Drug Safety and Quality Assurance
Duties:
Prescription Intake: Review carefully to prevent errors.
Order Entry: Ensure accurate data capture.
Order Verification: Catch and correct errors before dispensing.
Dispensing and Labeling: Avoid administration mistakes with precise dispensing and clear labeling.
Workflow Design: Implement checks and balances.
Education and Training: Ongoing staff education on new medications and error prevention.
Drug practices:
Tall Man Lettering: Capitalize certain letters in medication names (e.g., hydrALAZINE vs hydrOXYzine).
Institute for Safe Medication Practices (ISMP): Report medication errors to ISMP; ISMP works with USP and FDA to analyze reports and provide feedback.
Storage Practices: Store high-risk medications separately, often in distinctively colored bins.
Examples to Watch: prednisoLONE vs. predniSONE and DOBUTamine vs. DOPamine.
ISMP Error-Prone Abbreviations
AD, AS, AU: misinterpreted as OD, OS, OU.
OD, OS, OU: misinterpreted as AD, AS, AU.
cc: misinterpreted as u (units).
o.d. or QD: misinterpreted as q.i.d.
o.d. or OD: misinterpreted as right eye.
qhs: misinterpreted as qhr.
q.o.d. or QOD: misinterpreted as q.d. or q.i.d.
U or u: misinterpreted as 0 or 4, or cc.
ISMP High-Alert Medications
Adrenergic agonists (epinephrine, phenylephrine, norepinephrine) IV
Adrenergic antagonists (propranolol, metoprolol, labetalol) IV
Moderate sedation agents for children (chloral hydrate) oral
Anesthetic agents (propofol, ketamine) general, inhaled, IV
Inotropic medications (digoxin, milrinone) IV
Patient Info & Prescription Handling
Confirm patient details at intake and pickup.
Clarify illegible prescriber details.
Verify child's ability to take tablets for pediatric prescriptions.
Request patient's weight for liquid medication dose verification.
Match prescription numbers and patient names on packages to those on the receipt.
Offer pharmacist counseling.
Process sales with a friendly demeanor and provide pharmacy contact information.
Potential Medication Errors
Report errors promptly to the supervisor.
Focus on systems improvement, not blame.
Use Root Cause Analysis to identify underlying causes.
Promote Continuous Quality Improvement (CQI).
Reporting errors is a professional responsibility.
Communication & Documentation
Use discreet alerts for urgent error discussions.
Pharmacists handle error communication with patients.
Report errors through ISMP MERP and VERP.
Report adverse events through FAERS, MedWatch, or VAERS.
Documentation helps in understanding errors.
Adhere to employer protocols for documenting and reporting errors.
Pharmacy Work Environment
Community Setting:
In Window: Prescription drop-off and patient interaction.
Out Window: Prescription pick-up.
Data Entry Area: Input prescriptions and handle insurance.
Dispensing Area: Prepare and verify medication.
Hospital Setting:
Pick-Up Window: Nurses collect medications.
Data Entry Area: Process patient and medication information.
Dispensing Area: Medication preparation and pharmacist checks.
Compounding Areas: Sterile and nonsterile compounding.
Pharmacy Cleanliness & Organization
Sanitize counting trays and work areas routinely.
Use 70% isopropyl alcohol for cleaning.
Handle penicillin and sulfa meds separately.
Avoid automated counters for penicillin and sulfa drugs.
Clean nonsterile compounding areas before and after each preparation.
Identify sulfa drugs by the prefix "sulfa-" or suffix "-cillin".
Medication Quality & Storage Checks
Inspect and remove outdated medications monthly.
Update logs for controlled substances as they expire.
Monitor fridge and freezer temperatures daily.
Document and act on temperature excursions.
Quarantine expired medications and follow protocols for secure disposal.
Crash Carts
Ensure crash carts are fully equipped.
Update emergency medications monthly.
Restock the cart after each emergency.
Securely store narcotics and controlled substances in a locked compartment.
Place crash carts in key areas within the hospital.
Summary
Pharmacy technicians are vital for a safe and efficient pharmacy.
Report potential errors and use them as learning opportunities.
Adhere to systematic safety procedures.
Leverage technology and best practices to avoid medication mix-ups.
Engage in regular quality assurance checks.
Measuring Medication Adherence with PDC
Proportion of Days Covered (PDC) measures patient medication adherence.
PDC Formula:
A higher PDC indicates better adherence; 80% or more is considered good.
PDC influences pharmacy star ratings and reimbursement rates.
PDC is being adopted over MPR for accuracy.