1. Assuring Compliance with the JCAHO 2004 Standards: Medication Management Patricia C. Kienle, RPh, MPA, FASHP Medication Safety Manager Cardinal Health Pharmacy Management Patricia.Kienle@cardinal.com

2. 2 Medication Safety Federal and state laws and regulations Accrediting agencies Standards of practice

3. 3 JCAHO Focus: 2004 Standards Patient safety Medication Management chapter Safety issues throughout other standards –Provision of Care –Process Improvement –Leadership –Information Management –Human Resources

4. 4 Recurring themes Written policies and procedures Safety Security Education Staff knowledge and awareness Independent verification

5. 5 Medication Use System Phases Leadership and management Education Patient Information Selection Storage Ordering Dispensing Administering Monitoring

6. 6 Safety: Patient information Minimal information –Age and sex –Current medications –Relevant lab values –Past sensitivities and allergies Available as appropriate –Height and weight –Pregnancy and lactation status –Other information required by organization

7. 7 Safety: Selecting Medications Risk evaluation for formulary –medication errors –abuse potential –sentinel events Annual formulary review for safety and efficacy Organization identifies its high-risk medications

8. 8 Selecting Medications Resources are available prior to use of agent –drug information –laboratory test capability Review of non-formulary agents after 6 months Processes to address medication shortages and outages

9. 9 Safety: Medication Storage No concentrated electrolytes on patient care areas Standard drug concentrations Medications easy to confuse are segregated –look/sound alike –reagents and chemicals

10. 10 Safety: Ordering and Prescribing Identifies required elements of –standing orders –automatic stop orders –range orders –prn –hold –resume –titrate

11. 11 Ordering and Prescribing Medications If and when brand and/or generic names will be used If and when indications for use are required Review and update preprinted order sheets Weight-based dosing for pediatrics when required by the package insert

12. 12 Ordering and Prescribing Medications Minimize verbal and telephone orders Read-back verbal and telephone orders to verify Action to take when medication orders are incomplete, illegible or unclear

13. 13 Safety: Dispensing Medications Concerns clarified with prescriber prior to dispensing Labeled in standard manner Label minimum: drug name, strength, amount Dispensed in ready-to-administer form Only pharmacy admixes sterile products

14. 14 Dispensing: Unused & recalled products Unused, expired and recalled medications are managed by pharmacy Recalls –Medications retrieved –Staff & practitioners notified –Patients notified if safety reasons involved

15. 15 Dispensing: Non-24 hour pharmacy Pharmacist on call Access limited to approved set of medications Only trained, designated prescribers and nurses have access Another qualified healthcare professional reviews order and medication retrieved Pharmacist retroactive review Ongoing process improvement

16. 16 Safety: Administering Medications Resolve significant concerns Education patient about potential ADRs

17. 17 Safety: Monitoring Medications Monitor first few doses of medications administered Seeks patient’s perception of efficacy and side effects Identify trends and issues in internally- generated reports Method to evaluate medication management system for risk points and areas to improve safety Evaluate literature and new technologies

18. 18 What’s Next CAMH 2004 National Patient Safety Goals Best practices for patient safety