1. AFAMS EO 002.03 Addressing Complaints and Errors (Dari) 01/09/2013

2. AFAMS Importance of Lesson (Dari) In the prior lectures you learned the aspects of effective communication, the logical process required to solve problems, and where to find technical pharmacy information to answer these questions. However, not all problems are as straight forward as simple questions. During Pharmacy activities many difficult situations can occur. AFAMS Insert Dari

3. AFAMS Importance of Lesson (Dari) In the Pharmacy environment these difficult situations can include: –Patient complaints about: Service Medication errors Lack of empathy –Complaints from other healthcare professionals. The purpose of this lecture is to teach you to deal with these situations professionally. AFAMS Insert Dari

4. AFAMS Overview EO 002.03 (Dari) Identify the skills required to handle difficult situations; Medication Errors: –Define –Impact of medication errors –Types of medication errors –Medication error reports –Follow-up actions to rectify medication errors Lesson Review Scenarios (not graded) AFAMS Insert Dari

5. AFAMS Problem Solving Dari Remember: All problems have two features in common: Goals To achieve some objective or desired state of affairs and can include avoiding a situation or event. Barriers If there were no barriers in the way of achieving a goal, then there would be no problem. Problem solving involves overcoming the barriers or obstacles that prevent the immediate achievement of goals. www.skillsyouneed.com AFAMS Insert Dari

6. AFAMS Communicating in Difficult Situations Dari Most people want to avoid conflict and potentially stressful situations – this is human nature. www.skillsyouneed.com AFAMS Insert Dari

7. AFAMS Why Can Communication be Difficult in These Situations Dari Emotion and Change There are two main factors that make communication seem difficult: emotion and change. Emotion People tend to look at emotions as being positive or negative. –Happiness is positive and therefore sadness must be negative. Emotions are a natural response to situations that we find ourselves in. Emotions are appropriate or inappropriate to a situation. www.skillsyouneed.com AFAMS Insert Dari

8. AFAMS Why Can Communication be Difficult in These Situations Dari Change Difficult conversations can be about some sort of changes (e.g finances or health). It is important to remember that change is inevitable.  There has to be a balance between communicating something difficult and being as sensitive as possible to those concerned www.skillsyouneed.com AFAMS Insert Dari

9. AFAMS Using Effective Communications Dari In difficult situations assertiveness, empathy and remaining calm become very important: 1.Gather Information –Make sure you have your facts straight before you begin. 2.Be Assertive –Once you are sure that something needs to be communicated then do so in an assertive way. (i.e. Do what you say you are going to do) 3.Be Empathic –Put yourself in the other person’s shoes and think about how they feel. 4.Use Appropriate Verbal and Non-Verbal Language –Do not use confrontational language or body language. www.skillsyouneed.com AFAMS Insert Dari

10. AFAMS Dealing with Difficult Conversations Dari 5.Listen –When we are stressed we listen less well, try to relax and listen carefully to the views, opinions and feelings of the other person/people. 6.Try to Stay Calm and Focused –Communication becomes easier when we are calm, take some deep breaths and try to maintain an air of calmness, others are more likely to remain calm if you do. –Keep focused on what you want to say, don’t deviate or get distracted from the reason that you are communicating. www.skillsyouneed.com AFAMS Insert Dari

11. AFAMS Stages of Problem Solving Dari Once the information is gathered use the Stages of Problem Solving: 1.Problem Identification 2.Structuring the Problem 3.Looking for Possible Solutions 4.Making a Decision 5.Implementation 6.Monitoring/Seeking Feedback www.skillsyouneed.com AFAMS Insert Dari

12. AFAMS Questions?

13. AFAMS Overview EO 002.03 (Dari) Identify the skills required to handle difficult situations; Medication Errors: –Define –Impact of medication errors –Types of medication errors –Medication error reports –Follow-up actions to rectify medication errors Lesson Review Scenarios (not graded) AFAMS Insert Dari

14. AFAMS Medication Errors Dari “A medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. Such events may be related to professional practice, health care products, procedures, and systems, including prescribing; order communication; product labeling, packaging, and nomenclature; compounding; dispensing; distribution; administration; education; monitoring; and use.” National Coordinating Council for Medication Error Reporting and Prevention AFAMS Insert Dari

15. AFAMS Medication Errors Dari Consequences: Many medication errors are probably undetected. The outcome(s) or clinical significance of many medication errors may be minimal, with few or no consequences that adversely affect a patient. However, some medication errors result in serious patient morbidity or mortality. ASHP Guidelines on Preventing Medication Errors in Hospitals AFAMS Insert Dari

16. AFAMS Medication Errors Dari Ways to reduce errors: Adequately trained and supervised personnel Adequate communications Reasonable workloads Effective drug handling systems Multiple procedural and final product checks by separate individuals Quality management and Adequate facilities, equipment, and supplies. AFAMS Insert Dari

