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
Category
Description
Example A
No error, capacity to cause error NA B
Error that did not reach the patient C
Error that reached patient but unlikely to cause harm (omissions considered to reach patient)
Multivitamin was not ordered on admission D
Error that reached the patient and could have necessitated monitoring and/or intervention to preclude harm
Regular release metoprolol was ordered for patient instead of extended-release E
Error that could have caused temporary harm
Blood pressure medication was inadvertently omitted from the orders F
Error that could have caused temporary harm requiring initial or prolonged hospitalization
Anticoagulant, such as warfarin, was ordered daily when the patient takes it every other day G
Error that could have resulted in permanent harm
Immunosuppressant medication was unintentionally ordered at one-fourth the dose H
Error that could have necessitated intervention to sustain life
Anticonvulsant therapy was inadvertently omitted I
Error that could have resulted in death
Beta-blocker was not reordered post-operatively

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. Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
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