer (brand → generic)

Therapeutic Substitution

Different drug, same class (e.g., omeprazole → pantoprazole)

Concurrent DUR

While patient is in hospital, during treatment

Retrospective DUR

AFTER dispensing (look back at records)

Insulin (High Alert Meds)

Wrong type or dose → hypoglycemia, death

Anticoagulants (warfarin, heparin, apixaban) (High Alert Meds)

Too much → major bleeding; too little → clot/stroke

Opioids (morphine, fentanyl, oxycodone) (High Alert Meds)

Respiratory depression, death at high doses

Concentrated Electrolytes (KCI, NaCl 3%, MgSO4) (High Alert Meds)

IV bolus can be fatal — must be diluted

Chemotherapy Agents (High Alert Meds)

Narrow therapeutic index; toxic to healthy cells

Neuromuscular Blocking Agents (succinylcholine) (High Alert Meds)

Paralyzes patient — must have airway support ready

Methotrexate (oral) (High Alert Meds)

Weekly dosing often confused with daily → toxicity/death

Hypertonic Saline (NaCl 3%) (High Alert Meds)

Rapid infusion → brain damage

IV digoxin (High Alert Meds)

Narrow therapeutic index; toxicity risk

Why is using “U” for units dangerous?

It looks like “0” or “4,” which can cause a serious insulin overdose. Write “units”.

Why should “MS,” “MSO₄,” and “MgSO₄” be avoided?

They can be confused (morphine vs. magnesium sulfate). Write the full drug name.

Why is “D/C” considered unsafe?

It can mean discontinue or discharge. Always spell out the intended meaning.

Why should “cc” not be used?

It can look like “00” in handwriting. Use mL (milliliters) instead.

Why is “µg” risky?

The “µ” can look like “m,” causing a 1000× dosing error. Write mcg (micrograms).

Why is “QOD” dangerous?

It can be misread as “QD” or “QID.” Write “every other day.”

Why is “QD” unsafe?

It can be confused with “QID” (4 times daily). Write “daily.”

Why should “IU” not be used?

It can be mistaken for “IV” or “10.” Write “international units”.

Barcode scanning

Scan drug AND patient wristband before dispensing

Separating inventory

Store LASA drugs in different locations; use physical barriers or different shelves

Auxiliary labels

"Shake well," "For the eye," "Take with food" — reduce administration errors

Double-checking

Pharmacist verifies tech's work before dispensing (required by law)

Computer alerts/DUR

Electronic systems flag interactions, duplications, allergies

Patient counseling

Pharmacist must offer counseling for new prescriptions (OBRA '90)

What is MedWatch (FDA) used for? Who can report?

Reports adverse drug reactions, product problems, and medication errors for marketed drugs. Reported by healthcare providers, patients, and manufacturers.

What is VAERS? Who can report?

Vaccine Adverse Event Reporting System — used to report adverse reactions after vaccines. Anyone can report (providers are required, public is encouraged).

What is ISMP used for? Who reports to it?

Voluntary, confidential medication error reporting system that helps create national safety alerts. Reported by healthcare professionals.

What do State Boards of Pharmacy handle? Who reports?

Handle disciplinary issues, license violations, and dispensing errors. Reports can come from pharmacies and consumers.

Medication Error

Any preventable event that cause or lead to inappropriate medication use or patient harm

Adverse Drug Event (ADE)

Harm caused by a drug whether or not it was an error (includes side effects and allergic reactions)

Near Miss (close call)

An error that was caught BEFORE reaching the patient.. still must be documented and reported internally

Sentinel Event

Unexpected death or serious physical/psychological harm.. requires immediate root cause analysis

Class I Recall

Most serious — product likely to cause serious harm or death (e.g., contamination, wrong drug). Remove from shelves IMMEDIATELY.

Class II Recall

May cause temporary or reversible harm. Respond promptly.

Class III Recall

Unlikely to cause harm but violates FDA regulations (e.g., labeling issue).