17. AFAMS Medication Errors Dari AFAMS Insert Dari *When in doubt contact the prescriber* ASHP Guidelines on Preventing Medication Errors in Hospitals

18. AFAMS Medication Errors Dari AFAMS Insert Dari *Always read twice and double check calculations* ASHP Guidelines on Preventing Medication Errors in Hospitals

19. AFAMS ASHP Guidelines on Preventing Medication Errors in Hospitals Classes of Medication Error Dari NO ERROR Category A –Circumstances or events that have the capacity to cause error ERROR, NO HARM –[Note: Harm is defined as temporary or permanent impairment of the physical, emotional, or psychological function or structure of the body and/or pain resulting there from requiring intervention.] Category B –An error occurred but the error did not reach the patient Category C –An error occurred that reached the patient, but did not cause patient harm Category D –An error occurred that reached the patient and required monitoring to confirm that it resulted in no harm to the patient and/or required intervention to preclude harm

20. AFAMS ASHP Guidelines on Preventing Medication Errors in Hospitals Classes of Medication Error Dari ERROR, HARM Category E –An error occurred that may have contributed to or resulted in temporary harm to the patient and required intervention Category F –An error occurred that may have contributed to or resulted in temporary harm to the patient and required initial or prolonged hospitalization Category G –An error occurred that may have contributed to or resulted in permanent patient harm Category H –An error occurred that required intervention necessary to sustain life ERROR, DEATH Category I –An error occurred that may have contributed to or resulted in the patient’s death.

21. AFAMS Overview EO 002.03 (Dari) Identify the skills required to handle difficult situations; Medication Errors: –Define –Impact of medication errors –Types of medication errors –Medication error reports –Follow-up actions to rectify medication errors Lesson Review Scenarios (not graded) AFAMS Insert Dari

22. AFAMS All Medication Error Questions Are Clinical Therefore, Refer to the Pharmacist Dari

23. AFAMS NMH Medication Error Reporting Dari Medication Errors are recorded on a Pharmacy Medication Error Report. The final report is signed off by the Chief of Pharmacy.

24. AFAMS Pharmacy Medication Error Report Dari Used to report the occurrence of a medication error or a potential error within NMH or Polyclinics. It is a method of accounting for: –What happened? –How serious was the incident? –How was the incident handled? –What is being done to prevent it from occurring again?

25. AFAMS Pharmacy Medication Error Report Dari This information can be gathered by a Pharm Tech. Insert Dari

26. AFAMS Pharmacy Medication Error Report Dari The following areas must be filled in by a Pharmacist. –Level of Error –Type of Error –Narrative of Incident –Provider’s Comments –Personnel Involved –Corrective measures to prevent reoccurrence (Chief of Pharmacy) Insert Dari

27. AFAMS Level of Error

28. AFAMS Level of Error

29. AFAMS

30. Scenarios (Assessment) Dari Formative Assessment: Not marked Used to assess the students understanding of the correct handling of medication errors and patient complaints. Instructors will provide guidance for each scenario. Instructor will provide copies of Pharmacy Medication Error Reports. Instructor will provide a debrief after each scenario. Insert Dari

31. AFAMS Scenario (Assessment) Dari The class will be divided into small groups of at least four people. Each scenario will require: 1x Pharmacy Technician (Actor) 1x Patient (Actor) 2x Observers There will be three scenarios: 2x Medication Errors 1x Patient Complaint Insert Dari

32. AFAMS Scenario (Assessment) Dari Each scenario should take 10 to 15 mins. Scenarios will involve interactions between the Pharm Tech and the patient actors. After the interactions the observers are to provide constructive feedback to the Pharm Tech (actor) on how they handled the difficult situation. Both positive and negative points on effective communication and problem solving should be highlighted. After each scenario the Instructor can have a group who performed well re- enact the scenario in front of the class. Insert Dari

33. AFAMS Scenario One Dari Situation: Insert Dari

34. AFAMS Scenario Six Dari A patient has returned to Afghanistan from Canada. They were given a drug called Zyloprim. They believe it is was for allopurinol. They wish to know what is Zyloprim. Zyloprim is allopurinol. (Preparations: Proprietary preparations) The patient wishes to know what ingredients are in Zyloprim. Where is this located? Martindale Volume B Insert Dari

35. AFAMS Questions? Dari

36. AFAMS Game Dari

37. AFAMS Game (Assessment) Dari Formative Assessment: Not marked Used to assess the students understanding of technical versus clinical questions. Instructor will start at the left most row of students. The first two students in that row will stand-up. The instructor will ask the students a question which is either technical or clinical. The first student to answer correctly remains standing. The other sits down. The next student in the row will stand up and another question is read by the instructor. The student who answers the most questions correctly is the winner. Insert Dari

38. AFAMS End of EO Dari