Medication and Patient Safety and Quality Assurance

ISMP (Institute for Safe Medication Practices)

• Publishes best practice tools

• Identifies high-alert medications and common errors

ASHP (American Society of Health-System Pharmacists)

• Issues guidelines and promotes education

Just Culture

Errors are viewed as opportunities to improve the system, not to punish individuals

NIOSH

The national Institute for Occupational Safety and Health outlies safe handling procedures for hazardous drugs:

• Use of PPE

• During quarantining'

• Special storage away from nonhazardous drugs

Identify a Patient

• Full name

• Date of Birth

• Medical Record Number

• Telephone Number

Medication Measurement Standards

It is essential to standardize the measurement units for liquid medications. the use of milliliters (mL) is recommended over teaspoons or tablespoons ensure accuracy.

Updating Patient Info

Update patient info, allergies, current meds, and medical conditions is vital.

Weight Documentation

Documenting patient weight in kilograms

Tip: 1 kg = 2.20462

National Drug Code (NDC) Verification

Each med has a unique 11-digit NDC number.

Prescription Clarification

Consult the prescribing physician for clarification if a pres is illegible or unclear.

Controlled Substances handling

Count controlled substances at least twice to ensure accuracy. After the second count, document the quantity with initials on the prescription label.

Engaging the Pharmacist

Pharmacist play a crucial role in verifying prescriptions and counseling patients. Alerts the pharmacist to any electronic notifications, such as Drug Utilization (DUR) alerts, during prescription processing

USP 800 standards

Outlines standards for the safe handling of hazardous drugs, including storage, compounding, and disposal practices.

Why is Adherence Important?

Improved health outcomes: Proper adherence leads to better management of chronic disease like hypertension and diabetes.

Reduced Healthcare Costs;Adherence decreases the likelihood of hospitals readmissions and emergency visits.

Enhanced quality of Life: Patients experience fewer complications and maintain better overall health.

Proportion of Days Covered (PDC)

PDc calculates the percentage of days a patient has acces to their medication over a specific period

Formula:

(Number of days covered by medication / Number of days in period) x 100

Medication Pocession Ratio (MPR)

Measue=re the ratio of the total days’ supply obtained to the number of days in the evaluation period

Formula

(Total days’ supply obtained/ Number of days in period) x 100

Barriers to Adherence

Cost

Complex Regimens

Side Effects

health Literacy

Forgetfulness

Tools and strategies to Enhance Adherence

Medication Synchronization: Aligning refill dates for multiple medications

Pill Organizers

Reminder Systems

Educational Materials

Motivational Interviewing

1. Right Patient

Use two identifiers

Double verify when handling out meds. delivering, or responding to questions

2. Right Medications

Match prescription, label, and NDC

Use barcode scanning and visual checks

3. Right Dose

Watch for decimal point errors, unit mix-ups

High alert meds need double checks and warning labels

4. Right Time

Some drugs must be taken at exact times

5. Right Route

• Ensure the dosage from matches the route (e.g., eye vs. ear drops)

• Use auxiliary labels like “For the Eye” or “Typical Use Only”

6. Right Education

Ensure patients understand:

• Medication name

• Purpose

• Side effects

• Dosage Schedule

• Special warnings (e.g., pregnancy risk)

7. Right to Refuse

• Patients can legally and ethically refuse any medication

• Technicians must respect refusal and document it

8. Right Effect

Ensure medication is producing the intended result by monitoring side effects, especially with black box warning meds.

9. Right Documentation

• Document any discrepancies or follow-up calls

• In hospitals, meds must be logged in eMAR (electronic med record)/

Understanding Medication Errors and Taking Ownership

• It’s your responsibility to report any errors, near misses, or potential risks.

• Pharmacies follow standard policies and procedures for error reporting

CQI

A system for evaluating and improving processes to ensure safe medication use. It helps identify problems before the harm patients.

CQI Includes:

• Monthly meeting with staff to review incidents

• Discussion of trends and ways to improve

• Risk assessments to identify safety issues

RCA

A problem solving method used to find why an error happened—not just who caused it. It’s often required after a serious incident

RCA Process

1. Investigate the error

2. Identify the root cause

3. Create an action plan

4. Measure outcomes

5. Report results (within 45 days if required by The Joint Commision)

Best Practices

• Use a discreet phase: “I have an urgent matter to discuss.”

• Speak privately to avoid alarming patients or others.

• The pharmacist should explain the error to the patient

Patient Communication Tips

• Stay calm and professional

• Apologize sincerely

• Listen actively and empathetically

• Document everything

ISMP MERP (Medication Errors Reporting Program)

• Voluntary, anonymous reporting for all practitioners and consumers

• Provides national alerts and recommendations

FDA MedWatch

Reports

• Adverse events

• Product quality problems

• Therapeutic failures

Workflow and Physical Layout

Whether you work in a community pharmacy or a hospital setting, pharmacy design and organization are centered around workflow efficiency. Work should flow in one direction along the prescription counter—from receiving the prescription, filling it, checking it, to final dispensing

Designated Areas

Prescription intake, counting, verification, and pickup areas

Organization Tools:

Label printers, automated counting machines

Counting Tray Protocols

Clean with 70% isopropyl alcohol:

• At the beginning of the shift

• Between medications

• After counting sulfa or penicillin drugs

• At the end of the shift

Avoid using automated counters for high-allergy risk medications

Hospital Practices

Nonsterile compounding areas must be cleaned before and after each compound

Silver nitrate can cause chemical burns if residue remains on a surface

The clean room has dedicated schedule and supplies, including lint-free cloths and sterile 70% alcohol.

Temperature logs

Monitor and log refrigerator/ freezer temperatures daily

Crash Carts

• Crash carts are stocked with emergency with emergency meds and checked monthly

• After each use, they must be restocked and inventoried

• Controlled meds should never be stored in patient rooms or open carts

Handling Expired and Damaged Medications

• Expired stock is removed monthly and quarantined

• Controlled substances are logged and stored securely until destruction or return

• Always check the expiration format: MM/YYYY means the medication expires at the end of that month

Use smart thermometers that log temperatures and alert supervisors when temperature go out of range

Steps if the temperature is outside the safe zone:

1. Check door seal and power

2. Record the time, date, and temp

3. Recheck in 1 hour

4. Relocate meds if needed

5. File a work order and notify the manufacturer for guidance